the Taliban have taken back Afghanistan.  Who lost Afghanistan? This is awful. This is so bad. What's going to happen to gay rights in Afghanistan? What's going to happen to the rights of the transgendered in Afghanistan? What's going to happen to the principles of democratic freedom in Afghanistan? Why are people so up in arms? Like, who cares? What happened in Afghanistan has nothing to do with what goes on in America. And it doesn't have anything to do with American credibility.  Well, look at what happens in Afghanistan. It has nothing to do with American welfare, right? The collapse of whatever government was in Afghanistan getting replaced by the Taliban has absolutely nothing to do with my welfare or your welfare, with America's welfare, Spain's welfare, England's welfare, Australia's welfare. There isn't even a country of Afghanistan.  It's not a coherent country. There's no Afghan identity. It means nothing. So America's credibility does not depend upon setting up, you know, Western-style democracies in the Middle East. This is not doing anything to America's credibility. I mean, there's just so much nonsense with regard to what's going on in Afghanistan. Like, who cares? I mean, Biden blamed for Afghan fiasco. So what? Like, some costs are sunk. It doesn't matter if we spent a trillion dollars in Afghanistan. That says nothing about whether we should stay there. And then as for all those people who helped us in Afghanistan, we should act with regard to our own self-interest. Like, is it in our own self-interest to protect those people and bring them to America? Maybe in some cases. But it's up to the Afghan people, of which there isn't an Afghan people. But the people who are in Afghanistan, it's up to them to decide what kind of government they want. Like, what do I care about whether or not they want a government of Sharia law? Like, why should any of us care? And obviously, the people opposed to the Taliban are weak and without billions and billions and billions of outside support, they couldn't keep anything going. So forget about them.   So Richard Spencer tweets, I am proud of my president. I'm proud of Joe Biden. He made a tough call, but clearly the right one. He admitted to failure. He acted decisively. He articulated principles for moving forward. He did what Trump couldn't. So what exactly did Joe Biden do? Biden defends pullout. Good for him, despite Taliban route. Calls withdrawal messy, but says, I stand squarely behind my decision. Yeah, good for Biden, based Biden, getting us the heck out of Afghanistan. President Biden blamed the chaotic fall of Kabul on the failure of Afghans to fight back. Yeah, he's absolutely right. It's not America's fight. It has nothing to do with America's self-interest. Now, that's not to say in 2001, 2002, 2003, it made sense for the United States to perhaps invade Afghanistan, like, go through there fairly quickly, get the job done, get in, get out, you know, take care of Al Qaeda, right? I can see why there might be a reason for that, even for going into Iraq possibly. But we did not want to stay there. I definitely did not want to stay there. And so good on Biden for getting us out, man. Based Biden, based Biden. All right, let's get Peter Zion here. Why is America leaving the Middle East? Yeah, I like Peter Zion's analysis. You know, we may have had a good reason for being in Afghanistan at one point, but we no longer really have that reason. So from the folks that I know in the defense and intelligence community, that the basic goal was very simple, skill set, and the force posture to go after Al Qaeda. We attempted to hit them in Afghanistan. And when they were holed up in Torobora, we realized the number of troops we had in the area was insufficient to the task. So the Joint Chiefs brought W. Bush the option of nuking Torobora 11 times, because that's what it would have taken to guarantee that the tunnel systems under the mountain would have actually collapsed. And, you know, say what you will about W. Bush. He was like, that strikes me as excessive. So the folks in Al Qaeda got away. They went west through Iran, where the US couldn't go. The Iranians knew that they were passing through, and then they dispersed.  And since we can't invade the entire Middle East simultaneously, the solution that was struck upon was to get the Middle Eastern countries to do it for us. So we invaded Iraq, not because we thought they were in Iraq, they weren't, but because by putting an armored brigade in Fallujah and, you know, you don't use an armored brigade to do urban pacification. That's infantry, not tanks. It threatened Syria and Saudi Arabia and Iran because they didn't know what we were going to do next. So they destroyed Al Qaeda for us. And it worked. Unfortunately, we didn't pull the plug at that point because that was back in, what, 2003, early 2004. And so the decision was made at the top, trying to make Iraq look like Wisconsin.  So we shattered the bath party, which destroyed all the traditional spheres of influence that made Iraq function. And then we tried to remake it somewhat in our image and it completely fell apart. So the place descended into civil war and chaos and the Iranians got more influence in the country than they ever had before. And it took us 20 years to both admit that the strategy didn't work and admit that we couldn't put Humpty Dumpty back together again. So eventually we were left with the choice of being there forever or leaving. And so Obama continued the W plan of withdrawal, didn't even accelerate it, trumped it the same thing. And now we're in the final days. There is a theoretical possibility, although I'm not sure it's like the majority chance that if we had left back in 2004, 2005, that Iraq would be in a much better position now than it was then. Afghanistan would not have been.  It's a stateless area. And there is no way that we can beat it into any shape that we're going to like. So the only debate to be had from a security point of view is whether or not you leave a small footprint there to look out for trouble with enough kinetic power to drop the hammer on things that you think are going to be trouble. The problem with that theory is that it will always generate trouble. There are large portions of the world that geographically are simply incapable of sustaining what we consider to be a modern government, much less a democratic one. And Afghanistan is one of those. So you're either actively managing it badly or you're leaving it alone. And I don't mean to suggest that I have like the golden keys to a solution here. If it was easy, we would have done it 15 years ago. But the American people are simply done.  It might. But honestly, Afghanistan being a stateless area is more a problem for the countries that border it than for us. What exactly has this focus on the Middle East since 2005 accomplished? Nothing. Nothing. It's shattered a number of the secular institutions that ran the country and has either thrown them into chaos or made the Islamic groups far more powerful. And basically, we've been stirring the omelette of trying to turn it into a soufflé and it just hasn't worked. Now, moving forward, we're going to have a very different picture now that the U.S. is done. I mean, we're looking at a complete withdrawal from Afghanistan within a few weeks at this point. Come headquarters in Qatar are going to close probably within a year because there's nothing for them to coordinate anymore. And the general American footprint of the entire region is evaporating. And I'd even say even odds that places like Incirlik are going to be closed down because they don't support anything anymore, which means there's no need for a coordinating office there anymore, which means the Turks want to kind of take back control. And if the Middle East no longer has any troops, then all of a sudden the entire military commitment we have in Germany, which is scrupulously designed to support Middle Eastern operations, falls into question. We're in a position today where we only have three large-scale deployments in the wider world of Japan, Korea, and Germany, and the German one is in danger, and the Korean one is in danger. Had this happened 30 years ago. Wait, wait, wait, wait, don't, don't, don't, don't, don't, don't.  Gosh. Hate it when they do that. As of three years ago, the United States achieved that energy independence, so there's no longer an energy rationale for the US being involved. And as we've seen in just the last month, that when oil prices hit 70, the shale operators kick into high gear and produce more. So any energy shocks we have in North America are small and limited. That just leaves the general argument of supporting the global structures of the order because the idea has been that, you know, we will pay you to be on our side and we realize that for you to function in the modern era, you need energy. So we've been in the Middle East to make sure that the energy can flow to our order allies.  