The next item of business is a debate on motion 17191 in the name of Monica Lennon on urgent support for Scotland's midwifes. May I ask those who wish to speak in the debate to press the request to speak buttons and can I say at the outset that this is a very tight debate, so please keep to time. I call on Monica Lennon to speak to you and move the motion for up to seven minutes. On Sunday it was international day of the midwif and I enjoyed seeing my social media feeds filled with lots of cute baby photos and lovely sentiments about the special work that midwifes do in supporting women and their babies. The baby theme has continued with the Ireland Countess of Dunbarton announcing the safer rival of their little one on Monday and I'm sure the chamber wishes Meghan and Harry all the best. All babies are special and Scottish Labour shares the ambition of the Scottish Government to give all children in Scotland the very best start in life. That is why we have called this debate today seeking urgent support for Scotland's midwifes because we believe that they need extra help to keep delivering excellent care for women and babies. Before I say more about this, I'd like to pay tribute to the Royal College of Midwifes and thank them for their input. I'd also like to thank Unison and many of my own constituents who have shared their experiences of midwifery and neonatal care and their ideas for innovation and improvement. This morning I had the pleasure of visiting University Hospital Wishaw with Richard Leonard where we listened to midwifes telling us with great pride and passion about their work. We heard about the highs and the lows and I was very struck in particular by the care that has gone into developing dedicated bereavement and baby loss support. We met midwifes who wake up in the morning wanting to make a difference and that's exactly what they are doing. I want to thank NHS Lanarkshire for allowing us to visit and for creating a supportive environment where midwifes like Lorna Lennox who has developed this beautiful ribbon, which I know you can't read, but it's got a very helpful guide for mums who might be unsure about baby movements and so on. It promotes the triage service, but those are the lovely little touches and innovations that we're seeing when staff are truly supported. The work of a midwife, however, is clearly demanding and their jobs are made more challenging than they should be because of workforce pressures. Last year there were 127 whole-time equivalent vacancies in Scotland and all those 45.5 posts were left unfilled for longer than three months. Overall, the vacancy rate has increased from 1.3 per cent in 2013 to 5 per cent in 2018. Those vacancies put additional pressure on the rest of the workforce. Our midwifery workforce is highly experienced and that's a good thing, but over 40 per cent of midwives are aged over 50. Their knowledge and experience is invaluable. However, the ageing workforce also gives rise to concern about succession planning as midwives start to retire. That was an issue that we picked up on today during our visit in Lanarkshire and more widely in conversations with the Royal College of Midwives. Despite falling birth rates, midwives' workloads are not diminishing and we need a robust pipeline of midwives for the future. There are between 50,000 and 60,000 births in Scotland each year. There has been an increase in complex births due to a number of inductions of labour arising in the number of older women and women with a high BMI becoming pregnant and giving birth. That brings me to resources. I was worried to read a letter signed by community midwives at NHS Lothian, who described not having enough equipment, computers or pool cars. I expect Lothian colleagues like Miles Briggs and Alison Johnstone and Alex Cole-Hamilton to share that concern. I hope that today the minister will commit the Scottish Government to carrying out an investigation. 19 Lothian midwives signed the letter, saying that the understaffed and stretched service relies on midwives' goodwill to meet the growing caseloads and ever-droddening remits. Midwives, like all of our NHS staff, deserve to be treated with respect and care, but weaknesses in workforce planning is contributing to reports of burnout and stress. It is our job here in Parliament to have an honest conversation about how to fix this. If colleagues support the Scottish Labour motion today, we will all agree that low morale, bullying and work related stress must be urgently addressed. Scottish Labour broadly welcomes the Scottish Government's best start strategy. The continuity of carer throughout the maternity journey is valued by women. If adequately resourced, it can improve outcomes in maternity and neonatal care. We pay tribute to NHS staff and service users and organisations, including BLIS and the National Childbirth Trust, who influence the final strategy. We are pleased to see the Scottish Government's amendment motion emphasising that £12 million allocated to a best start is an initial investment, but we hear the concerns of midwives who are anxious to see further resourcing follow quickly. That is why we are calling for an additional £10 million to be released towards the best start roll-out. In conclusion, best start reforms, if adequately funded, could be transformative and lead to successful outcomes for women, babies and their families. Midwives do such an important special job, and they must feel valued. Pregnancy is a treasured time, but it can be challenging. It is imperative that all women receive the care that is right for them. We will happily support Miles Briggs' amendment recognising the positive work of the Royal College of Midwives. I am grateful that the Scottish Government amendment does not delete my substantial points around workforce pressures and the need for an urgent investigation into the resourcing concerns in Lothian. I note that the Scottish Government has removed our call for an additional £10 million, which makes it difficult for me to support the amendment, but I look forward to clarification from the minister about the funding that the Scottish Government will make available when she gets to her feet. Scottish Labour welcomes reforms that the Scottish Government is taking forward. We believe that the urgency of funding is essential. I move the motion in my name. Clare Haughey, to speak to and move amendment 17191.2 for five minutes, please minister. Thank you very much, Presiding Officer, and I move the amendment in my name. I thank Monica Lennon for highlighting international day of the midwife. In Scotland we are very fortunate to have highly educated, skilled and compassionate midwives who lead and deliver the high quality care so valued by women and their families during the pregnancy as they prepare for the birth. Their first few precious days and weeks with their baby. Our midwife supports the whole family, and that matters because all the evidence tells us that the experience in the early years can make a real difference to health and wellbeing later on in life, and support for new parents needs to start pre-birth. Let me repeat the thanks that Jeane Freeman recorded on Sunday on the international day of the midwife to every single midwife in Scotland and every young midwife in training to thank them for their commitment, compassion and dedication to their role. It's two years since the best start, a five year forward plan for maternity and neonatal care in Scotland was published. The best start describes a new model of maternity and neonatal care that is family centred, focuses on compassion and the best care, with the whole family involved in this experience. One of the central pillars of the best start is the introduction of continuity of midwifery carer. Under this model, women receive most of their care from a primary midwife and a small team through their pregnancy, labour and birth and afterwards. That's what women told the best start review that they wanted. Midwives told us that this is how they want to work, and this model is supported by compelling international evidence of its positive impact, including improved satisfaction with care, fewer medical interventions during birth, improved breastfeeding rates and reductions in pre-term birth and baby loss. Last year, five early adopter boards were identified and they were given the task of leading the way across Scotland in implementing the new model of continuity of carer and local delivery of care. The first teams are now delivering continuity of care to local women. Capturing and sharing learning from these early adopters is helping the remaining boards plan for change in their own areas, tailored to their own local needs. The underlying principle of delivering individualised care built around women, her family circumstances and needs will be at the centre of every midwife's practice. Built into the model is the recognition that some women with complex needs will need extra care. The midwife's caseloads are reduced to give them the time to provide that care. We know that the roll-out of continuity of carer and the delivery of the range of recommendations in the best start will need investment to deliver. That's why Jean Freeman announced a funding package of £12 million over two years for implementation across the best start programme. That has allowed boards to invest in infrastructure, training and equipment to make the best start a reality. We are looking at future funding, recognising that roll-out will take several years. No one is in any doubt that this model will mean substantial changes to ways of working, particularly for midwives. That is why our early implementer boards have invested time and energy in communications and change management, supported by our best start programme board and delivery groups. We expect all boards to roll out the new model in a planned and managed way, with safety at the forefront and our maternity teams are working hard to deliver that. In addition, boards have been supported by national groups that have developed a range of guidance frameworks and training for staff to support implementation. To support roll-out, the best start programme executive team and the RCM are engaging with the early adopter boards and listening to their experience of continuity of carer to identify learning at a national and local level to improve implementation across Scotland. A best start event in March was attended by more than 200 maternity staff, mainly midwives, from across Scotland, with many more watching on the live stream of the event. The event focused on sharing learning and experience of roll-out of best start, including continuity of carer, and giving staff the opportunity to ask questions. If you wish to, Minister Kezia Dugdale. I wonder if the minister would recognise the role of midwives in providing post-natal contraception for women, particularly in poorer communities. If she does, can she tell us how she ensures that that money goes to deprived communities to do that crucial work? Sorry, minister. I believe that I shouted Kezia Dugdale instead of Monica Lennon. Would you like to take them both and deal with them? I'll give you time. Thank you, minister, for giving way. I appreciate the explanation that we've had from the minister so far about future funding in the amendment. I'm struck by the word, if the plans will be successful, if fully and appropriately resourced. What I'm not hearing from the Government is an absolute commitment that they will be fully and appropriately resourced. That's why we've put down that reference to £10 million, which stakeholders tell