Maen nhw i chi'n ei bod yn ddigonio i ddiddordebeth i'r ystyried. A oedd gwnaeth hynny i ddiddordebeth, ac yn ansiwser i ddiddordebethau. Mae Gweithleithio ac mae'n gweithio i ddiddordebethau. Mae'n gweithio i ddiddordebethau, ac mae'n ddiddordebethau i ddiddordebethau i ddiddordebeth 1, 2, 0, 4, 5, yn y name of Richard Simpson, yn y dyfodd Llyfrgell. Felly, gallwni'n gwybod i ddiddordebethau i ddiddordebethau, Oes ar gyfor o bwahren, Mae cypododiaeth wirff resolutioniaid. Mor hwyl â мaintlintonion Dr Richard Simpson yn gwybod o gydag ar y môl hefyd mgreenilig. D truckerdysg maith grim newydd songfudd euанаill, yn fint alignedot i'r rhan heisiau. Busan yng nghylch yn iawn cymdeith leash llawn i fy Afford yma. Ar gŵr mwynig oewt i weld y beatengol lligion o Smart Enterprise gan pras fynd arwallol Llanfydd Pwladd. DwyTF loadsowno'r pwlad cafeteria sydd gennym na, icin allu yn gweld ac gennym iddon y gyr comfortably, we need to fulfil our prime duty of holding the government to account, and just as I expect, the government's vengeance will undoubtedly defend their record as usual. However, I hope that we can begin by agreeing that the valuable funding provided through the Barnett formula has proved useful over the years. Labour increased health spend by 100 per cent between 1997 and 2008. The largest increase in funding for the health service in 60 years. Of course, decisions as to what to do with the funds provided is wholly a matter for this government. In that respect, there are not a few questions that really should be answered. The independent office for national statistics reported that from 2008 to 2013 it showed that England increased per capita spend in real terms while the SNP reduced ours. Admittedly, both were in relatively small numbers, but nevertheless there was a reduction. More importantly, expenditure in the north-east of England, which is often used as a comparison site for Scotland and indeed other regions and other countries, showed a greater increase than the rest of England. I just wonder if the SNP is really comfortable that, for the first time in the history of the NHS, Scotland now has fewer GPs per capita than in the north-east of England. Richard Simpson would acknowledge the £40 million investment that we announced to boost primary care, and I am sure that that would be something that would be welcomed across this chamber as we take forward those plans. Richard Simpson? I want to acknowledge in the beginning of my speech that, since the reopening of our Parliament in 1999, Labour, Liberal Democrats and SNP have had common ground in seeking to sustain a public service model for our devolved NHS based on collaboration and co-operation and not competition. In June, the Conservatives joined us in that principle, which was extremely welcome. We have a cross-party agreement on the principles of the way forward, but, cabinet secretary, since 2007, demands on the Scottish NHS have increased. The elderly numbers over that period have increased from £400,000 to £500,000, and many of those extra £100,000, indeed, of the half million, will have complex morbidity. There has also been new and advanced medical diagnostics, ever more expensive medicines, which require specialised administration and new treatments. That is why, quite frankly, the oft-repeated defence of the SNP is saying that the comparison of staffing levels of Labour in 2007 to 2014 are not only irrelevant but, frankly, nonsensical. More staff are critical to meet greater demand. Malcolm Chisholm will also address that point. The main two drivers for improvement in patient experience since 2001 have been targets and the patient safety programme, and both of those are important and welcome. The target for time from referral to treatment, the target for diagnostics, the target for accident and emergency, targets for cancer diagnosis and treatment, the target for delayed discharges. Each has an output that began from a low base when Labour instituted many of those targets, and it has progressed under both administrations. In many cases, once the initial target was reached, new and more demanding targets were set, and they have transformed the patient experience. However, again, the comparison of the target levels that Labour achieved by 2007 and what is now being achieved will make good sign bites, I am sure, and again oft-repeated, but are frankly infantile. The comparisons have to be whether there are year-on-year improvements and, until 2012, that was indeed the case under both administrations. The problem is that, in many instances, apart from the new targets and calms and psychological treatments, we have been going backwards since 2012. I noticed that the target of the number of patients waiting more than 12 weeks for an outpatient appointment has increased by 4,200 per cent in the past four years. That just re-emphasises the point. I want to go on to say that there is a scandal at the centre of the target business. I do not mind the fact that the targets for accident and emergency have been reduced from 98 per cent to 95 per cent. I think that that was quite a sensible move, because 98 per cent was going to be too demanding. However, the scandal of the SNP's patient rights act legal guarantee has been breached every month since introduction and breaches are on a rising trend. Having a target is one thing, but having a target that is a legal guarantee is a complete and utter nonsense if it is not going to be met. Simpson would acknowledge that, under Labour, of course, there was no such guarantee, and under the SNP, there are 12 ones that have breached the target. Would he, though, commend the health service for the 600,000 patients that have been treated within 12 weeks? 98 per cent performance is truly the staff that deserve credit for that. Dr Simpson. If your Government had taken our advice and not made it a legal guarantee, no, it should not be a legal guarantee— Order, please. Could members speak to the chair, please? Ask him to address your remarks through the chair, please, not directly to the member. The cabinet secretary says that this is not a problem. I welcome the 600,000 that have been treated. I welcome the fact that 98 per cent have been treated. However, if you are going to give a legal guarantee—a legal guarantee—that is completely different. This is a law that we said at the time was a nonsense and it is still a nonsense, and it should be abandoned. It is a bad use of law. As the Government's amendment says, most have been treated, but it was not us that promoted it. Every breach is not a number but a person. Every person who has breached a breach of the guarantee that experience is poorer. One other crucial labour decision was to initiate a move to a largely consultant-led service, but it takes 10 years post-graduation to train a consultant. The maths are very clear. There has not been a single consultant that has been trained and in post under the SNP. They have also all begun under a labour plan. Workforce planning is never easy, but it has to be for the medium to long term. Let us look at what the SNP has done. Under SNP plans announced in 2011, the specialist training grades were to be cut by 40 per cent, and the FY01 and 2 to be cut by 20 per cent. At a time when implementation of the European working time directive was going to require more junior middle grades, the consequences are seen in three ways. The largest number of consultant vacancies that the NHS has ever experienced is now 339, or 6.5 per cent. 20 per cent in some specialties have to be very brief. When you have more posts in the system, inevitably there are more vacancies as those posts are filled, but Richard Simpson does not accept that. If you conduct the right plans and do not cut the number of specialist grades, you get more consultants. You cut the grades. The other thing that is happening, which is a scandal, is that 60 per cent of the consultants in the past few years were appointed not on the nationally agreed contracts but on nine sessions clinical to one session other, the national contract being 7.5 to 2.5. Nicola Sturgeon chose to ignore this issue in 2012, merely saying that is the national contract and it is up to boards. When I raised it the other day, cabinet secretary accused me of discouraging consultants coming to Scotland. Cabinet secretary, it is not me who is discouraging them, it is your failure to order boards to follow the national contracts. This is at the very least a matter describing examination, the Grampian reports to which I am sure Richard Baker will refer indicates the damage that is done by taking out of things two and a two and a half sessions of the consultants doing audit, research, teaching, personal development and the crucial service to redesign that we need. This cabinet secretary is not sustainable. We will not retain these consultants if you insist on them remaining on a 911 appointment. As if these decisions on medical staffing were not bad enough, the Government cut the nursing intake by 20 per cent against the advice of the Royal College in Unison in 2011. It also allowed the boards to cut 2,400 nursing posts, a level at a time that was six times greater than the cuts in England. The Government also cut the midwifery student intake by 45 per cent, closing three midwifery schools with only a few months notice. At a time when the birth rate had increased by 10 per cent, complex births had increased, conditions related to drugs and alcohol were being increasingly recognised and there was a UK shortage of midwives. That was a parochial bad decision. I welcome the fact that almost all those decisions have been almost totally reversed in terms of the intake, but to reverse something within two years of your work plan being announced is a disgraceful sign of poor planning. I think that John Plenton will illustrate the consequences of that in Lanarkshire. We have been calling for an independent, robust, integrated monitoring and inspection system that should now happen with an examination of emergency systems in each board and a more thorough inspection of Health Improvement Scotland's programme for the elderly care, the health environment inspectoring, boarding out and delayed discharges, because, as the cabinet secretary has just said in an answer to a question this afternoon, it is the integrated whole system of emergency care that needs to look at. The problems are across the whole NHS community and hospital, and it is about demand with inadequate preventive measurements or ablement, inadequate diversion to keep people out of hospital, then pressure on A&E partly due to a lack of a whole system approach with NHS, GP out of ours, as again we heard in questions about Cumbernauld today, as well as delayed discharges. Rhoda Grant will talk a little bit more about care in the community in relation to this motion. The problems have never been seen more clearly than Christmas and the new year. A&E was swamped, so patients lay on trolleys for up to 24 hours, some were readmitted having been just discharged and then lay on trolleys for 14 hours. Hospitals were closed to new admissions. Consultants seriously—I can validate this—seriously having to be persuaded by medical directors from leaving the next patients and ambulance that arrived at the door. We haven't seen this since 1997, and Cabinet Secretary, we haven't even had the challenge of a bad winter. The level of flu is subnormal at the present time, although I'm told from my advisers that this is about to rise. In 2008, Shona Robison proudly announced that Labour's target of zero delayed discharges in hospital for more than six weeks had been met. Frankly, her hubris led her to say that not only had they achieved this important target, but delayed discharges would now remain at zero. That was a claim too far. In 23 out of 27 of the subsequently reported quarters, that zero level, promised by the now Cabinet Secretary, has not been achieved. Despite the failure and despite the damaging and unprecedented squeeze on local authority care budgets, Nicola Sturgeon, in her one of her last acts, set new targets of four weeks maximum delay from April 2013 and two weeks from April 2015. Another extraordinary decision on a system that is under huge pressure where our staff are serving above and beyond and are now being required to do even more. The critical issue is that, when beds are blocked, admissions remaining are delayed, resulting in the trolleywaiths that I've described. The number of beds occupied has risen by 25 per cent since 2012, from 30,000 to 42,000, excluding code 9. Once again, this masks a vast variation. Renfrewshire reporting a rate of only 308 bed occupied days per 1,000 people over 75 compared to Aberdeen City at 2,212. That is another example of variation that needs proper inspection. Will the Cabinet Secretary invite his and the care inspector to examine the reasons for it? Will she commit today to working with local authorities, but in particular Aberdeen and Edinburgh cities, which have the bigger problems? In the remaining 60 seconds, I want to turn to the UK mansion tax. This is an example of risk-sharing and benefit-sharing, which will be levied by Labour to support NHS—not just in Scotland but in every area across the United Kingdom—to be paid only by those residences worth over £2 million, only £80,000 to £8,000 to £195 in Scotland. That is about the redistribution of wealth that is accumulated in London. I know Boris Johnson objects, but we all contribute to that wealth. We all contribute to mega-city development, and therefore redistribution from it is entirely appropriate. I said at the beginning that it is the duty of an opposition to be critical, but I do acknowledge that, until 2011, progress by this Government was being made and it was good progress. I welcome the Government's acknowledge today, in its amendment, of some of the pressures and challenges that are reflected in the worsening statistics that are occurring. We share common principles with the Government, but we need to resolve the problems before our hard-working staff burn out. I move the motion. I certainly welcome the opportunity to be able to set out the Government's priorities. It is absolutely a great honour to be Cabinet Secretary for Health. It comes with a great responsibility to address concerns about NHS performance and praise the achievements that our NHS staff deliver on a daily basis. I want to take this opportunity to thank all our hard-working staff for their efforts, particularly over the festive season and, of course, when they are on-going work in treating over 2 million patients that the NHS sees every year. I want to begin by addressing some of the current issues that have been highlighted in the system. I want to recognise that the NHS has had to cope with significant pressures this winter. As has been said, an ageing population, seasonal flu, increasing demands are features not just of this winter but past winters. Staff should be commended for their efforts, which has, despite those pressures, seen nine out of 10 patients seen within four hours in A and E. Those pressures have affected all parts of the healthcare system across the UK. We should remember that, because all the main parties in the chamber, of course, in one way or another, are in charge of the NHS somewhere on the islands. We all face those same issues. We should perhaps bear that in mind when it comes to scrutinising the performance of the NHS here in Scotland. Cabinet Secretary for Giving Way, like other parts of the islands, will the Cabinet Secretary consider publishing the A and E waiting times on a weekly basis? As Jenny Marra should know, ISD, which is independent from ourselves, decided when statistics should be published. It consulted in public, as she should know, and came up with the monthly A and E performance publication that will take place in