And the idea that the United States is going to fight to keep the oil flows in the Persian Gulf open so that China can be the world's largest energy importer, that's a little dubious considering today's political environment. We're not just looking at American withdrawal from the Middle East and an end to the forever wars. We're looking at Americans retreating from maintaining what allows the rest of the world to function because that's what makes sense domestically in the United States. And you could argue that it also makes strategic sense globally. That would require a deeper conversation that I've seen possible. Okay, so who lost Afghanistan? And stop. And who cares, right? I mean, there's all this hyperbolic commentary about who lost Afghanistan. I was talking to a friend in Australia yesterday. He's going, what a colossal stuff up, like the US really blew it here. Who cares? This is like in, I think it was in Kansas City. It was a court ruling that mandated that they had to start spending four times as much on certain school districts that were quite low performing. Well, guess what happens when you spend four times as much on education for low performing groups? They keep performing at a low level. Right? You can invest billions and trillions of dollars in groups that are low performing and they still keep performing at a low level. Right? The United States spent what 86 billion dollars training the Iraqi Defense Forces? It's pointless. You could pour 86 billion dollars into some other low performing group and they also have really low levels of performance. Like the problems with our schools are not bad schools, problems with our schools that we have a lot of bad students, right? People who want to get an education do really well in our school system. And Luke, however, consistently performs at a high level. Well, sometimes I do and sometimes I don't. So you could invest in me in certain areas and I'm not really going to perform because that's just not who I am. All right? So it's ridiculous to to think that just because we spent a hundred billion dollars on the Afghan Defense Forces, that that means something. That that's going to, you know, that we should expect some bang for our buck. All right? So the whole idea of setting up, you know, some first world Jeffersonian democracy in Afghanistan is completely silly. I mean, obviously that's not on and it has nothing to do with America's self interest. Why would the U.S. one rips? Come on. 7,000 documented penetration infections so far. But compare that to the 95,000 infections that we had overall reported just three days ago. The numbers are pretty obvious. You're about 40 to one in terms of your risk factor if you haven't gotten vaccinated. In addition, it makes you sicker. In addition, it affects younger people. We're seeing pediatric hospitals having to turn away patients throughout Texas at present. It's getting kind of ugly out there. Now, a few things. Number one, we're not going to have national lockdowns again. Because this is now in a pandemic of primarily the unvaccinated communities can make the decision based down to the zip code level as to what they're going to do to handle it. So in a lot of areas that have really good records for having high vaccine rates, particularly in the northeast, they're doing okay. In fact, they're not going to be facing any real pressure until this winter because they can all be outside until at least October. It's primarily in the south where vaccination rates are both lower and people are spending more time inside because of heat that there's a danger. So if we are going to see any degree of lockdown or restrictions, it's likely to be in those areas politics down with standing. And that's going to be the same whether it's for bars or for kids going back to school and needing to wear masks. We just don't know. We probably will be having boosters approved. So you can get your third shot that is more specifically tailored for the Delta variant within a couple of months. We expect action from the FDN in just a few weeks. So there is good progress here in the United States now is in a position where 70% of the population has had at least one shot. So the vulnerable population is shrinking day by day by day. We are moving in the right direction. It would be nice if we could get there a little faster. But so number one, most importantly, no big lockdowns. Anything we have is going to be local and targeted. Second, we are still not going to be done with this for at least another six months unless the pace of vaccinations triple in the next couple of weeks. It's just going to take that much time to convince people that this needs to be done. Some people are doing it on their own, but we now have court cases that are coming up to district courts in the Supreme Court level that basically throw out some of the restrictions against mandates that governors in Florida and Texas have thrown in things that are blatantly unconstitutional, but they still need to go through the court process ever. Anyway, district court just ruled against the governor of Florida when it comes to telling businesses that they couldn't require vaccinations. That case was practically laughed out of court by the judge as you would expect. So everyone who wants to require vaccinations either for their employees or their customers now has legal cover. So we should be seeing a cavalcade of those things go through. But if everyone makes the decision today to get the shots, they're not going to get their second shot for another three to four weeks, and it's another two weeks for full effectiveness. You're already talking a minute of five, six weeks. Six months is probably more realistic. In addition, the United States is kind of a couple of other cooked in-vectors. The most important one is Mexico. The Mexican president is a little bit like Trump and just he's not interested in dealing with COVID. So he kind of either pretended it didn't exist or shoved it off on the governors. So the country really doesn't have a COVID policy. And when it comes to tourism, there are no restrictions whatsoever in Mexico. You can just fly down there. You don't need to get tested or show a vaccine card. You have to show that you've been tested to get back, but not to get there. And this is turning Mexico into kind of this incubation center for the next variant of COVID. And since we've gotten after and since we have bilateral tourism, this isn't going to go away anytime soon. So let's call it six months before we've really broken this in North America. Third, we're finding out in real time what works against this sort of bug. Now a number of countries, Taiwan, Korea, Australia, and China had what we called zero tolerance policies. So as soon as they detected anyone had tested positive, they locked the entire area down. So I believe Melbourne is in its sixth lockdown right now. That might work with the original China strain of coronavirus that infects two to three people per infected. But Delta infects eight to 10. It's the most communicable thing that we've had since measles. And it's got at least five, probably closer to seven times the fatality rate. And it's not clear that these sort of measures will work. So Beijing is dealing with a multiple stage outbreak that was started on a plane that came in from Russia about a month ago. It's spread to about a dozen cities that are all in lockdown now. And the government has ordered all flights into and out of the capital of Beijing suspended, despite the fact that Beijing is not one of those cities. It's always difficult to know when you're talking about Chinese statistics, but it appears that they're losing control of the situation is which is kind of what you would expect by something that is this communicable. So as a result, we've got energy use in Chinese just collapsing. We're talking about like 5% of global energy demand has just evaporated in the last week that it will spread to their manufacturing space. And if you add in what the Chinese are doing for internal political reasons against their own tech sector, this is the sort of thing that can start a traditional recession independent of any other structural or demographic issues, which you guys know I spend most of my time talking about. So that sort of issue temporarily melancholy China out of a lot of global economic processes is the kind of thing that is going to hurt a lot of countries around the world, particularly the countries in East Asia that are integrated into their supply chains or commodity providers in Africa and Latin America that are dependent on continuing sales of their commodities to the Chinese system. We're going to see echoes of this around the world in countries that thought they had come up with a good strategy and most of them are in East Asia as well. So we should expect significantly slower economic activity at the East Asian Rim this year. In Europe, it's probably going to be a little better. They've done just as bad of a job of preventing Delta from spreading throughout their system as the United States has, but their vaccine rates are now a little bit higher, which brings us to the fourth and final point. We're going to get a really good lesson here into which vaccine works better against Delta and why. So Pfizer and Moderna, those are the two that dominated the United States. They were 95 plus percent effective at preventing the original China strain from getting into your system. They called it sterilizing immunity. It was fantastic, better than we could have ever hoped for. They don't do that for Delta. You're perfectly capable as a vaccinated person with Pfizer and Moderna of carrying the virus and spreading it to other people. We don't have good data as to how likely that is, but it's certainly something closer to 50 or 60 percent. You're still protected against disease. Very few people who have been vaccinated have died of COVID compared to the 100,000 plus that Delta has killed already throughout the unvaccinated, but it's not as your chance. And one more quick topic on labor business relations in the weeks to come. We're going to be hearing a lot about vaccine mandates. Let me explain why that's coming. There's some people who have concerns that the vaccines allow for breakthrough infections and based on whose numbers you're looking at, somewhere upwards of 15 percent in some cases, of the cases that we've seen recently have been breakthroughs. That's far from insignificant. And it's not so much that the vaccines prevent severe disease and