us would give them some confidence. I wonder if the minister can give me and the chamber some further assurance on that point. Thank you, Monica Lennon, and Kezia Dugdale for both her interventions. If I can take them in turn, I certainly echo and support what you say there, Mr Dugdale. I think that it's very important that we ensure that women are able to plan their pregnancies and do that in a safe and manageable way. That's why we have obviously free contraception in this country, and it's very important that midwives play a role in educating women about their fertility, particularly in the post-natal period. As for Ms Lennon's intervention, £12 million is an initial investment in the four early adopter sites. We anticipate that additional monies will be coming to the other boards, but we also need to recognise that that is not an addition to the current midwifery care. Transformation will become the new normal of maternity delivery of care. The vast majority of midwives and maternity professionals and key stakeholders such as the Royal College of Midwives, the National Childbirth Trust and Bliss support the introduction of continuity of carer. An introduction of this model is important in terms of satisfaction for women staff and staff, and from the perspective of improved outcomes, but changing the scale is difficult and challenging, as change always will. We know that it's important to listen to those staff on the ground and to learn from what's working well and to work with boards and help them to manage the change programme in the best way forward. No please minister, I think that we're running out of time. Again, can I give my apologies to all for that error that I made? I now call on Miles Briggs to speak to and move amendment 17191.1. Thank you Deputy Presiding Officer. I very much welcome the opportunity to debate Scotland's midwives and maternity services today and thank the Labour Party for bringing this forward. Let me start by echoing Monica Lennon's comments about the dedication, expertise and skills of our fantastic midwives who offer world-class levels of care to mothers, babies and families across our country. Their contribution to our health service is massive and we owe them a great deal of gratitude for the work that they do every single day. I also would like to pay tribute to the excellent work of the Royal College of Midwives and hope that members will support my amendment in my name on recognising their work and campaigns. I share the concerns that have already been voiced about the very significant midwifery workforce challenges that are affecting so many of our hospitals and communities. The latest statistics show that 114 midwife vacancies across Scotland and the vacancy rate for midwives has doubled over the last five years. There are fewer midwives in post than five years ago and less than 30 per cent of nursing and midwifery staff now feel there are enough staff. It is therefore little wonder that the RCN accused the First Minister, while she was health secretary, of a spectacular error of judgment when she cut the number of nurse training places. All of that is an indictment on the SNP's running of our health services and failure to put in place adequate national workforce planning for the last 12 years that have been in office. The midwifery shortage is another example of just how damaging the health surgical surgeons training place is. Clare Haughey, the member should be aware that we have more qualified nurses in midwives working in our NHS, up by 7.9 per cent, a new record high. It is up to over 44,000 full-time equivalents. Our nursing and midwifery student intake is up 7.6 per cent, the seventh successive rise. I think that the minister is very limited in time. He is still only up to four minutes. The key statistic, I think that the minister needs to understand, is that we have a shortage of 114 midwives today and the pressure that is putting on staff across our country. The Government's attempts to rewrite history in their motion does not recognise that NHS workforce challenges are this Government's responsibility. With our midwifery workforce ageing, a large proportion of Scotland's current midwives are now over 50. Extra midwifery student places should have been provided. Instead of the damaging cuts to training places that the First Minister made to exacerbate the current staffing problem, as one of Edinburgh's MSPs and a Lothian MSP, I agree with Monica Lennon that the open letter midwives across NHS Lothian have written is deeply concerning. It should concern ministers as well when they raise the shortage of key equipment. It should be urgently addressed by NHS Lothian, something that I hope the minister will take those concerns forward on as well. The best start recommendations were widely welcomed by stakeholders and experts, and Scottish Conservatives back their focus on patient and family-centred approaches. We agree that there needs to be a continuity of care for a mother throughout and beyond pregnancy, and it is up to SNP ministers to make sure that all required funding is delivered to implement best start. In regards to support for new mothers here in my region in Lothian, I have highlighted recently cuts to walk-in specialist breastfeeding services, which took place in 2017. Since then, I have been regularly contacted by mothers who do not know where to turn when they are having problems breastfeeding. I welcome the recruitment of more health visitors by NHS Lothian. However, if a new mother is having troubles in breastfeeding here in Lothian, they benefit from support straight away. That is why I am proposing the introduction of a dedicated telephone line for new mothers to phone if they are having issues with breastfeeding, allowing them to get the instant support whenever these difficulties arise. I again welcome today's debate on maternity services and midwives. I am pleased to support Monica Lennon's motion and I move the amendment in my name. I thank Monica Lennon for bringing this issue to Parliament and I, too, would like to thank Scotland's midwives for the incredible work that they do. There is agreement in both the motion and the amendment on the importance of the continuity of carer. The 2016 Cochran review found that the midwifery continuity of carer model made women more likely to have a normal birth. The best start recommendations recognise that all women should have continuity of midwifery carer from a primary midwife. That gives midwives a real chance to get to know mothers and families, taking individual circumstances into account. This is key. This relationship provides an opportunity to ensure that every growing family in Scotland who requires expert advice on financial and other matters get the help that they are entitled to. Midwives are ideally placed to identify families at risk of falling into child poverty at the earliest stage, but, of course, they require the capacity and the resources to have the time to do so. It must be acknowledged that there have been serious concerns expressed about whether the best start recommendations can be implemented with current staffing levels. In December last year, there were more than 114 vacant midwifery posts in Scotland, and there has been a year-on-year increase in those vacancies since 2015. Those serious concerns have been described clearly in the open letter referred to in the motion from midwives in Lothian. I recognise that the Government is taking steps to address issues around capacity. They have increased the number of training places and they have increased the student bursary. I welcome that. I am optimistic that the health and care staffing bill will help to ensure appropriate staffing levels, but those measures alone will not solve the problem. There are, as we have heard, concerns about retention as more than a third of midwives are over 50. There is consistently a significant proportion of the midwifery workforce that is aged over 55 and could therefore retire at any time. That is a lot of invaluable experience that will be lost, and it means that new midwives are dealing with complex cases without that back-up and support that is essential. The bursary is falling in Scotland, but the demand for midwives is growing. That is due, as we have heard, to arise in older women and women with a high BMI, accessing maternity services and requiring more complex care. According to the Royal College of Midwives, more than half of women accessing maternity services are now obese or overweight. We know that there is a well-established link between deprivation and obesity. Health care mothers reduce midwife workload, and maximising the income of pregnant women is one way that we can tackle the strain on midwifery services. In 2017, the Greens secured a commitment from the Scottish Government to roll out the healthier, wealthier children scheme across Scotland. I am keen that we do not lose momentum on that and will continue to monitor the progress of the roll-out. Midwives and other anti-natal service staff and health visitors have played a huge part in the scheme this far, and I would like to offer my thanks for their hard work. Miles Briggs was right to highlight the impact of community-based projects such as the pregnancy and parent centre in my own region. They help parents to have the healthiest pregnancy possible and they provide invaluable support to pregnant women and mothers, which in turn eases the strain on midwives. Cuts to services are undermining this, and Lothian, as we have heard, vital face-to-face help for breastfeeding mothers has been slashed by 60 per cent. Five-weekly, half-day specialist breastfeeding clinics in community centres were shut in December 2017. I would like the minister to respond to those concerns in closing. That would be very helpful. Imagine having to wait for a week, worrying that you will be unable to feed your baby. I will close, but it is imperative that we do all that we can to properly fund and resource midwifery services. Alex Cole-Hamilton is really grateful to the Labour Party for bringing this debate to Parliament today. It is sure that it is of our support in coming as it does just hot on the heels of international midwives day. I cannot think of another health care professional other than GPs with whom every member of this chamber has had some association, usually on the first day of their life, but many have had subsequent interactions with midwives in the birth of their own children. It was at 6 pm on Palm Sunday five years ago that my wife went into labour with our third child. The first two labors with our boys had been protracted over a period of days, so we thought that we had quite a lot of time. I took a leisurely trip out to Dalkeith to drop the boys with Granny and discovered to my horror when I was on the bypass that Jill was timing contractions as two minutes apart, so we realised that things were moving at pace. I got her into the car and back onto the bypass at which point she went into transition, which is quite a terrifying thing when you're driving at 70mph. My wife insisted that I phone the midwife at the Royal Infirmary and they talked us in. I said, we were coming in hot and I can't park this car. I need to dump this car at the door. This baby is coming now. Sure enough, they said, that's fine, just pull up outside the door. When we did pull out outside the door, there were three midwives ready and waiting for us right there. One of whom, it turns out, I went to school with and she told me that as I got out of the car and she said, but that's not important right now because your wife is about to