February onwards. If Jenny Marra does not think that that is correct, she should take that up with ISD. I think that monthly is correct and that is what will happen. Let me make some progress. Preparing for winter is essential, and there is a huge amount of preparation that has gone on for this winter. So far, as part of our £50 million national unschedule care plan, we have made £28 million available this year to improve general performance over winter, including tackling delayed discharge. The number of A and E consultants has almost tripled, rising from 75.8 to 207.4. We have increased the number of intermediate care beds by 200 on top of the 500 that are already within the system. Over the next few weeks, we will continue to work with the royal colleges that have endorsed that plan to make further improvements, because I absolutely accept that further improvements need to be made. I want to now talk about delayed discharges. As I said earlier on, delayed discharges are absolutely and tackling them is my top priority. I want to eradicate delayed discharge from the system. Richard Simpson is quite right to go back to when we did do that. Of course, the challenges have been around two systems that do not always work together. That is why we have brought in legislation, the biggest public sector reform that we have seen in years, to bring those two systems together. Delayed discharges have no upside. It is the worst outcome for individuals at the highest cost to the system. I am very confident that integration will help to tackle that problem. Parliament is also convinced and has passed the legislation to make this a reality from April. However, we have not waited for integration. We have been taking action now to tackle delayed discharge. My officials have been working closely with Seven Partnership, which should include Aberdeen and Edinburgh, but others as well, to tackle some of the worst delays in the system. I am encouraged that that is starting to bear fruit. Yes, some partnerships are investing in more home care, as we would want them to, but we are also seeing things such as intermediate care being developed, technology solutions being developed, more care home places in improved quality and the recruiting and training to retain and motivate our workforce. We have had health and social care integration in the Highlands for two years now, and we have people such as Debbie Michie who has been delayed, her discharge was delayed for more than 12 months. That is not the only answer. If Mary Scanlon wants to write to me about that particular patient, I will look into those circumstances. I am not saying that it is the only answer to Mary Scanlon, but it is a significant shift, because, as Mary Scanlon will know, having two systems with two different budgets, where sometimes there is a perverse incentive to not move someone out of the system, is a difficulty. By bringing those two systems together, I believe that we will make a real step change in tackling that problem. I want to turn to workforce. The NHS is a huge organisation employing an excess of 159,000 staff. It offers staff the opportunity to work in a world-class healthcare system that is modern and well equipped. We have a good record on staffing, and it is one that I am absolutely determined to tell as often as possible, because the staffing total is up by 7.6 per cent. Let us look at the number of consultants that Richard Simpson referred to. NHS consultants now at a record high, up 36.8 per cent. A and E consultants rise of over 173 per cent, having listened to the royal colleges of emergency medicine and taken on board what they have said. Let me turn to nurses. The number of qualified nurses is up by more than 1,700, and there are more to come. This last year alone, the number of nursing and midwifery staff rose by more than 1,000, and board projections indicate a further increase of over 400 nursing and midwifery staff by the end of the current financial year, and a further 500 community nurses coming into post over the next two years. 1,700 nurses are already delivered, 1,000 nurses being delivered. We expect boards to have rigorous recruitment processes in place to ensure that posts are filled appropriately and that we have the correct mix and number of staff to provide safe, effective care. We are backing that up with significant investment. Only last week, the First Minister announced that an extra £2.5 million will be invested in specialist nursing workforce. We have already committed £41.6 million over the next four years to substantially increase the number of community nurses. We will continue to look at ways in which we can attract the best talent to NHS Scotland. That is about real nurses and real posts, not about a general election slogan that is for short-term political experience. We need to be clear that, as the RCN is, that this is not just about nurse numbers, but about the whole healthcare system. It is about health and social care integration. We agree with the RCN on that very briefly. Of the £440 million that a Government underspent, has she asked John Swinney to spend on health? To be the finance spokesperson for her party, she will know that only £145 million of that could possibly have ever been spent on public services. It has been put into public services. If Jenny Marra seriously, as the previous finance spokesperson, thinks that student loan money could somehow have been transferred into public services, she really was not doing her job in her last portfolio. You need to do your homework on that. Let me turn to money, because money is important. In the SNP's manifesto in 2011, we guaranteed that the revenue budget of the NHS would be protected in real terms. I can confirm that the health resource consequentials have been passed on in full each year since 2010, a 4.6 per cent increase since 2010. That is despite a 6.7 per cent real terms cut in the Scottish Government's resource budget by Westminster over that period of time. As was announced as part of the 2015-16 draft budget by John Swinney in October, in 2015-16, we will in fact exceed that commitment by passing a further £54 million of health resource to the budget. That means that the Scottish health budget will top £12 billion for the first time next year. By anybody's stretch of the imagination, that is a lot of money. What is important is how that money is spent. That is why it is important that we set out the clear priorities that we expect the health service to deliver for that resource. Of course, it is important that we acknowledge that it is treating more people than ever before. I also want to say a word about waiting times. Let me be very clear that every patient should receive timely and quality treatment, and it is not acceptable that anyone has had to wait beyond those targets. However, let me be very clear that this Government has set tougher targets than was ever the case before 2007. The NHS has performed better against those targets than was the case previous to that. Let me give you an example of that. Since the introduction of the treatment time guarantee, more than 600,000 patients have been treated within 12 weeks, and 98 per cent performance against that target. While 12,000 people were not treated within 12 weeks, and I have said that that is not acceptable, let me contrast that with the previous situation. In an exchange between Nicola Sturgeon and the former First Minister Jack McConnell, just at the end of the tenure of Labour being in power, she said that more than 23,000 patients have been waiting for treatment for more than six months, and 12,000 patients have been waiting for more than a year. I know that 12,000 patients should not wait for more than 12 weeks, but do not lecture us about your record on waiting times. I will take no lectures from a party that has such an appalling record on waiting times when in power, but let me be clear. We have a vision and direction for our health service based on quality and sustainability, and our 2020 vision for health and social care has secured significant achievements over the past few years. Let me end on a consensual note, Presiding Officer. I am more than happy to work with parties across this chamber on taking that vision forward, and I will put out an invitation at our meeting at the end of January. I am more than willing to hear good suggestions about how we take the health service forward, but that works both ways. Those have to be proper health suggestions and health policies, not something off the cuff as a general election slogan. I welcome any item that you really must close. I look forward to working with parties, and I look forward to the meeting at the end of this month. Thank you, Presiding Officer. This is the first occasion in some short while allowing to a family situation that I have been able to participate in a health debate in the chamber, and while I have welcomed in my own way at the appropriate time the ministers individually to their portfolios, it is a pleasure this afternoon to be participating in a debate with them together as a team, and to say that I look forward to challenging them, and hopefully to working with them in the period ahead. This afternoon, I think that tone is very important. It is the first major health debate of 2015, and it is an issue of course, which I think is important to the public like no other. Our motion opens and in a way reflects the point that the cabinet secretary herself made, with the Labour Party in charge of health in Wales, with the Conservatives and the Liberal Democrats in charge of health in England, and with the SNP in charge of health in Scotland. There is no part of those aisles that has not found its NHS not only under enormous seasonal pressure now, but pressure way beyond that, with which they have to find a solution. In many respects, comparisons now of the health service in Scotland with the health service in England are invidious. Both because of the Blair reforms and the subsequent coalition reforms, the divergence of our health services, both south of the border and here in Scotland since devolution, are such that we really have to look and examine our own path, our own strategy and judge what the success of that has been and how it has to be altered in order that we make progress. That is really why, as Dr Simpson was kind enough to acknowledge, some 18 months ago, Scottish Conservatives accepted. I remember that there was almost an intake of breath at my use of the word collective, as if I had usherd language not known to a Conservative, but that a collective approach based on the principle of a health service free at the point of need and delivery within the public service in Scotland, that acceptance by all political parties, was fundamental if we were going to work together to move forward. I said when I made that commitment that that also meant that when the first opportunity came along, in the face of adversity or a deteriorating or a crisis position, for opposition spokesman simply to stand in this chamber and to shout at the Government that it was all their fault, their responsibility and that only if we were in charge all would be different, really was not going to materially add to the debate or the agenda. I could say after 16 years of having nothing to do with the management of the health service in Scotland and some may rejoice at that news in Scotland, Scottish Conservatives could quite happily stand back and say the responsibility lies elsewhere, but it is the responsibility not just of this Government of this Parliament for Scotland's health service and its destiny is ours and it is important therefore that we work together to achieve an objective and a strategy which is going to be successful. I have concerns at the Labour motion. Actually, in many respects, I thought that Dr Simpson made some telling points and it would be unfair not to acknowledge that some of the barbs did strike home. I do not think that we can simply dismiss all of these points as simply nothing more than Labour rhetoric, but I am concerned, partly by the tone of the motion if not the way it was introduced, that there is with the new Labour leadership in Scotland something of a Westminsterisation of our agenda and whereas Mr Murphy's ultimate boss wishes to weaponise the NHS in England as an electoral tool, I very much hope but suspect it will be unavoidable that there will be an appetite if not a temptation to allow the next few months to be dominated by the weaponisation of the Scottish NHS purely for electoral purposes. That comes on the back of a lot of agreement about the way that we might move forward, being slightly undermined by the previous health secretary who, a month before the referendum, sought to politicise the health service in a way that we had not previously seen. We now are in an environment, I am afraid, where that tactic has become preeminent and I very much regret it and hope that we can rollback from it because people like Malcolm Chisholm, people like Hugh Henry, people like Duncan McNeill have all recognised the way in which we have to move forward if we are going to be successful. Now our motion makes mention of the money. The cabinet secretary has referred to the full passing on of the consequentials and I refer back to the answer that Alex Neil gave a year ago almost to the day in which he set that out but what it also reveals is that it is just the consequentials being passed on that have been the monies upon which the health service in Scotland have had to rely. Without those additional consequentials, the actual core budget of health in Scotland would have been frozen whereas in England that budget has also increased as well as the consequential spending. In net terms one could argue that there has been greater funding elsewhere in the United Kingdom than here in Scotland and that is his concern but in itself it really is not a response to the measure of the situation. I will be summing up two and want to come back to points made by the RCN last week which I think the cabinet secretary touched on as well but I want to say this to the cabinet secretary. She is the third cabinet secretary with responsibility for health in this Parliament. The First Minister was a very effective crisis manager. I found her slightly Stalinist in her approach. I would characterise it by saying that I think frankly she lacked a certain amount of imagination in terms of responding to the wider dynamic that we have to face over the next 20 years to get health right. I found Alex Neil a bit more of an LBJ if I can characterise him in that way. I think that he is a bit of a fixer, a man who likes to find accommodations and solutions to problems. Still certainly centre left in his dynamic but I think that he was working with other parties before we had that interruption of the referendum and the rhetoric that spurted forth at that point to seek to find a collective strategy with which we can all support. The question is where does the cabinet secretary now see herself in this equation? She is one-half of the imperial second family of the SNP that now is responsible and she has to define where she will go. Our motion calls for an early debate on that and I'm delighted to see that in fact next week we will have that and that she wishes to pursue the cross-party meetings that we had seen embarked upon. I hope in her summing up she will define very carefully how she hopes to work and whether she believes that she has the bread, the vision and imagination to arrive at a consensus around which the whole of this Parliament can unite. Only if it can do I fear that we will respond successfully to the many well documented challenges that we have detailed in recent months. Thank you. We now turn to the open debate. I'm afraid that we have no time in hand and interventions are therefore within your own six