reduce chances of death by 99.5 percent, even against Delta. The point is it happens, but for folks who say that means that the vaccines aren't working and therefore you don't need them, that's really not the right takeaway. It has to do with the immune response. The immune response that you get when you catch COVID and get T cells and the antibody response and everything is okay, but we now have over a year of data suggesting in places like India and Mexico and Brazil that the original COVID strain could blow through that after a few weeks. And with Delta, we now have three months of data here in the first world that Delta can punch through it, not just once, but over and over and over. Whereas it's really hard for it to break through the type of immune response that you get when you have the vaccine. It's like a factor of 30 to one. So from an employer point of view, this is incredibly significant because if you're an employer and you have unvaccinated employees, you can look forward to them. You can plan on them getting sick every couple of months with COVID forever. And the number of sick days that you can get if you get COVID every couple of months, you know, you're building up to 20, 30, 40, 50 sick days a year versus if you have the vaccine where it might be two or three. We've burned past the point that we might get this out of our system. There have been so many unvaccinated people for so long that it is now endemic in the American population and we have to manage it moving forward. And if you're managing it with masks and if you're managing it with tests, you're talking about $100 test per employee per week going on forever in addition to the sick days or you can get the free shot. And so we are seeing a change in mindset in various businesses that are more customer facing, where people have jobs where they cannot work remotely. So I'm thinking here like utilities or food processing or healthcare. And we're seeing vaccine mandates come down from the top of these firms, whether it's Tyson or Chase Bank, where it's absolutely necessary in order to get to back to some version of normal and avoid the massive health costs that go along with it. And remember, Medicare isn't going to be covering the health costs for people who are unvaccinated who go into the hospital. So you're talking a cool $11,000 for a 23 hour visit that assumes you don't have to go on a ventilator, which can conscious upwards of $25,000 a day. That is now the personal or the corporate responsibility. And I think most corporations see that as something that they don't want to pay for. And of course, you've got all these people getting sick days. The only way you could adjust for that is to staff up in an environment of staff shortages in order to make sure that you've got backup staff for when the unvaccinated and the chronically ill just can't show up for work. So expect this sort of activity to explode across the business community. Yep. Expect vaccine mandates. All right. So today's show is brought to you by Beta Sister All Plant Sterols. So these really help if you get up a dozen times at night to go pee, take a couple of these before you go to bed in the evening. It supports healthy cholesterol levels and it's got added fish oil. So I heard about Beta Sister All Sterols on the Kaminsky method on Netflix. These old men were taking it. And then because I've got Ehlers-Dano syndrome, I like little rapid rehydrate, maximum performance. Something like 10 cents, about 10 cents per capsule. Oh wow, I feel the rehydration going on right now. Oh, this is sweet. All right. Looking at the chart, Jim says, why was the United States in the Middle East so much for the last 40 years? Was it to protect our greatest ally? No, the United States was not in the Middle East so extensively for the past 40 years to protect our greatest ally. They were there for their own self-interest because until three years ago, the United States was a net energy importer. And there used to be a very significant energy importer. So now the United States is energy independent. It doesn't need Middle East oil as much. And so the incentives for the U.S. to be so heavily invested in the Middle East have considerably reduced. So much to talk about. Who lost Afghanistan? The Afghan military was built over 20 years. Look, it doesn't matter how many years the group's built over. If it's not up to the job and it's not dedicated to the job, it's going to fall apart no matter how many hundreds of billions you spend. And we've done the same thing in the United States. We've invested trillions of dollars in low-performing poor people and it's done nothing. They're still just as low-performing as they were in the 1960s. So how did it collapse so quickly is a naive question. Why would we expect it not to collapse quickly? It's not like you invest trillions of dollars in a low-performing group and then they suddenly become high performers. That's not how the world works. In the wake of the horror of Al Qaeda's attacks on the U.S., most Americans believe the country was doing the right thing in going to war in Afghanistan. That level of support didn't last long. Why? Because Americans shock mostly about America. Americans, by and large, don't want Americans losing their lives in foreign countries where it doesn't have anything to do with American self-interest. So Donald Trump, you know, got the ball rolling by pulling troops out of Afghanistan.  Afghanistan's unraveling. They strike another blow to U.S. credibility. No. Do you know what U.S. credibility depends upon? The dollar is the international currency. The size and strength and vitality of the American economy. The American workforce is the most productive and hardest working of any workforce. And America spends more on its military than all other countries put together. That's where America's credibility comes from. It does not depend upon intervening in foreign countries and turning them into democracies. This has done absolutely nothing to American credibility. Losing the war in Vietnam did nothing to American credibility. We still had nuclear weapons.  Look, you can only count on Americans to act in American self-interest. Where should you count on your spouse? Whereas for her to act in her self-interest.  If that's in her self-interest you can expect her to do that. As soon as it stops being in her self-interest then you could start expecting her to move on. Can you count? Can a wife count on a husband to stay faithful? Well, number one. Number one question. What are his options?   Probably less than 10%. Most men don't have a bevy of attractive young women who are dying to have sex with him ago. Most men, you know, may well stay faithful. So this is going to do nothing for American credibility. It's not going to affect it in any way.  Afghanistan was never part of the free world. When you're in a hopeless cause you get out, sunk cost sunk.  Ukraine should not depend on upon us. That's in Russia's sphere of interest. Yes, we are not energy independent. Yes, we are. So we have massive natural gas resources. We do massive amounts of fracking. So let's, let's Google is America Energy independent. So America, United States energy independent. So United States was 90% self-sufficient in total energy consumption in 2016. So in 2011, the country became a net exporter of refined petroleum products. So yeah, Biden is not shutting down fracking. He may make it more complicated, more expensive. So November 2019, the United States became a net exporter of net exporter of all oil products. So yeah, United States is effectively energy independent. We love our cops. We love our law enforcement. We love our military because they're important. But what happens in Afghanistan does not matter for, for America's self-interest. Now, what about the tens of thousands of Afghans who worked with us? Well, is it in our self-interest to bring them on board? Why would they not work to try to build up their country? Right? And so it's up to them to, to work out what happens from here. Taliban, Taliban rendered Afghanistan unworkable as a country. Afghanistan has always been unworkable as a country. It's always been unworkable. Wasn't the Taliban that did it? Yeah, the Taliban did what the American forces of independence did in the 1770s, that they melted away in the face of overwhelming force. They regrouped. They restored themselves to fighting strength. They returned to the battle. And that's where they live, right? That's, that's their home. So we've got Stephen Erlinger writing in The New York Times. Most of the Afghan men whom I met and who led battles against the Taliban are now dead. Almost all were killed in separate assassinations as part of the Taliban's plan to return to action. Taliban were more effective. They fought harder. They fought more effectively. They won.  So the Taliban won just like the Viet Cong won, a classic example of successful guerrilla war of attrition. So stealth campaigns have hit and run military attacks, selective assassination, demoralize their adversaries, acts of terror, weaken the government, create an atmosphere that object compliance from local populations. Public campaign of arts and minds followed, accompanied by decoy negotiations to promote the idea that the Taliban are not really extremist. So Colin Liddell says the United States is not energy independent because value of the dollar is based on controlling foreign oil. All right. I'm not an expert on American energy independence, but all those of whom I'm aware who are expert on what it means to be energy independent have noted that the United States has been energy independent for the past three years, but I'm not, not an expert there. Now you're thinking what is, what is Richard Spencer tweeting about? So he says, Beast Macron strikes again. Macron, the leader in France vows European Union initiative to protect against migrant flows from Afghanistan. Well, that's excellent. So Macron doesn't want the Afghans pouring into Europe. Good on him. Richard Spencer says I'm at a hipster coffee shop in Austin. Lots of millennials. They're fed up with Biden's feckless Afghan policy. Living at the end of the American empire and I feel fine. We're not at the end of the American empire. Explain 2,500 American dead to the parents. What for? These kids signed out for the U.S. military. What did they think was going to happen? They signed up for the U.S. military. They wanted the benefits of joining the U.S. military, but they never expected they were going to have to fight. No one sent them to Afghanistan at the point of the gun. They signed up to fight. All right. And they paid the ultimate price for doing so.  