have a baby. Sure enough, 11 minutes between doorway and delivery, we were delivered of Darcy, our third child, and she was happy and healthy and well cared for. We were carried in those 11 minutes on very confident hands and we had an excellent experience. I know that is replicated in hospitals around this country every single day, so the profession have our great thanks. It's always easy to think of midwives in hospital settings, but they do so much in our communities as well. I think that my party make a great deal about the need for more adequate perinatal mental health support services. We forget that it is midwives who pick up the first signs of postnatal depression or other mental health difficulties associated with childbirth. That is an absolutely key issue to be addressed in terms of the first days, those early days and the best start in life for our children. More than that, we have asked with subsequent policy developments for midwives to do more with less. For example, they are the first named person that any child will get in their first days of life. It will be the midwife who is the named person until that is handed over to the health visitor. Again, like best start, it is a policy initiative that midwives will not be involved in the creation of. That is a serious misstep. We are asking them to do more with less. By less, I refer to the point that has been made several times in this debate, of the calamitous decision taken by the then health secretary and now First Minister Nicola Sturgeon to cut training places by a fifth. That is 300 places lost to the profession. There is no doubt of the causality and the causal relationship between that myopic decision, that cut to training places and the subsequent increase to 5 per cent vacancy rate that we see today. I just want to thank the Labour Party. We will be supporting the Labour Party motion absolutely. We will reject the Government's amendment because I think that it glosses over some of the problems that the Labour Party rightly bring rise to. We are happy to support the Conservatives today. It is important that we have more debates like this because I think that midwives are often forgotten about. They are more than just healthcare professionals. They offer councils, such as crucial advice in those first sleep deprived days of early parenthood, which we all rely on. We often forget just how much of a good start they don't just give our children but each of us as new parents as well. David Stewart is followed by Emma Harper. The international confederation of midwives created the concept of the international day of the midwife, which previous speakers referred to. The theme this year across the world is midwives defenders of women's rights. Of course, their organisation has a strong international message, but it is also applicable to Scotland here and now that midwives uphold and protect the rights of women every day, that midwives need safe and enabling environments to work in and that women have the right to make choices about their care during childbirth. It is a truism that is often worth repeating that maternity and neonatal care are crucial to the health and wellbeing of Scotland's people. As the Scottish Government's own report on best start said last year, I quote, services have largely developed over time, rather than being designed around the needs of women and families, leading to different approaches and care across Scotland. As previous speakers have said, we all know that the birth rate in Scotland has been falling but, of course, the work for midwives is not dropping proportionately because of increased levels of birth complexities, more inductions and a rise. As we've heard from Alison Johnstone and others, in older women and women with very raised BMI's becoming pregnant, that means that they are changing needs in the population, services need to change and develop, and with them, because some are no longer fit for purpose. My colleague, Rhoda Grant, will provide a case study shortly based around caseness, and I know from my own experience, along with others in the chamber today, as convener of the cross-party group in diabetes, that long-term conditions such as obesity and mental health problems need a strong proactive response from health services. Health inequalities is a concept that I've referred to many times in this chamber and in the health and sport committee. We all know that women from disadvantaged communities face particular challenges during pregnancy and birth, and best start has a number of key principles to address the problems that I've just raised, such as continuity of care. Particular focus on rural areas, for example, linking up transport services, enhancing telehealth and telemedicine. Along with wider targets, such as a single maternity network with a single neonatal clinical network for Scotland, is it working? Well, one midwife working Glasgow, whom I got feedback about from best start, said today, I just can't see how it can work safely for both women and midwives. We're being failed as it is, completely rewriting the system won't fix that. Honestly, this is a hot topic at work and people are so scared of this. We all know that midwives are the front line of the NHS, bringing new life into the world and a job that's both beautiful and heartbreaking, hard and beautiful as well. That's so much so. There's a feeling that some have no choice but to leave the job they love, tell us something of what must be done. I've already heard from a colleague, Monica Lennon. We believe that we need, from this side of the chamber, transformational change to midwifery, but it's crucial that this is not done on the cheap. We all know that existing midwifery workforce are significantly under pressure with high level of vacancies and increasingly complex cases to manage. In addition, the 2018 state of the workforce report from the Royal College of Midwives found that a number of midwifery vacancies co-drupled over the past five years. I would echo previous speakers who called for an urgent investigation into the concerns raised by the midwives from NHS Lodian, who believe that they do not have those sources needed to deliver the new models of care. The skills and commitments of Scottish Midwives need to be recognised and celebrated today. Let's ensure that all midwives have the time, the training and the resources to do their job properly. Emma Harper is to be filled by Annie Wells. I chose to speak in this debate today because it is a real concern for me to read the motion that was presented by the Labour Party. I acknowledge that May 5 was an international day of the midwife, and I would like to provide my thanks to all our incredibly skilled midwives across Scotland. I was an active clinical educator who used to participate in education sessions for midwives dealing with complex case issues, which was highlighted by Alison Johnstone. Obese patients had no venous access, so I had to look at supporting them to work with central venous access, which is something completely unfamiliar if you are a midwife. NHS de Friesen Galloway in my south Scotland region, as with other areas across Scotland, has its challenges with midwifery services, and this is something that I have been in communication with the local midwives and NHS de Friesen Galloway board about. I would like to focus my contribution. Of course, I will take an intervention from my colleague Finlay Carson. I declare an interest in being a father in the next 12 days, but does the member agree with me that, despite the incredible hard work of the midwives in Wigtonshire, there has been badly let down by previous decisions from this Government because there is only two midwives covering the whole of Wigtonshire, and there is the impending closure of the birthing unit in Stranrair, not down to improvements in the service but down to concerns around safe and resilient staffing levels, which will require women in Stranrair to have to travel 70 miles to Dumfries? Emma Harper I absolutely agree, Mr Carson, that there are real challenges in Dumfriesen Galloway. We had a midwife-charginger's die, and we had one retire, so there are major recruitment challenges. I am coming to the 75 miles of potholes that women in labour have to experience when they are moving from there. I am not in disagreement with you, but I concur that there are challenges, and I am coming on to that. When I read the motion that was put forward for the debate, I have just referred to recent case work that I have done, but at the end of 2018 I wrote to NHS Dumfriesen Galloway to highlight the concerns that have been communicated to me by constituent midwives. I wrote to the head of midwifery, and I asked about the challenges that were perceived by the midwives, because it is not just about recruitment and training. There have been moral issues that have been highlighted as well. I raised the issue with the clinic birthing suite, which I have just responded to, about Galloway community hospital as well. In response to my letter, I was pleased to read that the head of midwifery has met with the representative sample of midwives across the area, from Strenwart and Dumfries, to speak to them about morale, about the challenges they face and overall how they felt. Those meetings were based on modules of conversation from the Good Conversation programme and allowed the midwives to rate their feelings on how their morale, their experience was. Most of the midwives rated that the service delivery was 7 out of 10, which means that it is a satisfactory standard. However, it is worth noting that no midwife that was asked felt that staff morale was an issue, but that was a bit of a conflict in what I have conveyed. I would like to raise one issue. The NMC has declared that there has been a reduction of 13 per cent of midwives registering from our European neighbour countries, and Brexit has been cited as a cause of this. I would like to quickly highlight that the Scottish Government is keeping the bursary, is supporting free tuition, which has been taken away south of the border. The Scottish Government is investing, and I commend that. I would like to hear any further information from the Scottish Government about how we can support our midwives in Scotland. Annie Wells, to be followed by John McAlpine. Midwives play an essential role in the NHS, and many women who have given birth will remember their names, if not faces, of the midwives that took care of them on one of the most important days of their lives. I certainly remember all the help and support that I got as a 21-year-old first-time mum hundreds of miles away from my family. The support that I received before, during and after giving birth was greatly appreciated, particularly the emotional support that she cannot put a price on. It is so important that we give midwives our full support so that they can work in an environment that helps them and the vital work that they do. International Day of the Midwife, which was first celebrated in 1991 and, as we have heard, took place on Sunday, acts as an opportunity to celebrate and advocate for many ways that the midwives support women. Midwives have, over the past two decades, rolled with the changes in both technology and society. More women than ever are getting pregnant via IVF, and more women are having children later in life. Patience satisfaction with maternity services is high, with 74 per cent saying that their care in Labour was excellent and 61 per cent saying the same for anti-natal care. That is not to say, however, that we are doing right by midwives who are facing pressures