minutes. Linda Fabiani to be followed by Malcolm Chisholm. That was unexpectedly quick. Can I say, Presiding Officer, when I first saw the title of the Labour debate, Scotland's Future, I was actually quite pleased and decided I'd like to take part because I really thought, oh here we go, a bit of a shift in thinking. We're going to move on from negativity to genuinely looking at our nation's future. Perhaps a recognition that for the benefit of Scotland and everyone within it, we should be looking to Westminster and discussions on the Smith commission proposals with a view to try to get something that is indeed coherent and really works to the benefit of us all. So it was with great disappointment that I actually saw the Labour motion, not in that it was about health but in that it was here we are again. Let's just have a go at everything that we possibly can because it's the SNP, it's the Government and we don't like it because that's certainly how it seems. Yes, there are concerns in the national health service but I thought I would like to read out a quote here. A quote that says, we have come a long way. A decade ago, many of us who are sitting around the table were inundated with cases involving people who could not get an operation. They have disappeared in my caseload touchwood so there have been tremendous gains. Now that quote is from the health committee on 4 November 2014 and it was by Labour MSP Duncan MacNeill who perhaps alone amongst his colleague is recognising in fact that since the SNP came into Government, minority government in 2007, majority government since 2011, we have made things better within the NHS because, like me, he remembers the first eight years when it was Labour and Lib Dems in charge, our cabinet secretary just read out some of that stuff. We heard a lot of talk today about targets. I remember targets being set to loads and loads of targets by Labour in health. In fact, I remember when they weren't meeting any of them, they all disappeared and we didn't have targets anymore. It was just a case of, oh, this is showing us up, so we're not going to have them anymore, written off completely. No, thank you. I'll tell you what, that's the difference between Labour in Government in Scotland and the SNP in Government in Scotland. We know things are hard, we know things have to get better, we know that it can belong term before you can really, really make these differences, and it would be all too easy just to walk away and say, no, we're not doing this anymore, but that's not what we're about. We're about making Scotland better. We're about making life better for our citizens and we're about shaping a better health service. All you have to do is look at the wording that is used. If you look at the Labour motion, it's always me. Delayed discharged targets are not being met. Let's get that into perspective. In October 2014, there were 321 patients delayed from being discharged for over four weeks. In October 2006, under Labour, the figure was 908 patients. Things are getting better, but the honesty of the cabinet secretary for health and this Government is shown in her amendment, where she acknowledges that further steps are required to reduce delays in discharge. It's not about running away from responsibilities, it's about facing up to them, and that's why you have just now the discussion going on, the decisions being made about delayed discharge being a top priority, and about linking that in, because it's all about linking in with greater joint working between health and social care services, additional funding having been given to do that. That's difficult because we have entrenched attitudes in our public institutions, whether it be local authorities through social work and, indeed, the health boards. It is difficult, but the commitment has been made to move that forward. I think that we are doing good stuff. I think that the SNP has really grasped this and moved on with the recognition that it's not perfect and a lot more still has to be done. A couple of things I'd like to raise just before I close, because I know you are short of time. The Labour motion, the NHS in Scotland, is under extreme pressure. Yes, it is under extreme pressure, but I'll tell you one of the most extremes is the amount of the NHS budget that's spent on paying off Labour's blooming PFI debts. NHS Larnockshire will spend around £1.5 billion on paying off a capital investment of £127 million. That's what Labour did for our health service. Then we have this talk about the extra nurses funded by the mansion tax. Now, I don't have time to get into the bad accounting that has gone behind that proposal, but what I will say, money raised by the mansion tax will be absolute peanuts compared to the austerity measures that Labour walked through the lobbies with the Tories and voted for yesterday, thousands and millions of pounds of austerity cuts. Perhaps that's where they should be looking. If we are talking about Scotland's future, I'll close by saying that it's very clear to me through the NHS and other things that Scotland's future is best served by the SNP. The cabinet secretary's speech, to some extent, and Linda Fabiana's speech, to a greater extent, illustrated the main response that the SNP gave whenever they are challenged on the NHS. That is, they compare what's happening now with what happened under the Labour-liberal administration. I would like to make two points about that. Firstly, we expect continuous improvement from the base that you inherit. The reality is that the SNP inherited a good base in 2007 and, as their amendment emphasises, they have had £2.7 billion in a minute. Let me make my point—£2.7 billion extra to spend. We would expect continuous progress, but the second point that I would make, completely contrary to what Linda Fabiana said, is that there was continuous improvement from the base that Labour inherited, waiting times of 18 months and a lot more, in many cases, over the years that we were in Government. If I can just give one example of that, looking at the subject of delayed discharges and reading the Audit Scotland report of 2005 from autumn 2000 to the end of 2004, which just happens to be the years when I was hanging around the health department, there was a 40 per cent drop in delayed discharges. Now, from July 2012 to September 2014, the number of bed days occupied by delayed discharge patients has increased by 30 per cent from 95,000 to 124,000. We expect continuous progress. We had continuous progress under Labour and Liberal Democrats. That is now going into reverse. That is the basis of our concerns, and it leads to, for example, a 15 per cent of beds in Lothian being occupied by delayed discharge figures. I think that that is slightly higher than the 9 per cent Scottish figure. That plus the extreme financial difficulties of NHS Lothian mean that we are extremely concerned that we have only got £4 million out of the £65 million. If the health secretary wants to intervene as she indicated, perhaps she would comment on that as well. Can I say that we absolutely work with Lothian and particularly Edinburgh City Council to address these matters? Would Malcolm Chisholm acknowledge that the targets that we have set have been tougher than the targets that were previously set, and that the NHS has performed better against him? I agree that we need to see continuous improvement, but surely, being the generous individual that he is, he would acknowledge that they are actually much tougher than when he was in charge of the health department. Malcolm Chisholm? I have, over the past seven years, been happy to acknowledge progress when there has been some, but the basis of concern now has been that it has gone into reverse. Moving on to A&E, which is another concern in the motion, and that is not to do with tougher targets. The progress—this is the Audit Scotland report, most recently, in 2013-14—has gone into reverse. A number of people delayed in A&E while waiting for a hospital bed since 2008-9 has increased fourfold. I think that we just have to register those trends moving in the wrong directions and are concerned about them now. If we look at A&E, the answer to those things, obviously, pan-ant is important, and we should also remember what the RCN said. I have to quote this. It is time to stop thinking of A&E and, indeed, hospital care in isolation from the rest of the health and social care system. However, for the purpose of the debate, let's look at A&E and delayed discharges. I really think that everybody should look at the front page of the herald from Friday 9 January. This is not to do with money. This is Professor Derek Bell, the number one UK expert on emergency care, who established the emergency care collaborative in England, which I visited before it was set up in Scotland. He said that waiting times in A&E were better five years ago, but when the programmes of the emergency care collaborative were in operation, why not bring them back? He said that the recent surge was predictable. We need to develop far more robust and reliable plans that engage and support the workforce. We should listen to experts like that. That is not a matter of money, that is a matter of organisation. I am moving on to delayed discharge. Clearly, the level of community infrastructure is fundamental and the amount of money goes into social care. However, there are also issues of leadership, learning and micro-management. We can learn a lot not just from the expert group report on delayed discharge from 2012, but also from the 2002 action plan, which again had suggestions such as learning networks and ring-fence money. I was pleased. I have to say that, at the start of the 2012 expert group report in the very first paragraph, it quoted something that I said at the launch of the 2002 action plan. However, enough of that, because I want to spend the last minute on nursing. I am sorry that I have not had time for an intervention, but we need to cover all the three elements that are mentioned in the motion. I think that Labour's announcement about 1,000 nurses should be welcomed by everybody in this chamber and the whole of Scotland, because we all know that nurses are at the heart of the NHS workforce. As I emphasised on my member's debate on nursing last week, it is not just traditional roles, but they are the vanguard when it comes to innovative roles, compassionate care in the community, addressing health inequalities. I hope that the Government will not only follow the Labour lead in committing to extra nurses, but also support the RCN campaign in consistent long-term funding for the kind of posts that were highlighted in the RCN's nursing edge at the edge initiative. Nurses working against health disadvantage in the community and their call for the health and social care partnerships, which are starting very soon, to prioritise that kind of work clearly. A lot of the solution to those problems comes through integration, but through the development of new kinds of services in the community by those integration authorities. I hope that the Government will follow the RCN's advice on nursing and Labour's advice on all of those matters. Many thanks. Stuart McMillan, to be followed by Richard Baker. Thank you very much, Presiding Officer. Today's debate does come at an important time for Scotland's NHS, and the debate is also entitled Scotland's Future. I think that there is a report published by Audit Scotland in October 2014, and paragraph 58 of that report highlights this particular debate and the situation of the NHS. I will quote that paragraph. It states that longer-term forecasts to 2018-19 by the OBR show a real-terms reduction in total UK public sector expenditure of not 0.7 per cent in both 2016-17 and 2017-18, before levels are maintained in 2018-19. Such reductions in spending at a UK level will affect the level of funding available in Scotland, and the Scottish Government will need to plan for health spending within an overall reducing budget. The pressures on public spending on NHS are well-known and explained in the report, and it is something that we discussed this morning within the Public Government Committee. Yet, last night, we saw Labour MPs from Scotland walk hand-in-hand with the Tories to impose more austerity cuts on the public sector, as well as introducing further tax rises. Those austerity cuts, promoted by the coalition Government and by Labour MPs, particularly the Scottish Labour MPs, will see more cuts to Scotland's budget and more pressure put not just upon our NHS but on all of our public services. If the Labour Party members opposite are so concerned about Scotland's NHS and I generally believe that many of them are, then maybe they should have been lobbying their own MPs to stop them from backing Tory cuts to Scotland. The continuation of the austerity policies of the UK parties will put greater pressure on all of the public services in Scotland, including our NHS. Will Labour refuse to match the SNP's commitment to protect the NHS budget, this Scottish Government has managed to increase it, with the health resources budget rising to a record £12 billion in 2015-16, an increase of just under £3 billion, a 32.4 per cent increase under the SNP. However, the Scottish Government can only do so much to protect Scotland's NHS while Labour team up with the Tories to slash public spending. Instead of supporting the NHS, Labour put up another motion in the long line of attacks on Scotland's NHS. I wonder if it has been inspired by the appointment of a new aid to the leader of the Labour Party in Scotland when he stated that the NHS needs the savings that privatisation creates. Of course, Labour has previous privatisation of Scotland's NHS, but the outsourced cleaning services to private companies and the burden of the NHS with the PFI debts that we have already heard this morning this afternoon, took an SNP Scottish Government to bring Strathcarthal hospital back into NHS and stopped the privatisation of cleaning contracts. Whatever the funding levels—I am sorry, we will not have six minutes. I will try to let you in. Whatever the funding levels, there always will be pressures on the NHS. That was a point that was stated this morning in the Public Audit Committee. There always will be pressures on it. I will try to let you in later on, but not at the moment, Dr Simpson. Not least because of the demographic changes. For instance, between 2012 and 2037, the percentage of the population aged 65 or over is projected to increase from 17 per cent to 25 per cent. The percentage of the population aged 75 or over is projected to increase from 8 per cent to 13 per cent. The number of people aged 100 years or older is projected to increase by a massive 879 per cent. However, as opposed to Labour's tax on NHS, the Scottish Government has been working with health boards and other public bodies to look at options to improve the services. For example, there is a move to ensure greater joint working between health and social care services. Additional funding of £173 million has been provided in 2015-16 to support this transformation. That has included the work between the NHS and local government to reshape care for older people to ensure quicker discharge from hospital or to even find alternatives to hospital treatment where that is appropriate. Under joint working arrangements, NHS boards and councils are combining their budgets for adult social care, adult primary healthcare and aspects of adult secondary healthcare. That provides a good opportunity for NHS boards with their council partners to redirect resources and move towards more community-based and preventative care. As opposed to Labour's claims about the staffing levels in Scotland's NHS, the real figures show that the number of front-line NHS staff has increased under the SNP to record levels. Overall, NHS