Generally speaking, people aren't forced to get into a car at the point of a gun. People get in a car because they see it as in their self-interest and they weigh the benefits and they weigh the risks the same way that people join the military. Richard Spencer says what about Afghan gay and transgendered activists who are currently reading Nabokov in Kabul in a few days? They literally won't be reading Nabokov. Yes, remaining another two decades in Afghanistan might seem expensive and pointless, but have we considered the toll the fall of Kabul might have on girls with master's degrees working at national security think tanks in Washington, D.C.? Yeah, people join the military out of their self-interest and out of their patriotic desire to be of service. And it's just widespread notion on the distant right and all through a society that, yeah, I want to be a hero. I want to do something great, but I don't want to pay any price. Well, any option where you have the opportunity to do something heroic, there's always a price to be paid. There are always risks. So being shocked that there are risks and price to be paid while you are on a heroic mission strikes me as incredibly naive. The Joe Biden says there will be consequences for the Taliban if they harm U.S. personnel or the evacuation mission. No mention of consequences if they take Kabul. So yes, consistent message, the U.S. is leaving and it is final. So what's happening in Afghanistan now? Nothing new. Nothing new. Good point. So Edward Dutton wrote a book on Islam, an evolutionary perspective. Islam has its advantages. So the Muslims have elevated ethnocentrism, some Muslims, and more ethnocentric groups win in the intense struggle of Darwinian selection. So Islam will come to triumph in the West as Edward Dutton because of its ethnocentrism. Luke, shame on America.  Why? Why? Why should America feel ashamed? They got rid of Osama bin Laden and they destroyed Al Qaeda. Afghan troops did a heck of a lot more fighting than U.S. troops and mainly hidden bases and flew drones. Okay, let's say they did a heck of a lot more fighting.   Let the Afghans control their own destiny.    What happens in Kabul stays in Kabul. Exactly. Fight for whom? Unjust war. So people are reacting to this as though the state of reasons we were in Afghanistan are the true reasons. Like, oh, United States went into Iraq in 2003 to take out weapons of mass destruction.  There are two reasons why people do things. Number one is the state of reason. Number two is the real reason. And often people don't even realize the real reason of why they're doing anything. But guess what? The reason we were in Afghanistan for two decades wasn't to bring about peace and democracy and gay rights and women's rights. Yeah, I'm in terrible pain about what's going on in Afghanistan.  What has been achieved? Well, I guess early on we destroyed al-Qaeda. And early on, we put the fear of God into Iran and Syria that they might be next. So overall, yeah, it seems like a big stuff up. But we got some training for our troops. But yeah, from my perspective, we should have gotten out 18 years ago. Afghanistan was a sandbox for the military to practice in. That seems like that. We tried our best with our hands tied. Rules of engagement were only free for the first few years. What has been achieved? We got some training for our military. We got to try out some new weapon systems that the Arabs destroy Israel. Is that okay, Luke? Well, yeah, if Israel can't defend itself, then I don't think it's the responsibility of the United States or any other power to defend it. Israel is perfectly capable of defending itself. Israel's got the most powerful military in the Middle East. So now I don't think Israel needs to fear Arab intentions. So some smart people made a lot of money.   So research shows Afghan security forces lost 69,000. Yeah, because lower intelligent people, less effective people are going to die in much higher numbers than more intelligent, more effective, more trained people. So Afghan security forces died at 69,000. Civilians and militants killed at 51,000 each. Okay, it's whatever it is. It could be 37 million. It doesn't have any effect on American well-being. If Arkansas and Mississippi disappeared tonight, it wouldn't have much effect on American well-being. The American economy does not depend on Arkansas and Mississippi. So I'd be sad if Arkansas or Mississippi, oh, they did more real fighting than U.S. troops. I don't know. Like, who cares? I don't know what real fighting is.  I care about America. I care about my friends. I care about Australia where I come from. Biden's speech is BS. I didn't watch Biden's speech, but from what I understand about it, it was awesome. He says, we're getting out of Afghanistan and that's good. We should get the heck out of Afghanistan. We should have gotten out 15 years ago. So base Biden doing the right things.  Those are the primary things you should care about. Like caring about people of a different religion on a different part of the world who are completely unlike you, that just seems bizarre and it just seems like a virtue signaling. All right. We only have so much energy, so much time, so much money to care. We only have so much emotional, financial, moral resources to bring to bear. Why would we bring them to bear for people who are completely foreign to us, who have completely different ways? Just doesn't seem to make much sense to get all upset about what's going on on the other side of the world. Biden blamed for Afghan fiasco. I think Biden's done great with Afghanistan.  I don't primarily care about Afghans. I don't have any ill will towards Afghans. You know, let them live and be well and let them work out their own destiny. I care about Americans. So George Parker writes in The Atlantic, Biden's betrayal of Afghans will live in infamy. What does America and Joe Biden owe the Afghans? Nothing. Nothing. Do you think the Afghans were walking around carrying a load of guilt and are worried about you? How many people in Afghanistan right now do you think are worried about you? How many Afghans do you think lost their lives because they wanted to fight for America? The Afghans who got killed fighting in Afghanistan were not fighting for America. They were fighting for their own self-interest. So the Afghans don't care about us. The Afghans don't care about Joe Biden. The Afghans don't care about you or me and I don't blame them for that, but why should we care about them? George Parker writes, the abandonment of the Afghans who helped us, counted on us, staked their lives on us. The final gratuitous shame that we could have avoided.   Like, how much can you help idiots? Biden's new narrative that the Afghans didn't fight the Taliban so we left is BS. Well, I haven't seen Biden's speech, but the Afghans certainly didn't fight effectively. So who cares if they fought ineffectively? Like, big deal. If they are not up to taking control of their own country, then who cares? If the Afghans aren't up to the job, why should we keep subsidizing that? We've poured in hundreds of billions of dollars into that country. Let's get the hell out of there.  They were fools.  It's not our responsibility to protect Afghans. Look after Afghans, subsidize Afghans, take Afghans out of harm's way. Do you think the Afghans are crying and shaking with fear and guilt over what's going to happen to you or me? They couldn't give a task. The debacle is that we stayed in there after 2002. That's the debacle. There's no debacle in getting out now. It's the right thing to do to get out now.  And so good on Trump, good on Biden, and that the Afghans work out their own destiny. And who cares if getting out of Afghanistan didn't go according to plan? It's like getting out of a bad relationship. Getting out of a bad relationship is often messy. People often say things that they regret. They're often hyperbolic sentiments thrown around. It's often some really bad behavior. But if you're in a bad relationship, the most important thing are none of those, right? It doesn't really matter what you say and do presuming it's not criminal or highly unethical. If you're in a bad relationship, you should get the hell out of there. If you're in a bad job, you should get the hell out of there. If you're in a bad situation, you should get the hell out of there, right? You keep working for someone who abuses you. You stay in a relationship with someone who abuses you.  