on a daily basis. As we have heard from my colleague Miles Briggs, it is just to show that there is a current shortage of midwives with 140 vacancies across Scotland and fewer in post than five years ago. In a Scottish Government staff experience report, only 27 per cent of nursing and midwifery staff said that they felt that there were enough staff to allow them to do their job. We know that that is a long-term issue across the NHS workforce. In 2016, Audit Scotland highlighted a lack of workforce planning in health boards. As well as the issue of recruitment, retainment is also a huge problem. Two years ago, the former head of the Royal College of Midwives put on record her concerns about an agent workforce. The proportion of midwives aged 50 at older jumped from 34 per cent in March 2013 to 40 per cent in March 2018. She also stated that workforce behaviours were deterring trained midwives from staying in the profession. There have been reports, as we have heard, of low morale, bullying and work-related stress. A Royal College of Midwives survey found that over half of RCM members had experienced harassment, bullying or abuse from service users or their families in the last 12 months, and a third reported being on the receiving end of this from a manager. Although the midwife unions have supported the best start, they have expressed concerns about how it will be implemented. There are widespread concerns about the demands of being on call and the potential impact that this will have on work-life balance. That is why today we have put forward an amendment highlighting the work undertaken by the RCM to improve workplace culture. Given that a study last year found strong links in Scotland between the quality of maternity care and women's health after childbirth, it is all the more important that we get the necessary support in place. I want to finish today by again thanking midwives across Scotland who do such a cracking job. They are one of the most visible and valued professions working in our hospitals and communities, and to that end deserve our full support. We must look to improving workplace culture and creating an environment that supports the vital work that midwives do. I thank John McAlpine for being followed by Rhoda Grant. I am delighted to speak in this debate today, highlighting the vital work of midwives. I wanted to open by praying tribute to one very special midwife, my children's grandmother, Mae Cain, who died a few weeks ago in her late 80s. Mae was an old school midwife who, between the 1950s and the 1990s, delivered thousands of babies across Coltbridge and Lanarkshire, including I believe one of our own parliamentarians, Elaine Smith. Many of those babies were amongst the mourners, as adults of course, who came to say goodbye to Mae a few weeks ago in Coltbridge and demonstrated the esteem with which she was held in her community and indeed the high regarding which midwives are held. The priest said that many of them, some of the younger ones, had not met her, but they knew that her hands had brought them into the world, and that is why they wanted to be there. I think that it is fitting to put that record off her name into the Scottish Parliament. She often spoke of the importance of one-to-one care and the close relationship between mothers and midwives. Of course, that is exactly how she operated back in the 1950s and 60s when she set off on foot to homes whenever she was needed, often very poor homes, which she then followed up with a lot of aftercare. She would be the first to welcome the fresh focus on continuity of care, which has been outlined by the minister today. I am paying tribute to her and of course to all the nurses and midwives whose contribution of such critical importance to the NHS should be valued and celebrated. I am proud that, since the SNP came into office, there are now more qualified nurses than midwives working in the NHS and Scotland's staffing levels are up to a record high with qualified nurses and midwives up 7.9 per cent. I welcome the fact that, over this Parliament, the Scottish Government will continue to invest in education and training support with £40 million worth of investment allocated to create up to 2,600 extra nursing and midwifery training places. In addition to increasing places for new students to the profession, the Scottish Government also introduced the Return to Practice programme, which provides funding for encouraging former nurses and midwives back into the profession and understands that almost 460 have retrained on the programme since 2015. The Scottish Government is also funding the Open University to deliver a pre-registration programme currently supporting 116 nursing students. As well as increasing places for new students, the Scottish Government will invest £11 million to expand the available financial support for nursing and midwifery students. It is particularly important that all eligible students in nursing and midwifery courses across Scotland will benefit from an increased bursary in 2019-20, rising to 10,000 a year in 2021. The core nursing and midwifery student bursary has been set at 6,578 per year since 2009-10, as is increasing to £8,100 in 2019-20. Those bursaries are the best in the UK and are neither means tested nor repayable. The announcement that was made by the First Minister in October has been welcomed by experts in key organisations such as Glasgow Caledonian University, one of the largest providers of nursing education in Scotland and an additional discretionary fund of at least £1 million was launched in 2016 to provide a safety net for nursing and midwifery students in financial difficulty. That is in sharp contrast to the UK Government's position in England, where both the bursary and free nursing and midwifery tuition have been scrapped. Those measures taken by the SNP Government to both improve and safeguard the integrity of the NHS in Scotland demonstrates very clearly that the Scottish Government will deliver the best possible framework for continued support for both nurses and midwives employed in the health service, as well as students who will be the next generation to provide world-class care and support for millions of new Scots. I call Ruda Grant to be followed by Edward Mountain. We have heard this afternoon that the relationship between a family and their midwife is incredibly important. Best start lays out best practice and what we should expect from maternity services. Our motion highlights that that is underfunded. As you read the report, it becomes more and more obvious that that is the case. It talks about multidisciplinary teams and communities following the mother and family through the stages of pregnancy birth and beyond. However, in Caithness, only 10 per cent of births take place in the county. The rest take place in Inverness over 100 miles south over treacherous roads. A similar situation arose at Dr Grace hospital in Elgin, and that has slightly improved due to interim paediatric cover. However, that cover cannot be guaranteed and the situation remains precarious, with around 60 per cent of birth still taking place in Aberdeen. In Caithness, there was no attempt to provide paediatric cover. Previously, there had been obstetric cover but no paediatrician. A baby tragically died and it may have been that had there been paediatric cover available, that could have been prevented. Instead of addressing the lack of paediatric cover, obstetric cover was also removed. The argument being that having obstetric cover gave a false sense of security and mothers were not transferred to Riggmore quickly enough. There was also an argument that midwives were being de-skilled and birth was being over-medicalised. However, with only 10 per cent of the births now taking place in the county, it is difficult to see how midwives can hone their skills under the new system. The truth is that distances are so great that clinical staff transfer the mum if there is any concern over the birth, and I do not blame them because they do not have back-up locally. If during a pregnancy there is thought to be complications or risks, many mums opt to have elective cesarean sections. This is the only way that they can plan when they will be away from home and organise childcare for older children and indeed organise for their families. Sadly, that is even greater medicalisation of birth and, as with all major surgery, there are risks attached. That flies in the face of what best starts states and it says nothing about giving birth in the back of an ambulance. I raised already in Parliament the case of a mum who gave birth to one of her twins on route to Inverness. Those twins were born in different counties 50 miles apart, how distressing and how unsafe. If it is unsafe to give birth to a child in Caithness maternity unit, it is surely much more unsafe to give birth at Galsby community hospital, which does not have a maternity unit or facilities. The first twin then travelled separate from its mother to Inverness. Its mother travelled in another ambulance and gave birth to the second twin in Inverness. NHS Highland has not risk assessed the journey and I fear a tragedy will occur before they do. If the Scottish Government is committed to best start, they need to address that. Another point of concern is that the journey home is the journey home with a newborn baby, along three-hour journey by bus or four and a half by train and at least two and a half by car. Caithness health action team discovered that it was dangerous for a newborn baby to travel such long distances in car seats. For the journey home to Caithness, a journey of that length, there should be specialist baby cots to allow the child to lie during that journey. This is something that surely would have been picked up had NHS Highland carried out a risk assessment into the new pathway. The community then had to raise funds and purchase the appropriate travel cots and Tesco stepped in to offer to store them for the families when the NHS refused to do so. The truth is that the current practice does not reflect what is proposed in best start. It is unacceptable for both parent and midwife. I ask that our risk assessment is urgently carried out into the current practice at Caithness, whether that is a physical journey to hospital or back home, or the large increase in the elective caesarean sections. The whole patient journey needs to be safe. Thank you very much, Presiding Officer. It is always a pleasure to follow Reddy Grant, who has said most of what I wanted to say in my speech. It is good that we agree. I am delighted that we are holding this debate to acknowledge the international day of the midwife and also to champion the hard work and devotion of all midwives across Scotland. I would like to begin by celebrating the passion and dedication of our Highland midwives, which was brought to national attention on the BBC television series. I am pleased to see the first cohort of midwifery students enrol at the University of the Highlands and Islands this January. This is a groundbreaking course that will equip new recruits with the skills to provide care in remote and rural Scotland. Where progress is being made, we should definitely celebrate it. However, we should not forget that, under the Scottish Government, not all is well with our health service. I believe that our midwives are being let down by the poor-term long planning that has seen serious staffing shortages. We have fewer full-time midwives in posts than we did five years ago. Our health service is experiencing the devastating effects of the First Minister's decision