staffing has up to 7.6 per cent, an increase of just under 9,700. NHS consultant numbers are at record level, with an increase of 36.8 per cent, or that is over 1,300 more. The number of qualified nurses in my house is at a record high of up to 4.2 per cent or just over 1,700. There is much to be proud of in Scotland's NHS. That is something that I am sure that we can all agree on. Despite Labour's manipulation of the figures, waiting time targets are improving. Over 600,000 patients or 98 per cent of all NHS patients have been treated within the 12-week waiting time guarantee. Since it was introduced in 2012. Is it appropriate for a member to accuse other members of manipulation? The words are for the member who is making his speech. It is not a point of order, but your point has been made. Over 600,000 patients or 98 per cent of all NHS patients have been treated within the 12-week waiting time guarantee. Since it was introduced in 2012. In summary, Scotland's NHS is doing a good job. It is not perfect, it can improve, and it must always strive to improve. However, with the continuing alliance of Labour and the Tories over its austerity cuts, we will see more pressures placed upon our NHS and all Scotland's public services. I now call Richard Baker to be followed by Christian Allard, very tight for time, up to six minutes, please, Mr Baker. Thank you, Presiding Officer. I am pleased that Scottish Labour has given this Parliament the chance to debate health services today, because, while there are indeed concerns across Scotland over the ability of our health services to meet patient needs, this has been particularly the case for NHS Grampian, as Dr Simpson referred to earlier. That was reflected in comments at the annual review of the board that I attended on Tuesday. While the interim chief executive, Malcolm Wright, was quite correct in apologising on behalf of the board for the failures identified in the Health Improvement Scotland report on NHS Grampian, the fact of the matter is that ministers also must realise that they have simply not done enough to enable our local board to meet the specific challenges that it faces. That support must now be forthcoming to the new leadership team if we are to move forward, as the cabinet secretary has said she wishes to do. I would like to welcome the appointment of Malcolm Wright and the new chair of the board, Steve Logan. I am sure that his experience at Aberdeen University will be invaluable in moving NHS Grampian forward, but they will require more support than was received by the former chief executive, Richard Kerry and, indeed, the former chair, Bill Howardson, because of some 20 consultants himself said in a letter to the board just over a year ago that underfunding of NHS Grampian has been a key factor in services reaching what they described as a critical situation then. Since then, as Dr Simpson pointed out, we have had three critical reports of services at NHS Grampian briefly to John Mason. Is the member arguing that Grampian NHS gets more money at the expense of other NHS boards or at the expense of, say, the college sector or some other sector? Indeed, the underfunding of NHS Grampian specifically has been recognised across the board and I want to come specifically to the issues around this as my speech develops. Under the Government's own formula, NHS Grampian has been underfunded by £158 million over five years and more than 400 nursing posts have been cut. Over three years, the impact of this is clear. NHS Grampian continues to be the worst performer in Scotland against the 62-day referral to treatment waiting target. According to latest statistics, A&E waiting times against a four-hour standard are going backwards. I would like to point out to Stuart McMillan that more than £7 million has been spent on sending NHS Grampian patients to private hospitals over the past two years. NHS Grampian spent £6.6 million on agency locums in the last year, more than NHS Lothian, which has a greater population. In August, it spent more than £2,000 bringing in a consultant from India to cover a weekend shift. In accident and emergency, the board has spent £4 million on temporary cover since June last year. A cash-trap board is having to spend millions on temporary staff, and that is why the issue of recruitment is so important. It is vital to patients because so many of the problems that I have detailed are caused by the recruitment crisis in NHS Grampian if I have time later on to miss Stuart. It is vital for the staff who are working at NHS Grampian today. It is only due to their amazing efforts that we still have a safe service and that so many patients do still receive excellent treatment, but that situation that I have described is not fair to them. NHS Grampian has received hundreds of complaints from its own workers about staff shortages. On 625 occasions in a space of just 12 months, it is staff members themselves who have brought forward complaints about staffing levels, and that simply was not happening in previous years. At the annual review meeting, I suggested to the cabinet secretary that more serious consideration needs to be given by ministers to enabling waiting and salaries to aid recruitment in our health service. The cabinet secretary has acknowledged that the high cost of living locally is an important factor in making it more difficult to recruit. I was just wondering whether we are four minutes into Richard Baker's speech. At some point, will he welcome the accelerated NRAC moneys that are going to NHS Grampian next year in total 49.1 million uplift next year, the highest of any mainland board? I will welcome any additional funding for NHS Grampian as an improvement, but it is going to be put against a backdrop of years of underfunding by this SNP Government. I have been talking about the cost of living issues in terms of effecting recruitment, and the Scottish Government talks about plans on affordable housing locally. That is welcome in terms of some of the specific schemes, but it will not provide all the answers. Indeed, it is a longer-term solution when these recruitment issues are with us now. Leaving it to the health board alone to create incentives for recruitment and retention simply means that, once again, there will be a case of further pressure on a local NHS budget, which, even with the changes finally outlined by the cabinet secretary, will receive millions less than other boards. That is why the Scottish Government must provide additional support, as has long been provided to public sector staff in London who face similar costs of living issues. John Swinney said that he would give us serious consideration last May. It is now time for action from ministers. The Scottish Government has said that the problems outlined in the Health and Improvement Scotland report will be addressed. It is imperative that this is now what happens. Minister's change in approach saw a fairer funding formula agreed for NHS Grampian by Labour when we were in a Scottish Executive, not being implemented for eight years of this Government. For the sake of patients in Grampian and our hard-working NHS staff, it is vital that our new chief executive and chairman achieve the improvements in local NHS services. They have said that they are determined to bring about. I am confident that they have the ability to do that in themselves, but it will require a great level of support from the Scottish Government for our local health services that they have seen from ministers over the past eight years. Thank you very much. My name is Christian Allard, followed by Jim Hume. Thank you, Presiding Officer. I would love to say first of all to Richard Baker, but I was at that meeting. You might remember that I was only two seats away from him. I didn't recollect him coming out and sharing all these problems. If you let me finish my point. Sharing all these problems, the Cabinet Secretary was there with NHS Grampian, who was there and with the public. There were packed public audience there, and it was a very positive meeting. I don't remember Richard Baker disturbing that positiveness that we got at that meeting on that particular day. What happened since Monday, but I changed the attitude of the member? Richard Baker? The focus of my speech was on the particular issue of the recruitment crisis. That was exactly the issue that I raised with the Cabinet Secretary and in terms of the incentives thought to recruit staff to the area, and indeed a further issue over GP recruitment as well. Mr Allard? Fair enough, and I heard that you received a very positive answer, and would you speak about it during my contribution? I was surprised as well, just like Linda Fabiani who spoke previously about the motion which was tabled this week, and I was surprised again when Richard Simpson contributed to this debate and opening the debate in a totally different tone, but the motion was. I don't know what I'm going to say today. I'm going to talk about the motion. I'm going to talk about what Richard Simpson said. It's quite confusing, it seems to me, but the member's present wants to talk about something about the NHS, and maybe the motion wants to say something else. I wonder sometimes if it's something about what Jackson Carlos said earlier on we heard this week, and Mr Milliband had said that he wanted to weaponise the NHS. I have to say that under an SNP government, yes, if you want, yes. You talked about a party wanting to weaponise the NHS, but does it not recognise that the Scotland campaign weaponised the NHS by without NHS for yes? I'm sorry, I've got only six minutes. We're not going to debate again the referendum debate. I'll leave that to you in your six minutes to talk about the referendum debate, but the Labour Party is desperate to paint since the beginning of the year in the chamber. It's not based on facts. You would think that there's an election looming like some people said earlier. This is a desperate attempt to run the same Labour campaign against the NHS across the UK in Scotland. Today the Labour Party, as it was found out, it won't work. Let's look at the performance over the Christmas period of accident and emergency departments across the country. The four-hour accident emergency performance in Scotland was 88.8% during the period of high pressure, while in England it was 82.8%. Six percent down present in the office in the same difficult circumstances. So we have to understand that it's not only about the past, it's about what's happening today across these islands, it's how to judge different government, how they react to the problem that we have, the changes that we have, and I think we perform very well. I'll have to say, and Cabinet Secretary was there on Monday in Aberdeen. NHS Grampian's performance was even higher by the Scottish average during Christmas and New Year. It was 90.6%. This is why this week, as the Health Secretary came, I think it was to thank the NHS staff for the hard work under pressure. The NHS Scotland is not a political football for Labour to play with. It is delivering under this government. Our accidents and emergency are performing better than in the rest of the UK, and we're not getting away from it. We heard last week that the First Minister was at nine Wales hospitals in Dundee, announcing money for additional nurses in our National Health Service. This week, Scotland Health Cabinet Secretary was in Aberdeen announcing extra funding for NHS Grampian. The new board is now receiving a 49.1 million increase to its budgets for next year. Despite what Mr Richard Baker said, this underfunding was introduced under a Labour government, and what this government is doing is reducing it to stopping it in a few years' time, and that's a retailing again this week. So it's very, very important to recognise this. The SNP government is showing commitment to deliver for the North East. NHS Grampian funding is now with 1% parity with other NHS border on Scotland, one-year-head of scheduled Palestinian officer. So it is very important to recognise all this that what has been done at Grampian level and at Scottish level. The number of front-line NHS staff has increased under the SNP to record levels. In Grampian, we have 100 more new nurses post in 2013, 100 new last year, but the board wants another 40 this year, another 40 new posts that will be funded with this increase coming from the Scottish government. And the will of the board is to increase the number of permanent staff along with a decrease of number of back staff, and that has to be welcomed as well because it's very important. And these staffing are coming from abroad, who are coming from students, students who are studying at RGU, and there is a problem of housing, and I know your president met with NHS Grampian about it, and one solution has been found. The site of the prison of contingencies will now be available for affordable houses for a public health sector. So we are making fantastic progress, and we will have the opportunity next week to talk about the future of the NHS. Unfortunately today, despite the title of the motion, we can't talk about the future of the NHS. I think it's very important to conclude, President, in your face in this debate, that the reason why the Government is giving us public support is because the Government has a vision for our nation's public services, protecting funding for the NHS, stopping privatisation, and recruiting more nurses. Thanks very much. Now, Colin. Jim Hume, to be followed by Mark MacDonald. Up to six minutes, please. Thank you, Presiding Officer. I'm pleased to have the opportunity to discuss the NHS again. Clearly, it would be better if we were not discussing a crisis, but I think that's what we're facing. The Labour motion sets out well the pressure points within our health service, indeed waiting times, people waiting on trolleys for hours on end, because a lack of beds, waiting times missed, and we'll be supporting the Labour motion today, if an amended. If the member would reflect the points made by Jackson Carlaw in his opening statement that all of the main parties, including your party, have responsibility for delivery of the health service across the islands, I don't think that people in glass houses should necessarily throw bricks. It's never wise. No, Jim Hume. I'll go on to say how much I want to work with this party, and I'm quite well aware that it's all our responsibilities, but it is our duties as members of all position to hold the Government to account, and that's what we'll, of course, do. It's nothing personal, cabinet secretary. I would like to say that our NHS is an institution that's absolutely greatly valued, so I'd like to put on record, again, my thanks and respect on that of my Liberal Democrat colleagues for the vital contribution that those working across the NHS make. As Liam McArthur suggested in the debate, we need to know persuading that making that contribution has been more difficult in recent times with the need to rebalance the country's finance, and we do recognise that. We all do want an NHS with a strong, but we need an incredible economic plan behind that so that we can ensure that we can fund it, of course. The Government's amendment today does note the challenges but doesn't pay enough attention, in my view, to the real concerns that are being raised, and that is a wee bit disappointing. We can't really ignore warning signs. There are serious concerns that are now being raised, not just by MSPs across parties in this chamber, but also by the bodies representing our healthcare workers. On 7 January, the Royal College of Nursing Scotland's senior officer said that many nursing staff working in Glasgow have been in contact with him to let them know how worried they are and concerned about how they can care for patients safely when so few staff and equipment is in such short