Then that's on you. And Colin Liddell has had some interesting perspectives on this on affirmativeright.com. Real narrative should be we left, because after the Chinese built a pipeline to Turkmenistan in 2009, we couldn't make money on this deal. Sorry, it took so long. Yeah, I'm sure that's a major part of it. So we weren't in Afghanistan for the past two decades for selfless reasons. There may be an element of selflessness and idealism. But the reasons that countries put their troops on the ground in foreign nations and spend billions of dollars is out of their own self-interest primarily. The U.S. military industrial complex made their dollars. Everything is okay. So much for Luke's Talmudic view of the world. We were there too long. So nothing I said was okay. We should have been out there in 2002. Not sure we should have gone in there in the first place. America has no self-interest in Afghanistan. If Africa disappeared from the map, American welfare would not be affected. The pro-feminist, pro-guerrides, pro-democracy rhetoric, that's just window dressing. It's ludicrous to take people out their word. It's ludicrous to take politicians out their word. It's ludicrous to take nations out their word. America uses a lot of beautiful rhetoric for when it goes in and starts killing people. But don't confuse beautiful rhetoric with reality. We did really well in World War I and World War II by letting all the other countries slaughter each other. That was in America's interest to delay entering those conflicts as long as possible until at the last moment we provide the decisive strength and we get the benefits by paying very little of the price. So ideally, in a World War II situation, you want to let the Germans and the Russians just slaughter each other. It's fine to let the Germans go to war with the Poles and the French and the English.  You set the terms. America sets the terms because it paid comparatively a very small price for its interventions in World War I and World War II. But it got enormous benefits. It was the big kid on the block. It didn't suffer compared to what Russia and Germany and France and England suffered. You got to come in late, which is ideal.  That's how the real world works. Now, we can use all sorts of rhetoric about freedom, fighting for freedom, fighting for democracy. That's just window dressing. It has no meaning. America, generally speaking, acts in its self-interest, just like Saudi Arabia does. And it wouldn't matter if America was a dictatorship or a democracy. Whether a nation is a democracy or a dictatorship says nothing about whether it's more or less likely to go to war, whether it's more or less likely to go in its act in its own self-interest. And nation states have to put their own survival as a number one priority. They have to put their self-interest number one. And nation states that don't put their self-interest number one, they don't generally last long unless they're incredibly rich and affluent like the United States.  But we shouldn't condemn these foreign policy interventions by simply taking them at their word. Like we may well have intervened in the Korean War and the Vietnam War just to set certain signals that we are going to be the big dogs, that we are going to limit the rise of communism, so that we are going to be able to protect, quote unquote, the free world, and we're going to ensure an international trading system. We did that not out of altruism. We did that out of what we saw as our self-interest. So we had a threat from the Soviet Union, so we intervened to show that we were willing to intervene and doesn't really matter whether or not we won in Korea or Vietnam. It was just a statement that would incentivize other countries to line up with us. So most countries that mattered lined up with us in the Cold War. Most countries that mattered line up with us now. China's got virtually no allies. Who wants to be allied with China? Like almost all countries that matter are allied with the United States against China. So if we have to do a little foreign intervention here or there to keep other nations in line, then it might be effective. So don't assume that the United States intervened in Korea in 1951 for the reasons the United States did. Don't assume that the United States intervened in Vietnam in the 1960s for the reasons the United States did. Don't assume the United States intervened in Afghanistan in 2001 and Iraq in 2003 for the reasons it stated. On the one level, there's the window dressing, there's the rhetoric, but on the other level, there are hard-headed thinkers in the United States trying to pursue American self-interest. Yes, sometimes they make mistakes, but all these American foreign policy interventions, they weren't just quixotic, naive, altruistic actions. These were policies carried out by hard-headed men who definitely made some mistakes, but they weren't as foolish as their own rhetoric suggests. Bye-bye!


I encourage those members leaving the chamber to do so as quickly, as quietly as possible, and I encourage members in the public gallery to leave again quickly and quietly as possible, and as we move on to the next item. There will be a member's business debate on motions 129 for the name of Douglas Ross on SAVAR's surgeries, Muradinbestarys i hyn my чего, and books women to go off in sales syrup. The debate will be concluded without any questions being put. Rwyf ni'n meddwl i'n gwych ar yr hollwch gyda'r gweithio uchau i Hollyrute. Felly, rwy'n meddwl i'n meddwl i'r ddenislaith, Rona Grant, Nes Tuggl, Heso Grant, ac Liz Macnocter, ar y cwrthogau ysgolwch, i'n meddwl i'r gweithio i'r gweithio ar y cyfaint. Rwy'n meddwl i'n meddwl i'n meddwl i'r ddunkan Abbey, ar yr cwrthogau ysgolwch, ond mae hyn yn ei gael iawn. Felly mae'n ardu allan oherwydd oherwydd, mae chi'n gael iawn y gael iawn, fyddwch mwyn ac yn cewdd eu gwentiau, a hetfawr i chi i'r ddeichas gyf Ừ Iawn i'r ddechrau Sfoddolol.  Mae angen efo o'r gael iawn, dechrau'u gael iawn a bandangol, Those surgeries serve the communities of Duffas, Cummingsdyn, Rosile and the Outlying Rural Areas as well. So today the campaigners are not just representing Hopeman nice and Burghead, and those other villages, but 1,500 people who signed the petition to reinstate these vital GP practices. Their voice is now being heard in the Scottish Parliament, but it has taken us too long to get to this stage. yn gweld i'r rhaid o'r erdwag penedig y byddai'r campuennu? Ond rydw i'n gofio bod ar y dyfodol ystod yn mwy o'r respond commanderau a fyddai'r Gymdeithasol Cymru yn nhw anhil drwng mwy o'r ffeyddiaeth a gynweddig i gydig i gydigol yn ei gynwedd gyda'r gwybod hynny. Byddai'n gydig i chi i gydig o'r mwy o'r arbu yma felly i archifredinu ei gael argyfrifoedd pwrdd nesaf. Maen nhw'n gweithio yng Nghymru, ond wrth yng nghymru, nid nhw'n angen i'r ddeudio i'r Ffalt. Ond wrth yng Nghymru, o'r 14 wrth yng nghymru, ar y brwysau ar yng Nghymru, mae gennym ni'n meddwl o'r regulatiad Covid. Ond mae gennym ni'n meddwl o'r pryd o'r pryd o'r pryd o'r Llywodraeth Llywodraeth i'r newid. March 2020, now here we are, March 2024, those surgeries never opened their doors again. Indeed, the Hoatman premises has now been sold and the Berghead one, the lease, has been handed back. Berghead in particular, we have a local family so determined to continue with the presence in the village there that they offered to work with the health board, with health and social care money to offer that property, to put in the improvements needed, but that was rejected. That offer still stands today. They have offered the first year free of rent if the health board would go back to Berghead. But since then, that temporary closure has continued and we know there has been so much work done by the saver surgeries group and campaigners throughout that time. However, where the frustrations really come alive is the lack of any tangible, significant and realistic engagement with the health board and health and social care money. It is almost shocking to have to remind the chamber that a consultation was done, but it was a sham. It was a consultation in name only, a tick box exercise. How else can you describe the outcome when 85 per cent of residents who responded to that were against the closures that those surgeries are still shut? When 100 per cent of the people at the public engagement events said they wanted the facilities to remain open in Hoatman and Berghead and they remained closed, then it was nothing more than a tick box exercise. At a cost of more than £11,000, it is so frustrating that the voice that is so articulately making the case for those surgeries to be retained has been ignored in this way. It is also important and the campaigners have been very clear that, while this is a local issue in Murray and my motion refers to the Highlands and Islands, I know that there are members across the country who are feeling the same impact with local services in their own area. That is an issue that deserves to be addressed here in Parliament because the closures of local GP surgeries have an impact on national policies set by the Scottish Government. I will give way to a couple of members in a moment and I want to come on to how the closure of those local facilities hampers what the Scottish Government is trying to do with their national policies, but I will give way to Richard Lochhead. I thank Douglas Ross for giving way and congratulate him on securing this important debate. I also join Payne Tribute to save our surgeries campaign, who are here today for promoting the interests of their communities. I concur with the member's concerns as expressed in his opening remarks. Does he agree with me that it is really important, given that new GPs will be coming into the workforce in the near future, that NHS Education Scotland will work closely with NHS Grampian to ensure that those new GPs are channeled towards the areas that are most in need, such as Burkhead, Hoatman and the rest of Murray? I know that if we can attract those new GPs to Murray, they will want to stay there. They will want to work in our community. They will want to work