to drastically cut the number of training places for nurses and midwives between 2009 and 2012. The SNP's efforts to repair the damage that it has caused is not inspiring confidence of the health professionals either. The Royal College of Nurses has criticised the SNP plan for its lack of detail and for admitting how much money will be invested in growing the nursing workforce. That frankly isn't good enough and I believe that it shows a lack of seriousness about resolving a workforce problem that the SNP themselves have created. What we need is for the SNP Government to finally and fully support our hard-working midwives. What we don't need is more of the ill-judged approach to saving money by downgrading local maternity services. When I attended the NHS Highlands—I'll just make a little headwear then surely—when I attended the NHS Highlands annual review, it was clear that the centralisation of services to Ragemore hospital and maternity provision in Caithness remain very big concerns across the whole region. Presiding Officer, I'll give way to Emma Harper. Thank you for taking that intervention. Does the member agree that the number of births might be an indication of why it's difficult to maintain a small birthing unit open, like Strunrar last year, had less than 20 births? That's a challenge to maintain a midwives level of competence in order to provide the safest care. Indeed, I will, and I'm just coming on to that. For too long, I believe that our senior leaders in NHS Highlands have held the belief that centralisation is the solution to all of the problems, but downgrading services like Caithness and the one that the member mentions at Strunrar is simply not the answer. You talk about lack of births being carried out in Caithness general, although here's a fact for you. There were 219 births last year by Caithness mothers. 18 were born at Caithness general. Numbers like that are of huge concern to families wanting to have children in Caithness, many whom would prepare to give birth locally and avoid the long stressful journeys south to Inverness that Rhoda Grant has mentioned. They certainly don't expect to make that journey when they're in labour. Centralisation is not working for new families, and all this puts in terrible pressures on staff, pressures made even worse by the alleged bullying in NHS Highlands that we are now seeing talked about in other areas across Scotland. Presiding Officer, our midwives deserve better than the Scottish Government is currently giving them, whether it's cutting training places, staff source shortages or the deep problems with workplace culture. We need to do more for the midwives that are so critical to the future of Scotland. I thank our midwives for the work that they do and the care that they give before and after birth. Things are changing constantly. It wasn't yesterday when I had my three kids, so I know that things do change along. Things have improved immensely in regard to that. I've listened to a number of people quote the figures of midwives and older midwives, and I accept that we need more people and there are more midwives and nurses put forward for training. We should get together and congratulate the midwives who are here at 50, 55, 60 years of age. They may have to work to their 66 under the new obviously what's happening from Westminster. I know that we need it and I accept it, but I think that we should congratulate them. Lots of the midwives that Monica Lennon mentioned in her opening remarks bring huge amounts of experience with them as well. We should be congratulating the fact that our midwives are there regardless of what age they are. I want to concentrate on the best start, the forward planning, the plan that is there. Monica Lennon mentioned it and numerous others. If we are being honest with each other, we look at that as a very ambitious plan. It's a very honest plan as well. When you look at what has taken place, the minister went through the whole thing. I'm not going to go through it. I've only got four minutes anyway. When you look at the review that the minister went through, you look at the engagement that was engaged in there and you look at the key recommendations. I think that that's taking out to not just the local communities but the professionals as well of what they want to see. As I said, I don't want to go through the whole thing so I may just mention some of the recommendations and who actually took part in this review. The workforce took part in it, 14 NHS territorial boards took part in it. That's quite a huge undertaking in that respect and 600 staff engaged in it. It's ambitious, but it's honest to the review and 600 staff took part in that. That says something for engaging with your staff. 504 responses to the national experience survey. That's something that 2,000 women shared in the experience of care, the Scottish maternity care experience survey 2015. I think that that shows you that the Government is working. We may have a lot of work to do. As I said, I'm being honest about the actual report. It has some very, very honest recommendations there, but for 2,000 women to be able to share their experiences, that put into a report. I think that that's something that would put the way forward. Sorry, Monica Lennon, I'll let you in. Monica Lennon. I agree that that engagement has been really, really important. Does the member agree that the certainty that we're looking for is around the funding for the next phase? The word if in the Government amendment gives some pause for concern? I suppose that it's the way that you read the amendment, but I think that the minister's reply on her contribution. I don't think that if gives as much concern as perhaps is being read into it, but I do say, as I said, I'm being very honest and I think that the report is very honest that yes, we do need more money to put forward in the care report and put forward for the services, but it will depend on how it pans out and maybe that's where the if comes from. That's the way I'm reading it anyway. It might not be the way that Monica Lennon reads it, but I think that when you look at the review and you see how many people have took part in it, you're getting an honest answer from the staff, from women, from the professionals and from the health board as well. It might not make great reading to perhaps the Government even, but it's honest and we are replying to that in an honest way as well. As Monica Lennon says, the if, I don't know, perhaps the minister might say that in her summing up or whatever, but I'm quite confident that we will get there. It's ambitious, but we'll get there in the end. Thank you, Presiding Officer. Thank you very much, Ms White. I'll call Brian Whittle to be followed by the minister, Clare Haughey. Thank you, Presiding Officer. I first refer the members to my register of interests in that I have a daughter who is an NHS midwife. I also thank the Labour Party for bringing this debate to the chamber, but in saying that, I had my disappointment in the short time that we have to discuss this. Very early on in my time in this place, I started working with a constituent of mine, Fraser Morton. Mr Morton and his partner, June, had gone through the unimaginable tragedy of losing their son, Lucas, in childbirth. The circumstances leading up to the death of their son had troubled Mr Morton and his response was to investigate. He is a lecturer in health and safety. It transpires that, to add to their trauma, Lucas' death was avoidable. He asked me to go along with him to meetings with the health board, Health Improvement Scotland and the investigation team. I've got to say that I was shocked at the way in which Mr Morton and his family were treated. Mr Morton was insistent that there was a real systemic problem, but there was a consistent wall of denial. At one point, there was a suggestion that one of the mid-nives would carry the can. I have to say that Mr Morton did resist that. In the end, I had organised a meeting with the then Cabinet Secretary, Shona Robison. He is a very knowledgeable and very well informed individual, as I'm sure the Cabinet Secretary would have agreed. As would the Health and Sport Committee at which he gave evidence. That result was a reluctant, I have to say less than satisfactory in our opinion investigation by Health Improvement Scotland. However, that investigation resulted in an extra 24 neonatal staff recruited into the department. That must mean that the department was 24 staff shot at that point. Not only does that speak to the patient's safety and the high baby mortality rate at the time, but it must also speak to the pressure that the department was under being so chronically understaffed. A commitment in a meeting with Mr Morton and in the chamber was also made by Shona Robison to make CTG scan training compulsory twice a year for all neonatal staff. Given that the misreading of CTG scans is cited in a high proportion of childbirth mortality cases, that was a very welcome step. I have to say that Mr Morton has managed to achieve more than all of the members in here combined over that period of time. The problem is, of course, that this is not being universally adhered to. Perhaps the minister could tell parents in the chamber how this policy is being implemented and how its implementation is being measured in his summing up. Edward Mountain has been leading in the bullying culture in his local health board, and now we have another health board being accused of systematic bullying by almost 100 radiographers claiming that staff have suffered years of bullying, harassment and victimisation. That is the very same hospital that those issues were raised by Mr Morton some three years ago, and I would ask the question what has changed, because bullying is a lack of respect and it is undervaluing the work that it does. Creating an environment where healthcare professionals want to work has to be a primary priority. There is this bullying and blame culture that has developed into this aversion to risk that is shutting down experiential learning. How can we learn the lessons if the evidence is being swept under the carpet? There is claim after claim that the system is driven towards finding individual blame rather than looking at the flaws within the system itself. Until that issue is addressed, the chronic staff shortages not only in midwifery but across healthcare professional disciplines cannot be solved. So many midwives are taking early retirement because of their value and status eroded. I think that retention of staff is what we are talking about. There is a hole in the bucket, cabinet secretary, and no matter how hard we try to fill that bucket with water, it will never be full. We need to fix the hole. Look after the health and wellbeing of our healthcare professionals if we want to retain our staff. Midwifery is a vacation, Deputy Presiding Officer. Two of our shifts are commonplace and to add to the pressures of understaffing and a culture of blame and staff bullying will not encourage our midwives to stay longer term. So, look after their wellbeing first. I think that it is time that the Government understood that. Clare Haughey, Deputy Presiding Officer, and thank you again to Monica Lennon for tabling the motion today, highlighting the international day of the midwife for debate and for the comments from other members. I also want to repeat my thanks for the incredible support midwives give to women and families and provide reassurance to midwives that we are listening to their concerns and taking them seriously. As a close, I wanted to highlight some of the