supply. It is clear that we have issues to address within our NHS, and it is clear that it is not now just seasonal pressure when departments such as A&E, but it is now throughout the year. We have an increase in demand directly, I think, correlating to an increase in the age demographic of the country. I am afraid that the baby boomers have now of the 50s and 60s have now got old. There is no doubt that there are bed shortages. I am all for health integration and social care and care in people's homes as much as possible and whenever possible, but it is difficult to see how that can be done when we have the situation of fewer district nurses combined with an extra demand across the NHS to also providing healthcare in the community. District nurses are also expected to be children's names persons and the reduction in those district nurses numbers. I believe that there is a mismatch. That is what we need, I think, is a long-term workforce plan for across the NHS. I will say, and I repeat it now, that I am happy to work with any party and, of course, the new ministerial team and stakeholders to look at how we can do that. I hope that we can have that on the agenda for the health spokespersons meeting with the cabinet secretary later this month, and she is referred to that already. Just to further beef up the points regarding others' concerns, on the length of January, the RCN director, Teresa Fife, warned the cycle of A&E's struggling to cope, delayed discharges, too few staff, pressure on waiting times, delayed operations and so on will continue, unless there is real action to address the pressures. I know that the First Minister is keen to talk about consensus, and on that, it is essential that we reach it. I agree with the cabinet secretary's initial intervention that she made with me. With that in mind, I do not want to wish to spend the remainder of the time reading out a list of areas where targets have been missed. Of course, there is life-saving cancer treatments to vital mental health services for young people, which I think need improvement, and, of course, the patients having their rights breached, which is mentioned by Richard Simpson. I met the Wendell Welfare Commission about two weeks ago at the Royal College of Nurses yesterday and a meeting with the Royal College of GPs tomorrow. I want to share some of their concerns raised with me in the meetings today. The crisis that we are seeing is not seasonal, the older generation is already having that impact. There are simply more people with more complex health needs. There is a continual increase in the use of agency staff. Vacancy rates are going up. More nurses are being trained, but there is a time lag between training and having nurses sufficiently experienced to act independently. Staff are under such time pressures that they do not have time to update their date x systems, as they call it. There is real concern about the integration of health and social care. Delays are caused by a lack of appropriate community support. Primary health services need to be improved, and mental health services are under enormous strain with demand continually outstripping suppliers. GPs are not referring to psychological therapies because the waiting times are so long, and I echo my call for parity in law between physical and mental ill health. I hope that the minister will set out actions in those areas. The minister must listen to constructive criticism, not simply play lip service to it. The Government must ensure that the health service moves in the same direction that health and social care integration is successful and that we have the workforce that we need with the necessary skills now and into the future. I think that it is now time to have a workforce strategy that will future-proof us well into that future. Thank you very much, Presiding Officer. It is probably not reciprocal, but I genuinely have a lot of time for Dr Simpson when it comes to discussions around health-related issues. We spent time together on the Health and Sport Committee, and I think that when he was making his remarks at the beginning of the debate, I felt that large sections of his speech were very constructive in their approach. There were elements that I disagreed with, which I may come back to at the end of my speech, but generally speaking I felt that compared to some of the previous health debates that were brought to the chamber by the Labour Party in recent years, I felt that for the large part, a large part of what Dr Simpson said was constructive. I want to address a couple of areas that will be unashamedly parochial in doing so. The first is that I want to warmly welcome the announcement by the cabinet secretary at the start of the week that the additional funding for NHS Grampian to bring it within 1 per cent of NRAC parity one year early was announced. I think that that is extremely welcome and will be welcomed by not just health professionals but patients as well. I am sure that I would not be telling tales out of school to say that it would be important to look at the reports into NHS Grampian and recognise that additional funding is not the only solution to the issues and the challenges that are faced in NHS Grampian. Extra money does not, for example, buy you improved management ethos. That has to come through appropriate leadership within the NHS board and I think that it is vitally important therefore that all politicians in the north-east get behind the new leadership team of Malcolm Wright as the interim chief executive and also Professor Stephen Logan as the new chair of the health board and make sure that they are being supported. I feel that the Labour Party's approach during the whole process in Grampian left a lot to be desired. Firstly, there appears to have been at the very best a grudging acknowledgement of the funding that has been provided despite it being what Labour politicians had said needed to be done. Secondly, there approach in terms of the leadership situation at NHS Grampian, where, when the board chair vacancy came up, the Labour Party decided to push and promote Councillor Barney Crockett as the new chair of NHS Grampian. For those who are unfamiliar, this is the councillor who the Labour Party deposed as leader of Aberdeen City Council because they did not think that he was up to the job of running the council. They then tried to promote him as somebody who was therefore up to the job of running the local health board. I think that that leaves a lot to be desired in terms of the approach that the Labour Party locally has taken in supporting NHS Grampian. I hope that, perhaps now, we can start to see a new chapter in terms of the approach being taken by the Labour Party now that they are under new stewardship in the health brief. In terms of the issue around delayed discharge, this merits some exploration. Aberdeen was mentioned and highlighted by Dr Simpson. Indeed, it was during my time in administration in Aberdeen that we saw delayed discharge figures reduced to zero, and that came about as a result of a focused effort both at the health board level but also at a local authority level to drive down delayed discharge and ensure that the pathways from the acute setting to the social care setting were such that you did not have those situations arising. The difficulty that there is at present, and I am dealing with a number of constituent cases that relate to delayed discharges, is the availability of care packages. That is the real problem, the real thing that is blocking up the system at present. I have heard it mentioned on a number of occasions that the answer to this again is a financial one, that if you offer the incentives for individuals to work in the care sector, that will create the capacity. The difficulty that I have is that if you look at the situation in Aberdeen City and in Aberdeen Shire, it is not the same situation that is being faced in Aberdeen Shire. You would expect that if there were cost pressures arising within the north-east of Scotland, they would also be manifesting themselves in terms of the outcomes in Aberdeen Shire, but that is not proving to be the case. So we have to look at what exactly is it that is being done in Aberdeen City at present that could potentially lead to some of those difficulties. The council has introduced a step-down facility between the acute setting and either the home or other environment at Clashie now in my constituency, and that is a welcome development, and that is something that we can support. However, there are instances of individuals who ought to be at home with a care package but who have been put by the council into care home settings, which I do not think is an appropriate method for managing delayed discharge either for the system or for the individual who ought to be in their home setting where the package is in place. I think that the direction of travel that the city has taken in establishing Bonacord care and arms-length social care company, which has no elected member scrutiny on its operations, is very troubling. It is also very troubling that the council has decided to abolish its social care committee and now only looks at children's services as part of the education committee, but there appears to be no strategic oversight or elected member oversight of adult and older people's services within the council setting. So I would ask the cabinet secretary when she does have those discussions around delayed discharge to look very carefully at how social care is being appropriately monitored in terms of elected member scrutiny at Aberdeen City Council, because I have some very big concerns there, and they ought to be concerns that should transcend political divides. Very briefly, on the points that were raised by Dr Simpson, which I took a little bit— In your last 40 seconds. I do welcome the fact that Labour appeared to have ditched their review, the whole NHS shtick, that used to be the only thing that they brought to the chamber in terms of national health service debates. My concern is that that, using the mansion tax to fund 1,000 extra nurses—my understanding was that they were going to promise 1,000 extra nurses whatever the SNP promised, so presumably, if we said, we'll use the mansion tax money to fund 1,000 extra nurses, they'll have to find 1,000 extra nurses on top of that. However, it misunderstands how Barnett works. Barnett does not work on an assignment of revenue based on how much it's taken in. It is on the basis of expenditure, and the £250 million that Labour is talking about is more than the Barnett consequential would be from any expenditure at a UK level, so they'd have to explain how they arrive at that figure. It's all very well to complain about catchy slogans and sticking plaster solutions, but if all you're coming here with is 1,000 extra nurses, it does somewhat betray a lot of the content, the constructive content, that came forward in Dr Simpson's speech. Thank you, Presiding Officer. After months and years of warnings, we watch and despair as the NHS crumbles under winter pressures. This is not a failure in the part of the hard-working staff that have been vocal with their concerns about the state of the NHS. Sadly, they have also been ignored. We know that much of the NHS is operating on the goodwill of staff, working above and beyond to try to keep patients safe, often at the detriment of their own health. Despite that effort on their part, we see operations cancelled and increasing bed blocking and diminishing care in the community. I know how frustrating I find all of this. I can't imagine the frustration of those who work so hard on the front line of the NHS when they see that happening. We have a Government that ignores what they're being told and uses their majority in this Parliament to hide behind, and I'm sure they will do that again tonight. That does nothing to help the staff and patients that suffer due to their failure. Presiding Officer, winter brings no surprises. It comes around every year, roughly around this time, and with it comes an increase in pressure on the NHS. This year, due to Christmas and New Year holidays butting up against weekends, this should not have been underestimated. Indeed, it should have flagged up an additional issue, and plans should have been put in place to ensure that there was capacity in the system. We now see the operations that have been cancelled, the people that are being discharged before they should be, and other weight on trolleys. This is becoming an annual occurrence under this Government. How many more times must this happen before we see adequate planning for winter pressures? I wonder if the member would acknowledge that £28 million went into preparing for winter pressures. Indeed, Highland received a fair share of that resource, and would she welcome the NRAC funding that NHS Highland is receiving next year, which will help to address some of the daily discharge issues that she's raising? Rhoda Grant. I certainly welcome additional funding. What is very clear is that the planning that has gone into this winter has been inadequate, and that funding is coming too late to do anything with the crisis that is occurring right here, right now. We need to keep people out of hospital, and to do that, we need to make sure that they receive adequate care in the community when it is required, preventing their health deteriorating. Currently, people can wait for days before getting a GP appointment, and given that many surgeries were closed for eight days out of the 11 over the festive period, it's little wonder that conditions have deteriorated to the point where they need to go into hospital. Patients have been told to manage their own health and not go to A&E unless necessary, and that's correct, but it's impossible. Over the festive period, not only were GPs shut, but there was very limited pharmacy cover over Christmas in the year. In Highland and Argyll and Bute, a huge area, there was only one pharmacy open on Christmas day and six on Boxing Day. A similar story for Hogmanay and the Borders, there were only six pharmacies open over the same period, and given the huge geographical areas that those health boards cover, it's absolutely shocking. If we're to keep people out of hospital, we need both reactive and proactive NHS in our communities. People are living longer, and that's a good thing, but it often means that they're living with complex conditions, conditions that we're now able to treat and manage, giving them additional years. However, those conditions become more complex to manage, and often the treatments for one condition exacerbate or indeed lead to another and so forth. We need the expertise in the community to help people to manage their conditions in order to keep them out of hospital, and we've seen a decline in specialist nurses, and many of them being pulled away from their own area of speciality to fill gaps elsewhere. I welcome the announcement of MND nurses and would pay tribute to Gordon Aitman for campaigning successfully for this to happen, but we need specialists in the community and all disciplines to deal with the complex conditions that occur, and that will maximise health and manage care at home. We also need the ability to quickly pull in those services, along with social care services to support someone when they're beginning to struggle. Some intensive intervention in their own home or within the community could prevent the chronically ill or elderly going into hospital at all. Allied health professionals are underutilised in that respect. If we're able to help people become more active, assist with speech or swallow amongst other things, if someone's struggling at home surely is better to call a physiocupational or speech therapist to help them in home rather than wait until they hit crisis and go into hospital. We hear terrible stories