with the residents of Hoatman and Burkhead, so I fully endorse everything that Richard Lochhead has said. This has been a truly cross-party issue. There has been no party politics played here. I think that the fact that the leader of the Scottish Labour Party, the SNP health secretary, myself and others have all met with campaigners, Richard Lochhead, as well. They have worked right across the political spectrum because their case is far more important than party politics, and I think that that is credit to the saver surgeries campaigners. I will give way to Craig Hoy. Mr Ross, for giving way, is he aware that in my own region NHS borders is facing the prospect of cutting front-line budgets by 10 per cent and NHS Lothian faces £120 million black hole? As a result, Dr Joe Smail, a GP at Trenent medical practice, has written to me, warning that NHS Lothian is now set to increase facilities management charges on the practice by 600 per cent. She says that in order to cover this new cost on the practice, they will potentially have to lose around 3,200 GP appointments per year. She goes on to warn that we would no longer be able to provide primary care services for our patients and would have no other option but to hand back our contract. Does the member share my concerns that the chronic underfunding of GP services, particularly in rural and remote areas, is seriously undermining the delivery of patient care? I do agree with that. We have seen that throughout the country and it is a worrying trend that seems to be continuing. I spoke before the interventions about how the impact of local closures led to a problem with implementing national policies. We look at multidisciplinary working. That cannot happen when you close local facilities. The Scottish Government is supposed to be against a centralisation of service provisions, yet people in Holtman and Burkhead are now supposed to go to Lossymouth. I will come on to that very briefly in a moment. 20-minute neighbourhoods, that is something that the Scottish Government has promoted. That is not possible when you are closing surgeries like Burkhead and Holtman. I want to briefly finish with an excellent policy briefing that I received from Age Scotland ahead of this debate, and I am grateful to them for it. I asked for more specific Murray figures. They tell us that 44% of over 50s in Murray had to wait a week or more to access GP appointments. They have gone on to say that although Lossymouth is around a 50-minute drive each way, many older people are unable to drive or do not have access to a car from Holtman or Burkhead to Lossymouth. 21% of over 65s did not own or access a car in Murray. They go on to say that the journey by bus from Holtman and Burkhead to Lossymouth is not direct. For some, it could take four hours, round-trip four hours for potentially just a 10-minute appointment. That is the impact that it is having on local people. They also said that 44% of over 50s in Murray who had to wait a week or more to access GP appointments is almost double the national average of 23%. That is why this is having such a big impact. Finally, they say that this whole closure programme goes against Murray's own health and social care strategic delivery plan 2023 to 2025, which has a key focus on the progress of integration agenda by increasing access to community-based health and social care services. Murray's health and social care joint commissioning strategy for older people states that older people will be able to live more independently as long as possible in their own homes. They cannot do that if we are closing down local GP surgeries. I am grateful for your indulgence for allowing me a few more minutes. I reiterate my heartfelt thanks to the saver surgeries campaigners who have tirelessly put up and put forward the case for the reopening of these facilities or some kind of healthcare facility in the two villages. They have worked their socks off. We are proud of them throughout Murray for everything they have done. They are now in their Parliament here at Holyrood to hopefully get reassurance that their message is being heard at the highest possible level, but it cannot just be heard. It must be acted upon. We now move to the open debate. I call first Emma Harper to be followed by Rhoda Grant up to four minutes. I want to start by thanking all of Scotland's GPs for the invaluable work that they do to support people across Scotland with their health and wellbeing needs. I worked as a nurse for over 30 years and absolutely know how valuable and essential and important our GPs and the multidisciplinary team are who work in the GP practices. I am really sorry, Presiding Officer, that I will not be able to stay for the whole debate. I thank the PO for agreeing for me to leave as I have a long-standing meeting that I had already arranged. I also want to pay tribute to Douglas Ross, as he has done as well, to our saver surgeries group. I welcome that some of the members are here in the gallery. It is clear that saver surgeries, such as many community action groups such as Galloway community hospital action group in my own South Scotland region, are crucial in advocating for service improvements, for enhancements and advances for any healthcare delivery and that it should be delivered at a local level. No, I will not take an intervention because we have only got four minutes and I am really sorry that I have to shoot out here to meet the George Washington university students. The stats that have been described by Douglas Ross really highlight the challenges of older people in rural areas with travel, with getting to different areas. He described Lossy Mouth as a four-hour bus journey would be quite a challenge for older people. Turning to the motion from Douglas Ross and from looking into this case, I agree that Berghead and Hoatman surgeries closure had an impact on the local communities. The surgeries have been a feature of Berghead and Hoatman for many years and that was recognised by the local integration joint board, which carried out a consultation in 2022 to ensure that the voices of the community were heard. However, from my own casework, I am all too aware of how disappointing some of the approaches to IGB consultations can be so that, as this motion indicates, I can understand the concerns of the residents. I urge the IGB and NHS Grampian to ensure that the healthcare needs and indeed the voices of the people in smaller rural communities are being met appropriately. That can only be achieved through engaging with local campaigners, residents and members of the communities. I would expect that all partners work to this end. Our unfortunately challenges with the delivery of GP and associated services are not confined to the Highlands and across Dumfries and Galloway. I know that Mr Carson is sitting in the chamber because it is important for us as well in Dumfries and Galloway. It is also a very large rural region and we are hearing daily from the NHS board how they continue to struggle to recruit GPs to staff the region's rural surgeries. According to the ISD, the information service division, for which data is available, 100 per cent of GP practices in D&G are reliant upon local GPs due to recruitment challenges. However, some welcome recent improvements have been made. I am going to mention ScotGem, the Scottish Graduate Entry to Medicine programme. ScotGem offers people who are graduates in subjects such as pharmacy, nursing and science the opportunity to obtain a medical degree in a four-year graduate programme. ScotGem does have a particular focus on preparing doctors to work in rural areas of Scotland. The course launched in 2018 and, after the students' initial year of university, NHS D&G welcomed its first intake in 2019. The ScotGem programme is working well so far. The region in D&G supported 54 graduates, so that is pretty good news. The continuation of ScotGem, so I would ask that the cabinet secretary responds to tell us a little bit about the success and the commitment to continue with ScotGem so that recruitment can be made for our rural areas. I will stop there. I acknowledge the progress that has been made. Again, I apologise, Presiding Officer, that I am unable to stay. Thank you, Ms Harper. I now call Rhoda Grant to be followed by Edward Mountain in four minutes. Thank you, Presiding Officer. I also want to thank Douglas Ross for bringing this debate to the chamber and also joining him and the other speakers to commend the work of savers surgeries campaign. They fight to save their GP services within their community, which has been fantastic. They refuse to take no for an answer. I also want to thank Age Scotland for their briefing on the debate. As Douglas Ross said, those surgeries were closed, have never reopened, and now they will remain closed permanently. The branches not only cover Barchhead or Hoekman, indeed they encompass a population of around 7,000 people. Despite having no response from either the joint board or the practice or, indeed, NHS Grampian, the campaign group remained really pragmatic because they believed that there is a better local solution to be found. They have suggested nurse-led services, nurses available locally in the community for doing things such as taking bloods, physical checks and enabling older people who are not good with new technology to have video consultations with the practice at Lossymouth. However, that has fallen on deaf ears and they are being forced to travel from Barchhead and Hoekman to Lossymouth. Those are short journeys and miles, but there is no direct bus service, so patients need to travel by bus via Elgin, and that can take, as we have heard, four hours, but not only that, that is a £9 bus fare. If you cannot get a bus, you