positive work that is going on in maternity services in Scotland. Maternal mental health is a key priority for me. It affects as many as one in five pregnant women and we know that it is underdiagnosed and that without the right treatment there can be serious long-term impacts on women and families. Our investment of £50 million shows that we are determined to improve the recognition and treatment of perinatal mental health in this country, including improve community support, better access to psychological assessment and treatment and more specialist services for those with more severe illness. I would like to respond to some of the points raised in today's debate. As regards the mention by some contributors to the Lothian midwife's open letter, NHS Lothian has its first pilot team as part of its phased approach to implementation with safety at its core. The board reports positive feedback on the new model and has confirmed that all midwives have their own equipment, including laptops in the pilot team. I know that senior staff at NHS Lothian met with midwives who contributed to the letter to listen to their concerns. Further meetings, events and workshops are arranged with staff to explain the plans and listen to their concerns. NHS Lothian has also established a staff group to feed into their best start programme board to allow staff to engage with and influence the best start agenda locally. Returning to some of the other points raised about midwife numbers, I have heard the concerns expressed by some of the sustainability of the midwifery workforce and we will continue to work closely with the RCM and other stakeholders to address this. The Scottish Government has supported a range of actions that are under way to address this, including our return to practice programme, where 59 former midwives to date have undertaken training, a shortened midwifery course for nurses in the north of Scotland and a new programme for nurses in the north of Scotland. Up to 100 retired nurses and midwives will train as professional practice advisers, sharing their knowledge, skills and experience with new recruits. There has been a 99.2 per cent increase in midwifery support staff since 2007. Under the SNP, 1,000 more nurses and midwives are trained each year compared to the previous administration through the record high funding in our NHS. We are seeking to increase our midwifery student intake in 2019-20 from 226 to 257 to meet the projected future requirements. NHS boards are also exploring a range of innovative approaches, for example, bringing retired midwives back on reduced-hours contracts. One example of that being in NHS Lanarkshire, which is bringing back 80 per cent of its retiring midwives on 15-hour contracts. Finally, I want to underline the ethos of collaboration driving the best start. Recommendations were developed following the extensive consultation with over 600 staff and 600 women who have fed their views into the process. Key stakeholders such as the RCM, the National Childbirth Trust and Bliss have been involved throughout. Continuity of care is the right thing to do for women, for families and for midwives. I understand that many midwives in Scotland have never worked this way and that change is daunting. That is why it is so important that boards work in partnership with their local maternity staff to ensure that they feel safe and supported during the transition. Reforming services is not easy, but we should not shy away from moving forward when we know is the right thing to do. That is why we have five early adopter boards leading the way in testing what this new model might look like for Scotland. Both the best start team and the RCM are well into a series of listening visits to understand how continuity of care is being rolled out and hear any concerns, and we will use learning from these visits to inform the way forward for Scotland. The Government is committed to the aspirations that are outlined in the best start and, most important, to improve outcomes for women and their babies. The motion has been really simple on our side. It is about an urgent review of the very serious issues that have been raised by not just one but nineteen midwives in Lothian who put their name to that letter. I appreciate the ministers giving some update, but the concerns that they raise go far deeper than just the best start reform. We need to see an urgent review. We have asked for £10 million of funding to be brought forward on top of the £12 million committee already. The word if in the amendment gives concern, and I know that Sandra White is feeling optimistic, but I think that many of us are concerned. It has been a short debate, a share, but I am whittles frustration, but I think that members have packed a lot in. We have had very considerate speeches, and there has been very constructive challenge. I think that there has been personal reflections from across the chamber, which reminds all of us how much we owe to Scotland's midwives. Consensus on the importance of midwives and the skills, education and love that they bring exist, but we have heard about many of the challenges. Emma Harper, Finlay Carson, Edward Mountain and David Stewart and Rhoda Grant touched on some of the rural challenges. Of course, we heard about the importance of the road network, too. Pult holes are a real difficulty for women in labour, we heard. Dave Stewart was telling me that his daughter, Kirsty, was the first baby to be born in Regmore hospital. There have been lots of anecdotes today, and I believe that the Royal Baby now has a name. Congratulations, baby Archie. I am sure that my colleague Jackie Baillie will be inviting the Duke and Countess of the Barton arrow. I am not big on royal convention, but I am sure that she will get an invite out to Jackie Baillie's constituency. Annie Wells said that people remember their midwives. When Richard Leonard and I went to the University Hospital of Wishaw today and met fabulous midwives there, I had a lovely surprise where Ella Sinton, who delivered my baby Isabella in 2006, is one of those midwives who is still on the job 38 years later and she is doing fantastic work. It was lovely to be reunited with Ella, but Ella is one of the midwives who will be retiring in the next few years. It is important that we capture the knowledge and experience, because we need to go that pipeline of new midwives coming in. We do not want midwives feeling stressed and burnt out and affected by low morale, because that will put people off. It is important that we all do what we can to make sure that midwifery is attractive. I share the concerns of Tam Waterson, who is the chairperson of the Scottish Health Committee at Unison. He said that any changes to the provision of midwifery services should not be at the cost of hard-working, dedicated midwives paying with the erosion of their terms and conditions. I agree with Alison Johnstone that continuity of carer is the right approach, but it has to be backed up by the right investment. It is a very exciting topic for members. We are not in a picture of the royal baby yet. As I said, Richard Lund and I spent time and wish all with midwives this morning. They deal with some of the happiest occasions, but they also deal with some of the saddest occasions. I cannot think of anything sadder than the loss of a baby. I have not really had the chance to mention some of the charities that support families in midwives, but Cymba, Bliss and Sands are so many, but they do really, really important work. I heard and wish all today that they are looking at ways in which they can fund additional soundproofing, which might come in handy here in Parliament too. The mothers are experiencing stillbirth and baby loss. I would like to think that we do not rely on just charitable donations for that kind of work. Aside from the reforms in best start, there is a lot more that we can do. I think that there is wide consensus today for Scotland's midwives and our mums and babies. I am pleased that we have had a good debate. I hope that members can support the Scottish Labour motion. That concludes our debate on urgent support for Scotland's midwives. The next item is consideration of business motion 17207, in the name of Graeme Dey, on behalf of the Parliamentary Bureau, setting out a business programme. Can I ask Graeme Dey to move the motion? Move, Presiding Officer. No member wishes to speak against the motion or on the motion. The question therefore is that motion 17207 be agreed, are we agreed? We are agreed. The next item is consideration of Parliamentary Bureau motion 17208, in approval of an SSI, and again could I ask Graeme Dey on behalf of the Bureau to move this motion? Move, Presiding Officer. Thank you. We turn to decision time. The first question is that amendment 17190.1, in the name of Derek Mackay, which seeks to amend motion 17190, in the name of Colin Smith, on Scotland's future scrapped cut to the air departure tax, be agreed? Are we agreed? No. We are not agreed. We will move to a vote. Members may cast their votes now. The result of the vote on amendment 17190.1, in the name of Derek Mackay, is yes, 64, no, 59. There are no abstentions, the amendment is therefore agreed. The next question is that amendment 17190.4, in the name of Jamie Greene, which seeks to amend the motion in the name of Colin Smith, be agreed? Are we agreed? No. We are not agreed. We will move to a division. Members may cast their votes now. The result of the vote on amendment 17190.4, in the name of Jamie Greene, is yes, 32, no, 91. There are no abstentions, the amendment is therefore not agreed. The next question is that motion 17190, in the name of Colin Smith, as amended, on Scotland's future scrapped the cut to the air departure tax, be agreed? Are we agreed? No. We are not agreed. We will move to a vote. Members may cast their votes now. The result of the vote on motion 17190, in the name of Colin Smith, as amended, is yes, 65, no, 58. There are no abstentions, the motion as amended, is therefore agreed. The next question is that amendment 17191.2, in the name of Claire Hockey, which seeks to amend motion 17191, in the name of Monica Lennon, on urgent support for Scotland's midwives, be agreed? Are we agreed? No. We will move to a vote. Members may cast their votes now. The result of the vote on amendment 17191.2, in the name of Claire Hockey, is yes, 62, no, 61. There are no abstentions, the amendment is therefore agreed. The next question is that amendment 17191, in the name of Miles Briggs, which seeks to amend the motion in the name of Monica Lennon, be agreed? Are we agreed? Yes. Are we agreed? Yes. We are agreed. The next question is that motion 17191, in the name of Monica Lennon, as amended, on urgent support for Scotland's midwives, be agreed? Are we agreed? Yes. Are we agreed? Yes. We are not agreed. We are not agreed. We will move to a vote. Members may cast their votes now. The result of the vote on motion 17191, in the name of Monica Lennon, as amended, is yes, 92, no, 26. There are five abstentions and the motion, as amended, is therefore agreed. Our final question is that motion 17208, in the name of Graham Day, as amended—no, not as amended. It is not the final question, either. It is the final question, though, and it is on approval of an SSI motion 17208. Are we all agreed? Yes. We are agreed, and that concludes decision time. Thank you very much. We are going to move now to members' business. Members' business, in the name of Miles Briggs on Scotland and Nation of Lifesavers, will just take a few moments for members and the minister to change seats.