about old people being left in corridors and trolleys when they're frail and unable to look after themselves, and even a short time in hospital can disenable people who are used to looking after themselves at home. Even a short period when they're unable to move about and fend for themselves can take months of physiotherapy and occupational therapy to re-enable. Much of what's happening in our hospitals is due to the Government cutting nurses, cutting beds, but refusing to make that investment in the communities to change the balance of care. Their inability to deal with this is causing hardship and suffering, and waiting until the Public Body Scotland Act is implemented is too late. We need to change the balance of care now to relieve the pressure of our hospitals. Thank you for finishing so swiftly. Thank you very much, Presiding Officer. Can I start, first of all, by paying tribute and thanking the staff of our health service, not only the consultants, nurses, doctors, ambulance staff, but all of the staff that ensure that our health service is run as smoothly as possible. I'm sure that all of us here in this chamber can absolutely agree on that. I want to say that I appreciated Jackson Carlaw's contribution, which I thought was measured, and may even have been a cry for unity in some parts of it. However, there was one aspect of Jackson Carlaw's contribution, which I think touched on a very important area. That's a creeping introduction of Labour Westminster policies to this Scottish Parliament. When you look at this motion—I want to go through some of this motion—and, like others, particularly from the SNP, I can't quite thar them out to how a motion called Scotland's Future is just nothing except about how Labour, if they ever get into power, would do a better job than the SNP on health. It just seems to ring true to me when you look at Scotland's Future, and that is all it mentions. One of the parts in the actual motion mentions Scotland's Labour commitment to fund 1,000 extra nurses. That has been spoken about also when Malcolm Chisholm mentioned the fact about the RCN and about the 1,000 extra nurses. However, when the RCN was asked about the 1,000 extra nurses and if they knew how Mr Murphy—he was the one who mentioned the 1,000 extra nurses—how that came about, the RCN said that it had no idea how that came about and that it certainly never put forward this 1,000 nurses to it. That is something that perhaps only Mr Murphy knows and perhaps does not the Labour Party themselves here in the Scottish Parliament know. If they do know, I would be happy if they had brought it forward and told us how they got to this so-called 1,000 nurses. However, I think that I may have touched on something further than that as well. The motion then goes on to talk about the mansion tanks. Now, we all know the mansion—yes, I have taken advantage of that. Do I understand rightly from Sandra White and other members of her party that she does not welcome the extra 1,000 nurses and indeed they will not be matching the extra 1,000 nurses? Sandra White? I think that someone just answered for you there. That is nonsense. May I cut out the front bench interchange and allow Sandra White to proceed, please? Thank you. I will reiterate then what the French Bay said. That is nonsense. I think that Rhoda has got her answer. However, if I can just talk about the mansion tanks, I think that people really have to know about this particular. If the mansion tanks, which Jim Murphy has put forward, it is only if Labour wins the election in Westminster. So I think that you have been a wee bit generous there in that respect. I think that you have been a wee bit generous there in that respect. Can we just let Sandra White make the speeches, please, and everyone else? Be quiet. Thank you very much. Thank you, Presiding Officer. I want to go on and I think I will pick up on the point that Mark McDonald made about the mansion tanks. When you look at it, the Labour sums do not even add up. Mark could actually mention that in his contribution. You mentioned the fact—this is Jim Murphy, I mentioned it at Westminster Labour—UK-wide mansion tank to fund an additional 1,000 nurses in Scotland. He claimed that the mansion tanks would generate £1.2 billion across the UK, and he expect to see £250 million come to Scotland, which is more than 20 per cent of the total revenue that will be raised. That is one point. Another point that Mark McDonald brought up was that even under the reality of it is, under the Barnett formula, it would be even less. Let us just say that the figures are nonsensical. If I can just further on from that about the mansion tanks and it mentions it again in here, as I said, in the so-called motion for the future, let us look at what Labour MPs say about the mansion tanks, which is put forward by one of their own Scottish MPs. Margaret Hodge, chair of the Public Accounts Committee, is too crude to work properly. I do not think that it is the world's most sensible idea. Diane Abbott, I think that we have all heard that on radio 4, she mentioned just a couple of days ago. Jim Murphy is not helping matters by firing off without consulting. There is a lot of discussion and debate that needs to go on about how we can implement a mansion tanks fairly. Jim Murphy is jumping the gun in a highly unscrupulous way. Diane Abbott said that the point that I am trying to get across here is that it would have been much more honest if the Labour Party here, in the Scottish Parliament, when they put forward the so-called motion, if it had been in health, as it is, it had, it was in health, but if the ideas had came from the Labour Party here in Scotland— One minute. Basically, this is a reiteration of Jim Murphy's press release. I find that quite despicable. It is quite sad. You have a pool of people here who are elected by the Scottish people, and they cannot even bring their own ideas to this Parliament for a debate on health, which they call the future. It is nothing to do at all with the title, but I think that you should actually think to yourselves why you could not bring forward on your own ideas instead of a press release from Mr Murphy, a Westminster MP who does not even have a seat in the next Scottish Parliament elections. John Mason, Dr Milne. Thank you, Deputy Presiding Officer. Another Labour debate, another predictable war of words between the two major parties over the health service. So soon after the very recent Labour debate on health held on 3 December, I find it really quite difficult to find anything very new to say. I think that we are all agreed that the current failings within the NHS in Scotland need to be addressed. I think that what we actually need for the improvement of health provision and a sustainable future for the NHS in Scotland is clearly stated in Jackson Carlaw's amendment. If NHS Scotland is to achieve a sustainable future in the face of the many challenges facing it today, then all political parties must agree and unite in support of a long-term strategic plan and work with the Government to develop and implement such a plan within the lifetime of this Parliament. It is urgent, and we cannot afford to sit around and argue while the express train carrying the demographic time bomb hurtles along the tracks towards us. We all agree that A&E services have been under severe pressure in recent weeks, and that is for a number of reasons. However, I remember being called in to help my night off as a hospital resident doctor in 1966, because there were so many admissions from A&E that patients had to be spread across wards throughout Aberdeenmore than Firmry and the on-duty staff on the receiving ward simply could not cope without more help. The seasonal pressure on emergency service is not a new phenomenon. What is new is that many more people turn up at A&E with conditions better treated by self-medication or by their GP. What is new is that A&E departments are busy throughout the week instead of just at the weekend because of more people abusing alcohol and drugs. What is also new is the serious difficulty in finding care in the community for an increasing number of frail elderly people who are fit for discharge from hospital but cannot access appropriate care at home. Having to keep those people in hospital, which only increases their frailty, leads to difficulty in finding hospital beds for people who need to be admitted from A&E, and results in patients being detained in that department or on trolleys where casualty wards are full. Of course, at a time of year when I see pavements as a hazard, as I discovered to my cost this morning and fluid colds and chest infections are common, attendance at A&E rises dramatically and the system is stressed, resulting in the cancellation of routine procedures so that acute cases can be dealt with. I have to say that I agree with the cabinet secretary that the key to solving the A&E problem is to improve the patient's flow through the system. Although patient awareness of the appropriate point to access the NHS needs to be addressed, and also how to attract and retain more medical staff, particularly at consultant level, into the emergency medicine specialty, at present, because of a significant volume of inappropriate attendance at A&E departments, the existing staff—highly qualified and trauma medicine—are often unable to use their specialist skills and the job becomes unrewarding, particularly when they are on a 24-hour, seven-day-a-week rota of work. I also agree that the integration of health and social care, if it works effectively, should help patient flow very significantly. However, there are many hurdles yet to be overcome, and I do not think that we should underestimate that in breaking down the professional barriers that still exist between health and social care, at least in some parts of the country. With regard to funding, there are on-going party political arguments about commitment to fund the NHS in Scotland, but there is no doubt that the Conservative party is committed to this, both at Westminster and here. The nearly £1.4 billion of Barnett consequentials received by the NHS in Scotland since 2010 is testament to that, as is the more recent substantial funding for the NHS extra funding, announced by the chancellor in his autumn statement. I must, to be fair, also acknowledge the extra funding for health boards, announced by the cabinet secretary this week, which is welcome, particularly from my point of view, the £5.2 million allocator to NHS Grampian, which has undoubtedly been significantly below parity with other health boards under the NRAC formula for a number of years. The NHS, of course, will always absorb any resources available to it, and it is crucially important to maintain commitment to safeguard its funding. However, the answer to the undeniable problems currently facing the NHS, particularly in community care and A&E, is not necessarily just to throw more money at them, but to sit down and plan properly for the future. I personally think that this has to be done at a cross-party level, because patients want results, not political points goading. I think that we do politics as well as patients a lot of good if we took a joint approach to strategic planning within the NHS. Jackson Carlaw and I had a good working relationship with the previous health team, at least, as we have heard until just before the referendum. I hope that this will develop under the new health secretary. I look forward to the meeting that she has arranged later this month with Opposition spokesman, and I hope that this will be the start of a positive working relationship with her and her team of ministers. I know that people outside this place are tired of political sniping, and I think that if we can overcome this behaviour in the interests of developing and sustaining our precious and much-loved NHS, I think that we will be doing an enormous service not only to politics, but to the large and very dedicated body of people who work in NHS Scotland and also to the patients who depend on their services. John Mason, to be followed by John Penland. I think that, first, we can start off with the strengths of the NHS. Let's remember that we do not have a system like the United States where richer people get a gold-plated service and poorer people get the absolute minimum, nor should we forget that many parts of the world have virtually no health service at all—public or private. The Canadian friend I have quoted in a previous debate and who I was speaking to just after New Year said to me totally unprompted that if one thing annoys him, it is people in Scotland slating the NHS. He has lived in a number of countries around the world and he reminded me that in most of these countries people are very jealous of what we have here. Of course it is the opposition's job to look for things that are wrong rather than welcoming the things that are going well. I have occasionally done that myself in a past life. To be fair, Labour does mention the hard-working NHS staff in their motion. Let's keep things in perspective. Of course I am happy to accept, as others have done, that there is and always will be room for improvement. It would be good if we could have a mature debate on that rather than just rhyming off easy slogans. I think that that is something of what Nanette Milne has just been saying. I would suggest that sometimes at committees we are able to have more nuanced discussions than here in the chamber. At finance committee, for example, we have had a number of sessions with an emphasis on preventative spending. Do we really believe in that? If so, how should we be spending our health money? Those are the kind of questions that we should be discussing. Putting more and more resources into accident and emergency is ultimately a sign of failure. If we only do that, it would show that we had given up on preventative spend. Another issue at the finance committee has been whether we emphasise inputs, for example, the number of nurses, outputs, for example, the numbers treated at accident and emergency, or outcomes, i.e., a healthier population. Should we be making the number of nurses the key factor, after all, where do we want to go in the long term? Presumably, we want a healthier population, which would mean fewer hospitals and fewer nurses, or, if there are to be more nurses, they would be keeping people at home rather than treating them at A and E. Surely that would be a success. However, we face a challenge in sticking to outcomes, as they are often harder to measure or more long term and do not have such a close link to the budget. So the easy way out is to count numbers of hospitals and numbers of nurses. I confess that, as an accountant, my profession can be guilty of emphasising what can be easily measured. However, if we are serious about outcomes and preventative spend, it is going to take self-discipline on all our parts and political leadership, which avoids petty point scoring. I did feel that the last part of the Conservative amendment is along those lines, and Jackson Carlaw, in his speech, got the tone right, I think. However, not only does the Government have to produce a long-term strategic plan, presumably emphasising outcomes and preventative spending, but Opposition parties will have to place less emphasis on inputs. We cannot spend money on everything. In fact, we have also heard witnesses at the finance committee during the budget process say that they think that we are spending too much on health, and we would be better spending more on growing the economy and getting more people into jobs. That might help people's health in the longer term. I do not particularly agree with that argument, but it is there. So there are choices to be made on whether we spend on health or on some other part of the budget. There are also choices as to how we spend