take a taxi and that is £60. That is no way for an NHS free at the point of need if people have to pay those huge amounts of money just simply to see their doctor. There is a dial bus service as well and it was suggested as an alternative, but it requires to be booked the day before, so if you are unwell, you need an emergency appointment. It is absolutely unsuitable and it does not cover the whole of the surgery time, so it may be that you could get the dial bus service to the surgery but you could not get back home again. Add to this that Age Scotland tells us that 82 per cent of older people prefer face-to-face appointments with their GP. Therefore, those changes are more likely to impact on the very vulnerable. Age Scotland also tells us that 26 per cent of those with a disability or 47 per cent of those with long-standing health conditions in Murray do not have access to a car, so they are absolutely dependent on public transport. As we have heard as well, those villages are expanding and therefore are in more need of GP services. Anywhere else would be seen as a success story because we are always talking about depopulation in rural areas. We are growing populations and we really need to preserve the services to allow people to continue living there. The whole debate speaks more widely about closures and changes to services in rural areas centralisation. It means that people just are not receiving the same level of services if they live in rural areas. There are wider issues, as others alluded to. The 2018 GP contract was supposed to make GP services sustainable going forward. They actually had the opposite impact on rural GPs and the Scottish Government can see that it has demonstrated on front of them and yet they have not acted in looking at a rural GP contract. Those do not appear to be the problems at play here but we need to find a solution for the people of Murray. I would ask the cabinet secretary, will he make sure that the IJB meets with the campaigners, something that they have been looking to do? Will he also intervene to make sure that those people have access to local GP services in one form or another? I would like to thank Douglas Ross for bringing this debate to the chamber and for the contribution from Rhoda Grant. I would not say that she has done a lot of my thunder but she is obviously very well researched on the problems of the closure of Hoekman and Berghead surgeries. I would like to welcome the campaigners to their Parliament to make their voices heard. Let me be entirely clear that every GP closure is a disaster. Every single doctor GP surgery is a failure and every GP surgery that hasn't got a succession plan is doomed. We can't afford to have this. Let's be clear, some of the figures that are open in the public domain in the last 10 years, we've seen 89 GP surgeries closed. One in 10 surgeries, GP surgeries are now run by health boards and there's been a huge increase in the use of locums. In Murray alone, I mean I know the Abelair Health Centre, which is my health centre, got to the stage where it had to be taken over by NHS Grampian because there weren't sufficient doctors there and all the patients were leaving. It still hasn't been resolved but it's a huge concern to communities. I wonder to myself why this happens. Why do we get ourselves into this situation? I think that a lot of it can be put down to the point that Rhoda Grant made about GP contracts. The 2018 GP contract that was negotiated seems to work fairly well if you're in the central belt, maybe Glasgow and Edinburgh, but doesn't work for rural GPs, doesn't work for rural practices. If it did work for rural practices, we would see more GPs in these rural practices. What we know it hasn't done is it hasn't delivered the extra staff that was promised as part of it. We've also seen NHS boards removing vaccinations from local GP surgeries, something that GPs across the Highlands were against and we've seen them also removing secondary care from GPs, undermining GP practices, which frankly we can't do. I mean we've just seen and I'm delighted to say that I'm working with Mr Ewing and Rhoda Grant on the issues faced by grant and medical practice who've had funding removed from the building project that they've been promised and was almost completed. Frankly, that is a disaster for the local community and I have to say that in the five days that the petition's been open, I've never seen such a flurry of people trying to sign it and they can't all sign it online and there's paper applications to join it but I think there's well over 500 people signed up in the first five days. That's how important GP surgeries are so I trust that we will get a chance to discuss that in time but we need a review. We need a review of the mechanism of how we run our GP surgeries and we need a review of the GP contract. The problem is that when the government negotiated the GP contract there is no review process within that so it looks like we're going to lurch on and on and on with declining GP numbers and contracts that don't work across rural Scotland. That to me is a huge mistake so my plea today and I'm delighted to be part of this debate on a wider scale across Scotland, let's review the GP contract, let's get a new workforce plan out, let's deliver to the GPs the extra workforce that we promised, let's stop removing the very sensible additional services that they provide and then we wouldn't be faced with the disasters that the closure of GP practices like Hopehead and Burgwyn of course. Thank you very much. I now call the final speaker in the open day, Fergus Ewing, around four minutes, Mr Ewing. Yes ma'e, I congratulate Mr Ross for bringing this debate forward on the essential spirit in which everybody has participated. I used to with my late wife Margaret to live in Lossy Mouth just along the road from Burghead and Hopeman and nearly visited the Burghead surgery many many years ago when I was dive bombed by a seagull who managed to make contact with my ear in the breeding grounds just beyond Burghead which I'm sure our visitors will be aware of but seriously if Margaret had been here she would have been campaigning alongside people in all other parties as she did with the mum campaign and others over her 19 years as the parliamentary representative. Presiding Officer, the motion and Mr Ross did refer beyond Burghead and Hopeman to the wider highlands and the motion refers to serving local communities so I hope it's an order for me to to refer to the campaign currently being mounted on a cross-party basis by myself, by Edmonton, by Rhoda Grant, all of whom are here to persuade the cabinet secretary for health to overturn the decision to halt the refurbishment of the Granton health centre, a project which we understand from our conference call with NHS Highland this morning was substantially completed. £2.4 million, £2 million of the work had been done and it was cancelled because of £400,000. Now we've been besieged with letters locally all making the same point that people can understand the cancellation of projects that haven't started, a motive though that is. I mean many many excellent campaigns the Belfort for example but for a project that's nearly completed it makes no sense because it'll end up costing an awful lot more and my specific plea without laboring all this is that the meeting I requested last Friday take place very soon if possible next week or thereafter I know it's the recess coming up soon and the reason for that cabinet secretary is that Morrison's the contractors are still on site they're champing at the bit to complete the contract but if we don't sort this out quickly they will have to remove their two ported cabinets from the site they will incur further abortive costs and the abortive costs will which we will intimate to the cabinet secretary will mount and exceed the notional capital savings which is £400,000. I think ways could always be found in government I know they can to sort this out so I wanted to make that plea and just the other brief point I'd make is to back up really what Mr Mountain says about the GP contract and it wasn't popular in the Highlands it was a metropolitan concoction really and in particular recently Dr Adrian Baker from the Nairn GP practice has been arguing in fact for the last three years with successive health secretaries I may say to restore the right for GPs who wish to do so to provide various services which the GP contract is taking away from them including vaccination and in the case of vaccination my understanding is that the NH Highlands own internal report found that moving the service back to GPs would not only secure the greater number of people having vaccinations and protection particularly against measles where the centralised provision is resulting in a dangerously low level of cover so moving it back to GPs would be better for the patient but it would also save several million pounds several million pounds now I'll deal with the cabinet secretary if he grants GPs the right to restore their vaccination services and thereby taking up my vice he's saved several million pounds I'm happy with that as long as he makes the modest contribution of 400,000 pounds towards the grant and health centre thank you Mr Ewing I now call on the cabinet secretary to respond to the debate cabinet secretary around seven minutes thank you very much indeed Presiding Officer first of all can I thank and congratulate Douglas Ross on on bringing this debate today and like him and everybody else that spoke spoken welcome to save our surgeries campaigners to our national parliament today looking forward to meeting with us with them after this session because I recognise as Douglas Ross and others have the very doubty campaigning