If there's anything traditional Chinese medicine should be famous for, it's for women's health. It is very, very inspiring how many case studies I have seen of women having unique and specific gynecological problems that should not have been able to be fixed according to their doctor or specialist that I have been able to treat with internal medicine and Chinese formulas. But why do they occur in the first place? In this video, we're going to discuss three of the most common causes of women's health issues within my field. Hey guys, I'm Dr. Alex Hine, author of the Health Book Master the Day and doctor of acupuncture and traditional Chinese medicine. So before we jump into this video, there are two very important links right below the video. The first is if you'd like to become a patient of mine locally in Los Angeles or virtually via telemedicine, you can reach out to my private practice and contact us that way. The second is I've put together a free guide, which is four daily rituals that can potentially help you add years to your life with traditional Chinese medicine. So those links are right below this video. Now there are three interesting causes of menstrual issues that are most common within my field. And everyone is intimately familiar with them. But maybe these stories and these examples will help illustrate how common this is. So when I see the top three most common, I would say they are what we call cheese stagnation, deficiency taxation, and the third would be what we call cold, deficiency cold. And let me explain and give examples for each of these. Now I once had a female patient that came in, this woman that came in and she was going through an extremely rough patch in her relationship. She said they were fighting all the time. She was stressed out at her job. She wasn't eating well, but in general was feeling the highest stress she had ever felt in several months. Now to compound it even further, she said she came in and was worried that she was pregnant and she didn't want to be because mysteriously she hadn't had a menstrual cycle in several months, which was very uncommon for her. Now eventually over a few months, that menstrual cycle restored itself and her mentees was fine and she wasn't pregnant. But she had uncovered and unpacked a very common cause of menstrual irregularities in women, which is stress. So Chinese medicine calls this cheese stagnation. And the best way that I can explain cheese stagnation is it's almost like that feeling of having to cry, but you're in a scenario where you cannot cry. Meaning you have to push it down. You're at work or you're in a professional scenario or you're being criticized publicly and it wouldn't look good to cry. Where someone is saying something to you or there's something bubbling up and you feel that overwhelming pressure in your chest and throat where you want to cry or yell, but you have to swallow it down. That pressure creates a kind of stagnation. And that emotional stagnation can lead to cheese stagnation. So for many women, they know under high stress they may miss a cycle. And that is one of the common causes of menstrual irregularities, specifically when we talk about the cycle. Now it can often sometimes be a reason for dysmenorrhea or painful cycles, but in general I tend to see women have variable cycles with this pattern. Reason number two is what we call deficiency taxation. Another way we could call this is maybe over exhaustion. I once had a patient who is a very, very high level division ranked athlete and a runner and she was running so many miles and putting in so much mileage that eventually she told me I hadn't had a menstrual cycle in several years. Now this woman was totally ripped, had a six pack like any athlete and her body fat was so low that her body was now into survival mode effectively where it said, hey, you know what? Body fat is so low, we're not going to have a menstrual cycle anymore. Now in many ways, this is a kind of stress placed upon the body because the ability to have children and get pregnant is a sign of good health. And if a woman is not, in some ways it's just an extension of poor health. There are underlying barriers to conception. But with athletes and women that are very, very, very hard trainers, their body fat may drop low enough that they are no longer able to have their cycle. So for some of the women that I see, primarily the ones that are very athletic, they tend to lose their body fat, they tend to have very low body fat, and as a result tend to lose their cycle. But in many ways, I view this as a stressor placed upon the body. So deficiency taxation is when a person is pushing or working or stressing the body so hard that it produces what we consider a state of deficiency, deficient resources, that then leads to a whole bunch of other problems. Now, how do you know you're in this picture? If you're not ripped with an eight pack as a woman and you're an elite athlete. One of the ways is that we tend to see what we call blood deficiency. And blood deficiency tends to show up in the skin, the hair, the nails, supposedly dry skin, sometimes pallor or pale facial complexion, a scanty or very light menses or menses that stops altogether, or the bleeding is very light. Or the number of days is no longer five days or three days, it's even less. All of these can be signs of blood deficiency, which means the body is pushing itself into a taxed state from our point of view in our profession. Reason number three is what Chinese medicine calls deficiency cold.  Because the vasodilation that happens from placing a warm heating pad on your low abdomen to relieve pain is what ancient doctors and ancient people observed. But what's interesting is that from an internal medicine point of view, we are literally using herbs that are warm and spicy to increase that micro circulation in what Chinese medicine calls the lower burner. The lower burner can be the reproductive genital urinary organs. So we use herbs, they can be herbs like Guajir, Cinnamon Tig, Twig, Wujiu, Evodia, Baishao, which is peony, that will actually what we call move the blood, tonify the blood, regulate blood stagnation or blood stasis. And these herbs help increase the circulation and therefore the functioning of these organs. So cold can occur due to many different reasons. For a lot of people, lack of blood circulation can lead to symptoms related to stagnation, right? Like the river that has stopped flowing because you're not moving anymore. Poor diets can sometimes lead to this, whether they are just bad diets overall. Or I've seen women that have been raw vegans for a very, very, very long time that begin to manifest with basically clinical hypothyroid symptoms and associated menstrual related phenomena. All of these can lead to cold. It can be lack of activity, literally eating a very, what we call cold diet. Raw vegetables are energetically, the cold is diet, basically you can have outside of, I don't know, ice cubes in your water or drinking watermelon juice or celery juice all day, I see. But cold, we treat with literally pungent warming herbs. So exercise is good for this. And formulas are very, very good for this, probably the king and the queen of treating this. But these three scenarios, cheese stagnation due to stress, deficiency stagnation due to really, I mostly see in very athletic women. And then cold, which can be sometimes just genetic, the tendency. Sometimes this runs in families, sometimes it's dietary, sometimes it's inactivity. But these three scenarios are the most common clinically that I see. And nothing is better in my experience in the world than Chinese formulas for regulating this. So I thought that's interesting, something you don't hear every day, but women know these anecdotes well. Again, that's what I have for you today, guys. Check out those other related links right below the video. And again, if you guys want to help with this, come see me in my practice in Los Angeles. I'll be happy to help. All right, guys, check out those videos, check out the links below. I'll see you soon.


So there's a lot of 3D printers on the market, a lot of 3D printers here at CES, but I'm talking to Braden Moreno from Robo 3D who says they're doing something even cooler than everybody else. Yeah, the first year this is our third year at CES. The first year there's probably about 25 companies in the whole 3D printing section. Now there's over 180 companies in the 3D printing section. So for us it's like how do we differentiate? And what we've been spending a lot of time on, especially within the retail environment, is bringing content to consumers' use cases, things that open their mind to what they can actually do with the product. That's actually a really good idea, because there's a lot of stuff where I'm going, yeah it sounds really cool, but I don't know what I would do. Yeah, most definitely. And that's, you know, the most common question we get is what can I do with it? And you know, unfortunately most people don't, I like when people are like, oh my god there's so many things I can do with it rather than what can I do with it, but We don't all have imagination, so don't make fun of us. Yeah, that's the world we live in right now. So for us it's, okay, how do we open their minds up to it, and the only logical way was to make these kits. And these kits are things, like the one we have here is a Bill Jerome guitar. An entire guitar. An entire guitar. It comes with all the hardware inside, I'll open it up for you here. So it comes with everything you need on here is instructions on how to make it. It comes with all the files you need, so you can download all the files and you can print it in any color you want, you can add your name to it, anything like that. So what we're looking for the audio listeners is what are the things called the Tighten the Wires? What's that? What are these called that you tighten the wires? I'm blanking on the name of it, yeah. Those things that you tighten the wires, it's got those, and then these are the Tuners. Tuners. Tuners, these are the strings themselves, right? Yeah, strings, and it comes with a little pick. And other than that it's the instructions. All the files. You said you lay this out like a twister mat on your floor? Yeah, it has a big poster in there and it shows you, it's a big image that shows you each piece broken down, and then when you actually download all the files you can reference them and go, okay, well I want maybe a yellow top with a black, you know, frame, whatever you want it to be. So you have to buy your own filament, right? Yes. And you said a thing of filament is about 30 bucks and this doesn't even use an entire one to make a good talk. Yeah, that's exactly right. Does it sound? What does it sound? Oh, it sounds good. We actually just made one out of a wood-infused plastic that we print with. So it's actually wood-infused in a PLA plastic, which is a biodegradable material. I have one here, and I actually sanded it and stained it, so it's actually a really, really cool guitar, and it sounds fantastic. I'm holding a little lion that looks like he's made out of wood. Yes, he is. Yeah, wood-plastic, but you get a lot of the properties of wood. Yeah, the texture, it feels like wood, also wood, maybe, but it feels like it. So show me the even cooler kit you've got. And so this kit right here is actually what we are planning to include with every 3D printer purchase in 2016. Why we want to do this is we've been thinking, okay, how do we get involved with kids, because kids love 3D printing. And so we're like, oh, do we go donate to a charity for every 3D printer purchase? It just didn't make sense to us. That wasn't the thing we wanted to do. So including these in every box. Say what it is you're holding. Oh yeah, we're holding a prosthetic limb 3D print kit. So this is kind of based on how our story, we were building prosthetics when we got started. This gives people right out of the box an opportunity to print a prosthetic limb. It comes with all the hardware. And then they can go and donate that to a kid around the world and join the enabled community. Oh my God. It has over 7,000 members. That gives me chills. Yeah. Let's see what's inside that kit. Yeah, so well actually, so the hardware is not inside of it, but we just have it kind of built out here as a prototype. But these will be coming, I would say around end of February. This looks like the ones I've seen other places. Is this an open source design? It is an open source design and actually the most popular and most requested by children that are in need of a prosthetic. Wow, that is so cool. So now that we've had all that fun, tell us really quickly about the two models we have here. Yeah, so when we were building, this is our first model right here that we built. This is called the R1 Plus. This has been our staple product that we sold in all over the world. And we realized when we built this and we started giving it to consumers that they needed, they wanted more. So we then built this version, which is called R2. It's been in the works for about a year and a half. It's really everything we ever wanted to include in the 3D printer. So we had a list. We had our must haves, our wants, and our wishes. Is this everything? And we got it all in, down to the bottom of the wishes, which we didn't think we were going to do. So I mean, when you talk about 3D printer users, everything is in this machine at a phenomenal price. You said that people who do this maker stuff really like to mess with it. So you let them mess with it, right? 100%. We're open source right now. So you can print with, we have over 15 different materials right here that you can make with. Wood infuse, bronze infuse, plastic, copper, and I mean there's all sorts of materials. You said you can even change the parts inside the machine. Yep, the way this one is built, the extruders right here, you can actually pop them out and you can put like paste extruders on or food extruders. Things that will actually deposit different materials. So it gives people that option. And then you've got the R2 Mini in the middle. Yeah, so this is the baby of the R2, if you will. This will be at a much lower price point. It'll have slightly less features, but still a lot of the same functionality in terms of speed, the ability to print directly from the machine, things like that. How much are you looking at? What kind of price are we talking about here? We have it at a sub 1000 price point. I know that doesn't give you much, but it's probably going to hopefully be in the $500 to $700 range. And about when is that going to come out? I think around May, timeframe. All right, this is really cool. So how can people find more about Robo3D? Yeah, you just go to robo3d.com. You'll find all our information there and yeah. Sounds good. Thank you very much, Braden. Good work. Bye bye.