the money within the health sector, should we spend more on early years and less on older folk, should we spend more on preventative, less on reactive, should we spend more on healthy food for children, less on end-of-life drugs. Let us be clear that we have to make choices in all of this. Labour can pretend that we can have more money for everything, but I do not believe that that can be done. The public does not believe that that can be done, and simple arithmetic says that it cannot be done. I also mentioned the intended Lib Dem amendment with its emphasis on mental health, which many of us would welcome. However, if there are to be more mental health beds and nurses, presumably they want to cut mainstream beds and nurses, that is a valid choice for them to make, but perhaps they would have more credibility if they had actually said it in the amendment. Others have said, but it is also worth saying again, that accident and emergency is not the most appropriate place for every health problem. When the announcements were made on Monday about the extra funding, I think I heard a radio piece correctly, which said that actually some 30 per cent of people going to A&E could have been better attended to elsewhere. I can also just mention the subject of privatisation within the health sector. Although others have mentioned that already, in a people-intensive area like health it is pretty likely that if the private sector can do something cheaper it is because they have fewer staff or staff on poorer terms and conditions. If we are serious about the living wage, doing away with zero-hour contracts, proper holiday entitlements and decent pension provision, let us not be hoodwinked into thinking that a cheaper bid has some kind of magic formula and produced money out of nowhere. No, it has come about nine times out of 10 because there will be fewer staff, lower pensions, longer hours, etc. That is not to say that the NHS could not do things better. Why are GPs and dentists self-employed rather than being employed? I am not entirely sure. It does seem a bit illogical. Yes, let us look at how we could use the current resources better, but let us be realistic about the financial resources that we do have. I believe that we do have an NHS to be proud of. Let us always seek to improve it, but let us keep our eyes on the long-term goals and not just on what is easy to count. When it comes to the Scottish Government's treatment time guarantee NHS Lanarkshire, it did unbelievably well with just eight breaches. This came as something of a surprise in light of the reports that I have had from constituents. People can wait a long time to see a consultant, then many more weeks for tests, then another long wait for an appointment to get a diagnosis and discuss treatment. Only then does the guarantee kick in. If tests are to be repeated on other tests done or appointments are unsuitable times, that all adds up to the time and the fairer patient back to their GP resets the clock. Before you go to the actual treatment, a year or so can pass and it is a piece to say that Lanarkshire's 18-week target is not quite as good. Before I go any further, we have to make it clear that NHS workers are without any doubt extremely hardworking and dedicated. They are having to cope with extreme pressure under a heavy workload in the face of staff shortages due to the unfilled post and sickness absence. That is not just my opinion. In June, the chair of the BMA said, what I have seen over the past five years is a continuing crisis management of the longest car crash in my memory. Just last week, the RCN Scotland director, Theresa Fife, said, the whole system is creaking at the seams and the last few weeks have been seen a perfect storm of conditions that demonstrate just how perilous the state of the NHS is. This echo statement was made by Lanarkshire NHS Board about the fragility of services such as A&E, with plans already lodged with the Scottish Government for closures of up to 48 hours and plans being developed for longer-term closures. The fragility is due to the lack of staff, particularly for certain posts and disciplines. When I look at the NHS Lanarkshire staffing report, I cannot help to think that there are far too many shortages highlighted in the red and amber. In one year alone, NHS Lanarkshire staff complained about the staffing shortages 434 times. That is over 35 times a month and rarely a day goes by without a complaint. There were also the whistleblowers who bravely went to the press about their worries about the lack of suitably trained workers. In response to their concerns, the independent report on NHS Lanarkshire neonatal services concluded that the complaints about the lack of a specialist neonatal staff were justified. I will argue for a second that finance is the answer to all of the issues, and partly it is a challenge to recruit in some of the specialities. However, I am sure that the member will welcome the fact that NHS Lanarkshire is going to be one of the main beneficiaries of the Enrack uplift for next year, which will hopefully help with some of the expansion of posts that he is alluding to. I welcome the money, but I think that the cabinet secretary needs to realise that what he is offering is only a short-term fix, because in Lanarkshire we have been moving from crisis to crisis to crisis, and I think that the US cabinet secretary needs to realise that. When we see the impact of staffing and resource problems in repeated failure to meet such targets in any waiting times, in October and November last year, 170 NHS Lanarkshire patients waited 12 hours or more to be treated in their hospitals. Across the rest of Scotland, over the same period, only 142 patients waited 12 hours or more. Audit Scotland also highlighted NHS Lanarkshire's failure to meet targets in relation to outpatient waiting times and delayed discharges. Then, there was that and famously chief executive document that showed a £400 million gap in sustainable funding, and highlighted the problems caused by the lack of service reconfiguration in NHS Lanarkshire. Lanarkshire's mental health services are still dealing with the problems arising from the mental health reconfiguration plans. Nearly a year ago, the rapid review of NHS Lanarkshire highlighted the problems of Lanarkshire's A and E services, yet A and E is still under pressure. All the more so, as a result of the disintegration of GP out-of-hours services in Lanarkshire, which the NHS says has reached the point where it is becoming extremely difficult to provide a safe service. Cabinet Secretary, you need to realise that when staff, patients and stakeholders are criticising and using words and phrases like perilous, fragile, creaking at the seams, the longest car crash in memory, you need to realise, Cabinet Secretary, that the Scottish Government has to stop pretending that everything is okay, is basically okay, and I would hope that you would agree with me that Lanarkshire NHS is in crisis. Thank you very much. Thank you, Presiding Officer. Yesterday, I welcomed the £15.2 million additional funding for NHS Grampian, which means an uplift in the next financial year of £49.1 million. I mentioned the late Brian Adam, who campaigned for years to get parity for NHS Grampian, and he did so before he came to this place when there was a Tory Government in power at Westminster, when Labour would have power at Westminster, under a Labour Liberal Executive here and while the SNP had been in power. We have seen that shift from our birth note with this Government to Enrack, and now we are seeing that parity take place. I am sure that he would be very proud that that has been delivered. I would also like to pay my respects to others who have done likewise. Dr Milne's speech today was very good and, as per usual, very thoughtful about the health service. I know that, like Brian, Dr Milne has consistently called for that parity of funding. What does annoy me is some of the chancers who have discovered only in recent times that that parity was required, but I probably should not say much more about that. I attended the NHS Grampian annual review on Monday. One of the most refreshing things for me about that review was that there was complete and utter honesty about where they thought they could do better, where they were not doing as well as they should be. That is extremely refreshing and was not the case even a few months back. The issues that they mentioned were difficulties, and they are exactly the same issues that have been crossing my desk and probably the desk of a large amount of colleagues in the north-east for some time. Difficulties around orthopedics, dermatology and mental health services for young folk. They recognise those difficulties and it seems that they are taking action to try and resolve those difficulties, and that is extremely good news. I will give way to Mr Hume. Jim Hume. Kevin Stewart, for taking intervention. During the deliberations and meetings that happened with the NHS Grampian, and you mentioned about mental health and young people, was it brought up that Aberdeen city does not have one single chams bed at all? Were they looking to address that? It was not mentioned at that meeting, but I have raised that separately, Mr Hume, previously. There is a promise from the new team that they are looking at those things very carefully, indeed. I have to say that, again, the responses that I have been receiving have been particularly refreshing. He will understand that sometimes you do not get into the finer detail on your review, but I know that that is being looked at. The strap line that they used in their presentation, and I have to say that sometimes I do not really agree with the use of the strap lines, but I think that it was the right one—caring, listening and improving. I have to say that, from what I have heard on Monday and what I have heard from the new team since they have come into post, they are certainly caring about the areas where they think that there are difficulties. They are certainly listening, not only to parliamentarians, but we heard on Monday how they were dealing with the views of groups and individuals. I think that, already, we are seeing signs of improvement. We can do what politicians do all of the time and snipe at one another about the bad things and forget to mention the good things. We often do not give folk time to breathe to improve on what is currently there. We need to take a different attitude, a different tack, when we are discussing our national health service, so that we can, in all honesty, point out where there are some difficulties, and then get on with the job of trying to improve those areas of the business to make sure that patients are treated as best as they possibly can be. I will take a very brief intervention from Mr Robins. The member acknowledged that the hard work of the staff is testament to the patient satisfaction with the number one. I agree with that. In terms of the staff in NHS Grampian, although we have been told about all the difficulties that they have been, they have performed brilliantly during this time, including under a lot of media pressure and unnecessary pressure from politicians. I always say hats off to those folks who deliver on a day-to-day basis for the people of Scotland and deliver for the national health service. I move the amendment to my name, which I may have overlooked to do when I spoke earlier. I begin by thanking Jim Hume, who observed that the baby boomers have now got old. I hope that I do not feel as old as Mr Hume looks, if I can put it that way, and I will thank him very much for his observation and move smartly on from that as one of those baby boomers. There were a lot of contributions in the debates that wore on to which I warmed, but I am going to concentrate on just a couple. I want to pick up on something Christian Allard followed up on, and that was my concern about the potential for the health service to be weaponised in the language of Mr Murphy's leader at Westminster. Mr Allard said that it will not work. We see that as the problem, it does, because it was the most effective campaign tool in the referendum. When it weaponised the NHS with the outright bilge that it would be privatised on September 19, if we did not vote yes, hundreds of thousands of Scots were motivated to vote in the referendum on that basis. I am afraid that the truth is that, if you weaponise in this language we suddenly have evolved the health service, I am afraid that it does work. The point is that, as a political party, we have to be prepared to rise above that, and I am concerned. I say this not from the conduct of Mr Simpson in the way that he moved the motion, but in its tone that there is a temptation to do exactly that. It brings me directly to my taxi driver this morning, who is a lifelong former shop steward and Labour voter, who said to me that he was absolutely dismayed by the mansion tax. He said that he reminded him of the rabbit-out-of-the-hat spin politics of the Blair-Brown era, and he was absolutely dismayed by it. He was concerned that he had gone from being the quiet, deliberate man to the angry man who was now going to demonstrate his credentials for standing up for Scotland, which has to be the most flaccid, flashy, flim-flam mansion tax, a preposterous confection of a policy, which, as Sandra White, Mark McDonald and others illustrated, has been completely ridiculous. I think that, as Rona Grant stood up and said, do we not want these thousands, as if they are standing ready at the moment on the border waiting to cross over if only the SNP will embrace them? It is an ephemeral nonsense. Scottish Conservatives have argued for 1,000 nurses on the basis of a tough decision, which other parties do not agree with, about the reintroduction of the prescription charge at the level that it was at when it was abolished. I properly cost it in a funded way to underwrite that policy. Other parties do not agree that I accept that. It is also the case that elsewhere in the United Kingdom, in other health services, they need the additional resource of nurses, too. The right way is to increase when possible health spending and, for the consequential that would arise from that to come to Scotland, or for the Scottish budget to be directed in that way. To simply talk about a mansion tax is to insult the intelligence of voters. I have to say that, if that is weaponising the health service, I very much hope that it does not work in the election that we are about to enter into. Mark McDonald made the comment, and I think that, again, Richard Simpson did, and I said that I would make some telling points and barbs in his speech, which the Government would do well to take note of. However, he said that it was a change from the kind of motions that we had in recent times from Labour. It is true that dear old Neil Findlay was forever asking us to look to Cuba and Venezuela for our health service policy, and it was interesting and refreshing to see Dr Simpson concentrate on the actual dynamic with which we are confronted. Across Scotland, as we speak, the pressure that we have talked about is not illusory. It is not some fanciful debating point in here. While we talk this afternoon—it is not something that is passed, it is not something that is over—doctors and nurses are rushing around packed wards. Many of them have been closed because of the norovirus, with all the pressures on bed-blocking, as patients are unable to be moved to other parts of the hospital to undertake treatments and the consequential backlog and consequence of that. They are managing as best they can. Their legs are as exhausted as is their spirit. A debate in here that is based on nothing more than recrimination can do nothing for their morale or their expectation. I think that we all know the measure of the task that is