efforts that they have undertaken the fact that they are here today as a testament to that campaigning effort in spite of the situation that the the branch surgeries are in Douglas Ross rightly outlined the fact that one facility has closed one the leases has expired but I think that the very helpful suggestions that were made by Douglas Ross and indeed by Rhoda Grant which so spoke of pragmatism I think is something that something I'll return to but I think is is very welcome I want to respond if I can to the points that have been made and what I think is very fair debate the fair point raised by Douglas Ross around the wider area being served by Burkhead and Hopeman and the situation that will be faced not just by the residents of those villages but by the wider area as well I also recognise the offer that has been suggested through Douglas Ross that is available in terms of a property and doing so free of rent for a period on the consultation point that Douglas Ross Ross raised he will be aware that my predecessor Michael Matheson obviously instructed a review by Evan Beswick from Argyll and Bute health and social care partnership that report is imminent I understand that the campaigners may well have seen an early draft of that which I understand they feel to be fair I would expect NHS Crampian the health and social care partnership to take due cognisance of what is in that report and to respond accordingly I also think Richard Lochhead makes a helpful suggestion as well regarding new GPs there's been some commentary in this debate around where we are with GP numbers we've got 1200 new GPs in training which is a positive move forward we've seen an increase in GP numbers since we announced the position to which to see it 800 from 2017 going forward we're not exactly where we want to be but we're making progress and I think the suggestion that Richard Lochhead makes and the evangelical advocacy that I would expect of Richard Lochhead and Douglas Ross around the beauty of Murray and the reason that you'd wished to locate yourself there that we can see what is possible with regards to some of those GPs coming through also very helpful briefing a very grateful for the briefing that came from Age Scotland that was referenced by colleagues across the chamber as someone who grew up in a rural island community I more than recognise the challenges of access to public services healthcare services in particular and I will do in just a second and indeed the expectation that there is amongst residents that you have to travel some distance in order to access some of those services because by their nature you can't safely deliver all of it in those areas however I think that their point around and the point that's been raised today around the need to make sure and I concur with it that we see services being provided as effectively and as locally as possible is absolutely one that I concur with I'll give way first to Finlay Carson and I'll come back to Finlay Carson Richard Lochhead very much appreciate the treatment intervention I think there's a theme coming out here you know I heard Emma Harper talk about action groups trying to enhance services but that's not what it's really about it's about saving services whether it's GP services whether it's maternity services whether it's saver cottage hospitals there's a complete crisis in rural Scotland and a lack of delivering services close to home as possible as you would wish to see but is this not a time to to review the NRAC formula because it certainly doesn't seem to be working I know you've given us assurance it that we take place but can you accelerate that process to make sure that rural health boards get the funding that they need comments to the chair cabinet secretary thank you president officer I think Finlay Carson makes a fair point about ensuring that we continue to see services being provided as locally as possible in terms of GP provision and I pay tribute to general practice managers, GPs themselves, those in the multi-disciplinary teams that serve our constituents incredibly well whether they're in rural and island communities or indeed in urban Scotland and I point Finlay Carson to the remote and rural GP working group that was chaired by Professor Salewis Ritchie in response to the concerns about rural GPs of the 2018 contract we're still one of the recommendations there was around establishing a centre of excellence for more than rural health care and following the business case development that national centre for remote and rural health care was launched in October has been delivered by Nez and the Scottish government is providing funding of £3 million in 2026 but I take the point it's something that I'll go away and look at and come back to Finlay Carson I'll give way to Richard Lochhead Richard Lochhead can I thank the cabinet secretary for giving way in his constructive response to the debate so far he may be aware that Glasgow school of art have a campus in my constituency of Murray and that hosts the rural centre of excellence for digital health and care innovation and that my instigation they've been discussing with the Murray health and social care partnership the possibility of a project to look at innovation and the delivery of rural health services using Murray as a pilot as being prompted by what's happening in Burkhead and hopefully in that area I understand they're looking for around £30,000 to take this forward there may be some question marks over how that's going to be funded I wonder if the cabinet secretary could look into how that could be funded because the whole of rural Scotland would benefit from the outcome of that research project cabinet secretary can give the time back for that thank you for that officer I thank Richard Lochhead for his intervention and for pointing out the situation that's being faced there I'm conscious that Jenny Minto has met on this I'm happy to take away in concert with Ms Minto Richard Lochhead's ask and see if anything can be done in order to see that continued because this is obviously an opportunity for us to learn more and to be able to see what can be done in rural communities and I go back to the briefing from Age Scotland because I recognise the point made by them in terms of access to public transport access to a vehicle and the statistics that Douglas Ross pointed to in terms of car use in that particular part of Murray and how that increases the challenge when we see facilities such as those in Hopeman and Burkhead close and that makes it a particular challenge in this part of Murray due to the public transport link so while Rhoda Grant rightly points to the dialabus option that is not suitable for same-day appointments so I think again this is why I think Evan Beswick's work is going to be really important and why I would encourage the health and social care partnership in NHS Grampian to engage with that engage with the campaigners around any practical suggestions that there may be for how that can be overcome if I've got time present obviously I'll give way to Douglas Ross. Douglas Ross. I'm grateful to the cabinet secretary for allowing the intervention and I think there will be great comfort taken by campaigners and people in the area with the approach that the cabinet secretary has taken to this and that encouragement would go even further if he will look to use his influences cabinet secretary for health to accept these are local decisions that will be taken by NHS Grampian in health and social care Murray but with the cabinet secretary stressing the importance of facilities in these villages that will make a big impact to the campaigners on what they are seeking to do and they're also not looking for all singing all dancing GP practices to be reopened great though that would be and I would absolutely support it there are other opportunities to have some healthcare facilities in either or both of Burghead and Hopeman that doesn't need to be a full replacement service that could make a big impact to local people in the villages cabinet secretary I think that's a helpful suggestion and one that's characteristic of the way that Douglas Ross opened this debate which was fair and pragmatic I'm happy to take that consideration away and I think working with NHS Grampian health and social care partnership because this is a local decision and there are practical issues that need to be overcome in terms of who runs these facilities how it is staffed if that is something that could be got to so I can't make any promises to Douglas Ross or indeed to the campaigners I wouldn't wish to do so but I think a consideration where there is a suggestion where there are a practical areas of change that can be brought forward to benefit those communities recognizing the demographic and geographical challenges then I think they should at least be considered and they should be considered in consort with those local communities so in closing president officer I wish to thank everybody who's participated in this debate to Douglas Ross again for bringing it forward and in particular to the local campaigners who have ensured that Scotland's national parliament is considering an issue that is being faced by colleagues across Scotland to differing extremes it's an issue in terms of branch surgery closures that I have faced with in my constituency as well their doubty campaigning means that we've had it under consideration today they were going to have a further conversation shortly and while I can make no promises about what the future holds I hope that at least they will feel that their voice has been heard today and going forward thank you thank you very much cabinet secretary that concludes the debate and I suspend this meeting of parliament until 2 15