How do I explain this? Seriously, how do I explain this weird event I've run into about the most talked about creepypasta? Well, I guess I can start slow. The original SpongeBob bootleg creepypasta is the story about five teenagers who found a bootleg episode of Dumped that was heavily distorted and heavily damaged which lead to this face. The most popular lost episode next to Squidward's suicide. Of course, the original was fake, but the events that I've suddenly run into. Oh god, that's what I kept saying thinking about this distorted and uncomfortable alternate version of the episode, Dumped. I'm thankful I was able to get this recorded on my camcorder. Around March of 2023, I was watching old rerun episodes of SpongeBob SquarePants. I've become so attracted to the reruns that I've forgotten what time it was. I was about to get up and go to bed when the song, daytime drama, played from the episode Dumped. Fine, one more episode and I can go to bed. I sat down and watched the episode. Outside of the flickering and the occasional buggy pixels, the episode played as normal until the infamous scene from the bootleg. At the time, I grabbed my camera and quickly pressed the record button. As SpongeBob was asking Patrick if he wanted fresh scent or heavy duty like in the original, the Nick logo vanished, replaced with a black blob. Where did the logo go? I said horrified.   Oh no, here it comes.  I was visibly horrified, but that wasn't all. When the episode came back, SpongeBob had a sad face, but the color aspect was gray-stale, with a voice in the background belittling SpongeBob. I was able to piece the insults together and came across this. All right, that does it.  I stopped into my room, and then I suddenly started getting into a tirade on how these mysterious voices were bullying SpongeBob, and how they were ungrateful narcissists, saying these and called messages to him. Then, just as I was about to go to bed, something flashed in my head. The logo. It doesn't normally vanish during an episode, unless it's going to a commercial break. Quickly, I opened my laptop, and looked up the SpongeBob bootleg episode's story, and the supposed version of Dumped. The story and the alternate airing didn't line up with the story, however, the footage that was shown was edited, which meant Nickelodeon aired an edit of a SpongeBob episode.


Γεια σας και παιδιά! Είμαι Βικη και είμαι εδώ με ένα πολύ καλό αδερφό χαρά σήμερα. Θα σας δημιουργήσω ένας από τα χαρά που πρέπει να χρησιμοποιήσεις το χαρό να αδερφιστείς το μονο. Και για αυτό θα χρησιμοποιήσω έναν νέο αδερφό με τα πιο καλύτερα μου, που είναι η Πικαμπού αδερφό. Όπως μπορείτε να δείτε, είναι με το χαρό με το αδερφό που κομμάσει ένα τάμπ, όπως 4 χαρές να κομμάσει από το χαρό για τα μονοδά σας. Αλλά για αυτό θα μου επικαμπο MORE, και να κομμάσω όλα τα πιο καλύτερα μου, και όλα τα πιο καλύτερα μου, και όλα τα πιο και μοναχές μου, και ήθελα να σας δείστω επίσης πhow μεταφέρ όλους μπορείτε να αδερφιστείς βασικούς αδερφό. Και πει ότι μπορείτε να σας φύγει το μεκανικό! Θα χρησιμοποιήσω τα χαρές από το νέο τάμπ, που βάζει ένα σημανιλάκι και τελευταία των στιγμών από το αυτά που θα εξέλουν με τα πιο καλύτερα μου. και θα στυμπω ένα δυο νερόντρο, και ένα λίγο καθαριστό. Θα στυμπω το καθαριστό με το μυαλό και θα σιχθω στιγμό με τα μεταφύλα λόγια μου, και για τα νερόντρο αν μου είχα στιγμό με τη σύγχωμα οράντρα που είναι η λύκη, στυμπωνο στιγμό που βλέπετε μου εναντικό. Και θα επαναθώ σε έναν κολλοδο, κολλοδοο μυαλό, που είναι χαμμυαλόντρο. και θα τα φρατωθώ το μόνο μου. This way I achieve a little bit of shading at the bottom of my trees so they don't look as flat. Now I'm going to use my alcohol markers to colour the owl and then I'm going to use the matching dice to cut out everything. When you are going for a card such as this one with a rotational wheel, then it's always nice to have all the elements for the top of your cards ready to go So that you can place them on top you can see where the little window with where the message is going to be revealed is going to fall so that you know exactly where you need to cut out things. So here as you can see I'm cutting out a couple of slopes. I'm using dice from the hit the slopes dice set which is a dice set that I have been using again and again for winter cards. These are going to go at the bottom so I'm just going to try and decide where everything is going to go and I'm not gluing anything down right now. I'm just trying to decide where this die that is going to cut out a spitz bubble window is going to fall. Now I have used the wheel to cut out this template and this is just printer paper. I'm just going to fold it in half so this way I have four quarters. Hopefully you can see the fold lines there. Now I'm going to place it at the back of my panel making sure that this wheel is going to fit inside the panel and you don't see any edges coming out of it. Then I'm going to place the tie on top and make sure that it's going to cut out on one of the four quarters just inside that quarter.  And I end up having the blue background with the little window as well as the template with the window in the same position as well. Ok now it's really easy to decide where you want to stamp the messages and make sure that they are going to fit inside that window. So I'm working on my template now and hopefully you can see the lines that I marked with my pencil just so you can see them better. I am placing the template on top of my actual wheel and now with the pencil I'm going to mark where those lines are going to fall. And now I'm going to show you how you can do the stamping. I am going to use one of the sentiments in the same stamp set as the little owl and the trees that says guess who thinks we are special. Now of course you can mask parts of this sentiment to stamp it but I went the easy way. I'm just going to chop off the sentiment in four parts and then I can stamp each and every one of them separately. Now I have placed the template on top of my actual wheel making sure that the marks on the wheel match the lines on my template. Then I'm going to stamp the first sentiment inside the window. Now rotate the wheel 90 degrees, place the template on top again making sure that the lines on the template match perfectly the dots on the wheel and stamp again the second part of the sentiment. And I will repeat the same process turning the wheel 90 degrees placing the template on top, aligning the lines with the dots on the wheel and then stamp again the third part of the sentiment. It's really easy to do if you have the template and of course you can create a template once and keep it with the die so that you can use it the next time. Now I am going to stamp the fourth part of my sentiment which is special.   So for that there is a die that you can place. I would suggest to place it at the back so that you know exactly where you need to cut out. And here comes the part where you need to secure the wheel with the brad. You can either secure it at the top with the brad but this is where you will need to cover it up somehow. So I decided to secure it at the back panel, the white panel that I have here. So I'm just holding everything in place with my fingers. I'm using some tape to make sure that this is not going to move on me. And then with a pick tool I'm just going to create a little hole at the center. And now I can put those two pieces together with a tiny little brad. Making sure that I don't secure the brad very tightly so that I allow for spinning with ease. And here is a close-up on how I attached the brad. You can see how easily I can turn around the wheel. You don't want to make the life of the recipient difficult when it comes to spinning. And this is a tiny little stamp set that has been released by my favorite things. And it is called Interactive Labels.  And little arrows. You can use the one that says rotate or spin. I'm going for the little arrow now. And I'm going to stamp it in four different areas. Exactly where those pencil dots are. And if you love interactive cards I think this tiny little stamp set is a must-have. Because it has all those little words and arrows and little symbols that we need for this type of cards. So now let's put the card together now. I'm just going to add some foam squares at the back of my blue panel there. Making sure that when I stick one on top of the other I don't block the spinning of my wheel. And you can see here a close-up of the wheel in action. As I'm spinning the wheel the message is revealed. Super fun. Now all I have to do is to just place all the elements at the top of my card to create my little winter scene. The snowbanks go at the bottom. The top layer has a foam tape at the back for dimension. While the second layer is going down with tape. And then on top I can add my little owl as well as the trees. And this is where I decided to use that blue tap that I have cut out from the front panel. And I'm going to stick it just at the back. This way the wheel is going to pop more since it's going to be white on blue instead of white on white as it is now. And of course you can do this step before you put your card together. This is going to make your life easier and you won't have to fight with the pieces like I'm doing now.  The snowflake I'm using comes from the same stamp set as the rest of the stamps. I'm using a pigment frost white color box ink. And this is going to create some very subtle snowflakes at the background. Which I'm going to finish them off by adding a crystal gem at the center. And here is my finished card using the pick-up wheel and the adorable warm and feathered hugs stamp set from the latest release by my favorite things. I hope you had fun that you got inspired. I certainly had lots of fun creating this card. Don't forget to leave me a comment to like the video. And I'll see you all next time.