there. It is possibly a bit late in the day to come in and say that we have just discovered that there is an aging population, I would say, to Mr McMillan. We have understood the consequences—mental health, primary care, the avoidable conditions, dementia, the public contract that we need the public to have with the NHS that we all wish to see, the atmosphere, the reward for staff—not just financial but in terms of job satisfaction, which is leading far too many of those that we train to seek employment and health services elsewhere. Those are the challenges collectively that we have to face, and I really look to the two concluding spokesmen for the Government and for the Labour Party to inspire the public with hope, to inspire the staff in the NHS with hope, that this is not going to be a political-tribal fight but this is going to be a genuine effort to find a way forward strategically for the health service in Scotland around which we can all unite and which, collectively, we can all deliver. Many thanks. I now call on Jamie Hepburn, eight minutes, all thereby, minister. Thank you very much. We are listening very closely to the debate, and I will try to pick up on a number of points raised over the course of my closing contribution. First of all, I turn to the opening and closing remarks of Jackson Callan and also of Nanette Mill. They both spoke of the ambitions for the NHS being shared and, indeed, John Mason reminded us of the advantageous position that we have in Scotland with our health service by comparison to many other parts of the world. I recognise that all of us in this chamber have a collective interest in ensuring that the NHS is effective working going forward. I agree with that absolutely. It has been clear from today's debate, Presiding Officer. We will not always agree with one another on every single point, but where we can work together, I think, we should seek to do so. Cabinet Secretary made that point in her opening remarks. She will seek to work with Opposition spokespeople on a consensual basis. I make that commitment as well. I know that the Minister for Public Health will work on that basis, too. We recognise that the NHS faces challenges. The Government does not shy away from that fact, and we look at our amendment that has been presented today. We recognise that there have been challenges in meeting the increasing demands in A&E departments. We acknowledge that further steps are required to reduce delays and discharges. Cabinet Secretary set that out on many times in this chamber, since she has been appointed to office. We also acknowledge that further steps are required to improve patient flow and ensure that A&E targets are sustainably met in the future. We are not shying away from the task that is before us, and indeed we have put that in our amendment, which I commend to members across the chamber. I would make the point that the Government has a clear vision and direction for our NHS. We are committed to delivering this vision and ensuring person-centred care, so that each and every person in Scotland receives a fair and appropriate service each and every time. That is, of course, no less than they deserve. Of course, next week the Parliament will debate the 2020 vision for the NHS and members can contribute to that. We continue to work with our NHS boards, putting in place a range of actions to support the delivery of our vision. We have set targets for calm psychological therapies, alcohol and drugs as well as IVF treatment, all of which will offer patients the best available care. We can do that because of the record levels of funding that we have put in place, the record levels of staffing that we have, and the commitment to invest in the NHS capital and infrastructure. I think that I want to put in record that there have been achievements waiting times under this Government, which have dramatically improved since March 2007, when only 85 per cent of new inpatient day cases were seen within 18 weeks. Indeed, it was this Government that removed the availability status code, which meant that some 35,000 patients had no guarantee with significant numbers of patients waiting well over a year for their treatment. I think that it would be appropriate to thank all those who work in the NHS for their efforts, down to their efforts, that we have seen those improvements in waiting times. Having mentioned targets, I want to turn to the contribution of Dr Simpson, because that was an area that he touched on. He also raised concerns about the number of GP's per capita. I thought that it was interesting that he was quite selective in selecting the northeast of England only, because if we look at GP headcount over the piece from 2006 to 2014, GP headcount in Scotland is up 6.9 per cent, and in Scotland we have one GP per 1,077 people who are in England, and it is one GP per 1,339 people. We have a good record in that regard. Dr Simpson, the reason that I used the northeast was not out of some selective thing for me. That was the Nuffield report. It used the northeast of England as a comparator, because it has very similar problems to Scotland. That is why I used that. It actually got 115 per cent of the funding when Scotland deployed only 99 per cent in terms of the increase that was given by the UK Government. I make the point that, over the piece 2006 to 2014, we have increased GP headcount by 6.9 per cent. In that regard, we are delivering more GP's per person in Scotland. I turn to the issue of the treatment time guarantee. Clearly, there is, of course, this point that our patients are not being seen within that time frame. I should say that the six months data from ISD's new way warehouse indicates that the majority of patients that breached the 12 weeks were seen within 16 weeks, so those who were not seen within the 12-week target time frame. We absolutely want to deliver that target, but those who were not seen within that time are seen pretty quickly thereafter. However, let me make clear that we expect boards to meet that target. Of course, we should make the point that 600,000 people have been seen in that time frame since the guarantee was introduced. Of course, that is why Duncan McNeill made the point. Was it not that we have come a long way in the last decade? He made the point that a decade ago, many of those sitting around the health committee table were inundated with cases involving people who could not get an operation. He said that they had disappeared from his caseload. We will not abandon that guarantee. I thought that it was very interesting to hear from Dr Simpson that that is not a guarantee that he would have put in place, and it is one that I think I have picked them up correctly in saying that he would seek to remove. Without that commitment, I think that we would be in danger of letting standards slide. We would be in danger of moving backwards. The cabinet secretary made the point and she was quite correct to do so that tough targets lead to good results. I think that I will be looking with great interest to see if Labour's manifesto commits to removing that commitment to treat within 12 weeks, and we can return to the Government returning to the days of 35,000 patients languishing on hidden waiting lists. I turn to some of the other comments that were made over the course of the debate. Jim Hume mentioned mental health. John Mason mentioned the Liberal Democrat amendment, which, of course, was not accepted to set out issues around mental health. I totally agree that that should be a priority area. We, of course, held a debate on that subject matter last week. I think that it is a subject matter that we should. Again, I accept the point, so there have been challenges there, too. Some of the challenges in mental health services are born of good news. For example, CAMHS is under pressure because more people are presenting and wanting to access help and assistance from CAMHS services. That is not an of itself a bad thing. That is a good thing that more people are seeking assistance. Of course, again, I expect health boards to meet our targets in that regard. I turn to John Pentland's comments. He spoke about the challenges in NHS Lancer. I recognise that there are challenges in NHS Lancer. It covers my area as well. He spoke of long waits before treatment. I confirm that NHS Scotland has consistently delivered the 18 weeks referral to treatment targets in Lancer in September 2014. 93.4 per cent were seen in that period. That is over the 90 per cent standard. In Wales, where the Labour Party run the health service, it has a 26-week referral to treatment targets. Only 85.7 per cent of patients were seen and treated within a target during September 2014. It is just one indication of many, Presiding Officer, while the NHS is safe in the hands of the SNP. I now call on Jenny Marra to wind up the debate in half of the Labour Party. Thank you, Presiding Officer. I would like to start my closing remarks this afternoon by turning to the biggest issue in the health service in Scotland today—a delayed discharge. Shona Robison has said this afternoon—as she said on the television on Sunday—that she was the first to admit that we have a problem with delayed discharge in our hospitals. She said this afternoon that it is her biggest priority, and we welcome that. We have all heard appreciation across the chamber this afternoon of the complex challenge that delayed discharge is. Every single situation is different, because we are talking about individuals and the choices that they make and the packages and the care and the support that surrounds them, perhaps in the past years of their lives. My initial meetings with the chief executives of health boards across this country reflect that challenge in boards up and down the country. We know that blocks in patient flow, as Nanette Milne said this afternoon, exacerbate the pressures that we have seen in our accident and emergency departments over the past couple of weeks, as accident and emergency departments are not able to move patients through the hospital. It is a planning and an organisational challenge as well, and it is one that has been highlighted by Audit Scotland. I hope that members across the chamber will agree that it needs extra resource. On that point, I ask the cabinet secretary a couple of questions. I know that she is committed to interim beds, but the £65 million that she has re-announced at the weekend has been calculated on the NRAC formula, letting the health boards catch up, as it were. The Scottish Government's press release that was issued this weekend specifically says that that money is for the cost of expensive new drugs. I ask the cabinet secretary this afternoon where is the extra money, that extra resource, to support the biggest challenge—her biggest challenge—to delay discharge. Can the cabinet secretary, if she is about to intervene, tell us what is also happening to that other £60 million from the autumn statement? I am very happy to confirm that the health service will get £380 million of additional money next year. We have said what we will do with £65 million out of the £127 million that has been announced. I will be making further announcements about the rest of that resource, but the NRAC uplift is for boards to meet a whole range of pressures. It is down to them what those priorities are. I welcome the cabinet secretary's comments, but I hope that she will make some money specifically available for the challenge of delay discharge, since she has made it her own priority. Labour will not support the Government's amendment tonight, for the simple reason that we cannot, in a Parliament, vote for a Government amendment that congratulates itself on breaking the law. The cabinet secretary herself does not seem to understand—the minister just highlighted this as he closed—the difference between Government targets and the law of this land. It was this Scottish National Party Government's decision to vote what should have been a health target into a legally binding law for treatment within 12 weeks. If you allow me to make a little bit of progress on that. For 12,500 people across this country, this Government has broken their legally binding law to them and the legally binding law of this land. What is their legal recourse, cabinet secretary? Usually, when a law is broken, the person against whom the breach has been committed has some sort of recourse in this country. Will the cabinet secretary do the decent thing and at least apologise to the 12,500 people who have had their legal rights breached by this SNP Government? Or is this a Government with so little respect for that law that they will use it as a PR stunt to convince people that they are the custodians of our NHS? If the cabinet secretary would like to respond— I am not sure that I got the last point, but I absolutely regret anybody not being treated within the targets that we set. Let me remind you of what was said by Jenny Hepburn. Out of those 12,500 people, the vast majority were treated within 16 weeks. Compare that to the year-long waits that happened under you. Can you confirm, Jenny Marra, that you will abandon the legal guarantee that patients have? Can you confirm what Dr Simpson said that you will remove that legal guarantee? Jenny Marra? We would very much like to meet the law of this land as pass, but what should, Presiding Officer, what has been referred to by cabinet secretary and the minister as a target is, not a target? This Government puts it into law and has a legal obligation to deliver it and has breached it. Those 12,500 people deserve at least an apology for that breach. I asked the cabinet secretary when she opened this debate this afternoon if she would publish weekly waiting times for accident and emergency departments across this country. I was very surprised to hear her response, because Shona Robison aggregates responsibility to the information services division, who have advised her to publish it on a monthly basis. She is the cabinet secretary. A political decision has been made in England and Wales to publish figures on a weekly basis. The cabinet secretary surely has the power in the interests of patients across this country that she overrides the rule and demand weekly published figures on accident and emergency waiting times. We understand that she is appraised on a daily basis on any waiting times. Why not publish this every week so that patients can have the information that she is also privy to? Is the cabinet secretary telling me that she is prepared to break the law for 12,500 patients right to treatment across the country, but she is not prepared to override advice from a quango saying that she can only publish figures every four weeks? I think that you have to ask who exactly is in charge here. I think that it is important that I am very new to this job, as you know. I was doing a bit of reading on a health check on our health boards across the country. You go from board to board and bear with me, because that is interesting. NHS Ayrshire and Arran has 137 breaches of the Scottish Government's treatment guarantee time. Audit Scotland reports a staffing crisis. Half the maintenance of the board is due to be carried out as classed as high risk or significant risk. It was forced to postpone operations after 1.3 million of surgical equipment was stolen. This month, some patients waited more than 12 hours for a bed. NHS Borders has 250 breaches of the legal guarantee treatment time. It has breached every month since it passed the law. Backlog of maintenance is over £6 million. NHS Fife has 354 breaches of the SNP law. It has breached every month apart from one. The largest increase in Scotland of future maintenance costs is over £13 million worth of work waiting to happen. The second worst vacancy rate in Scotland is the second worst record on cancer waiting times in the countr