Programme for Government - Improving Lives Through Delivering for Scotland - 02 September 2026

apologize to those members that it was unable to call. Um the next item of business is a debate on motion 10003 in the name of Angela Constance on the program for government improving lives through delivering for Scotland. Members wishing to speak should press their request to speak buttons now. And I thank the ministerial team for being in their places. I call Angela Constance to speak to and move the motion 12 minutes. Cabinet Secretary. >> Thank you very much, Presiding Officer. The first minister yesterday introduced the program for government to this parliament and to the nation and fundamental to this is the delivery of a significant reform of our public services. And let me be clear, these are vital services to the people of Scotland that require partnership and require to be delivered uh by an exceptional workforce that we're very blessed to have. And we absolutely value their work and all who work in them. But it is time for change, presiding officer. It's time to look with clear eyes and open minds at the shape and size of our public sector. And we must ask is it in the right kind of shape for the challenges that this country faces now and in the future. Do our systems fit around people or are we expecting people to fit into systems? Because public services designed for the 20th century must be ready for the realities of the 21st century. And that's why over the course of this parliament, we will rewire the Scottish state. Public service reform will be at the very heart of delivery in this administration. And this, I have to stress, is not about marginal change. It's about working with communities, those who rely on services, the workforce, and trade unions to re-imagine the state. A state that is more joined up, more efficient, and is more focused on prevention as early as possible. And in this people of Scotland must come first. Not the systems, not habits, not assumptions, nor institutions. Indeed, these public services reforms will be the biggest reform in this country since the Scottish Parliament was reconvened in 1999. But as N Beavenon, the founder of our beloved NHS said, there are also many dangers to staying in the middle of the road. So why do we need change? So let us be frank. If all of us in this chamber were to sit down today and design a modern, efficient and responsive Scottish public sector on a blank sheet of paper, it would not look like this. There are 134 public bodies in Scotland. And in health and social care, there are 14 health boards, seven special health boards, 31 integration joint boards, 31 health and social care partnerships, and 84 accountable officers. 84 accountable officers and multiple layers of decision making that remove services further and further away from the people in need on the ground. >> I certainly will. >> Jackie Bailey, >> I'm grateful to the cabinet secretary. would she recognize that in the past 19 years that it is actually her government that have been responsible for creating some of this institutional clutter and I point to health and social care partnerships and integrated joint boards. Angela Constance. Uh >> well, of course, uh this government has to bring forward, as we've done in the past, proposals that Parliament either endorses or does not endorse. And in all sincerity, we have had an election campaign where we have critiqued the past. But I think now in this parliament, it is time that we debate the future and ensure ensure that our public services aren't fit for 20 years ago, the 20th century, but are fit for today. and tomorrow and the 21st century. And the point is, presiding officer that this uh complex and cluttered landscape that members of our public need to navigate demonstrates why we need to simplify how decisions are made and who makes them. reducing unnecessary complication and confusing duplication and addressing the inconsistency and the variability of how services are provided. But simplification, >> of course, >> Marjo Fraser, >> I'm very grateful to the cabinet secretary for giving way and I I agree with her about the need for simplification, but can you tell us how local accountability will be secured if we're moving to two geographic health boards rather than the number we currently have? And does the Scottish government have a number on the amount of money it would expect to save from this particular move? >> Cabinet Secretary. >> So in terms of whether there are upfront costs or you know longer terms savings, we of course are in currently in a design phase and there will have to be a full uh business case so that we can lay out the the detail all the intricate detail uh to partners uh and others. It is an important point that Mr. Freezer makes. But the other point he makes about local accountability. I also h support the the endeavor in which he makes that a point because we need accountability at each and every level of the system. Of course starting with the government but there must always be local accountability as well. And the point that I really want to emphasize to parliament today presiding officer is that the simplification of decisions, governance and planning does not mean centralization of service delivery. And our reforms are about putting people and their care at the heart of our services wherever uh you may live. And the intention is that local services remain local wherever that is the best way to meet the needs of communities and our reforms must ensure that no matter where you live in Scotland that you can access the same high quality care and this is an issue that I've seen firsthand during the summer as I visited Dr. Grace and Murray and also in the time that I spent with staff and citizens in Kirkwell too because our vision is of a Scotland where citizens enjoy excellent public services delivered to meet their individual needs regardless of geography and we want the staff providing those services to feel valued and empowered to make a real difference to people's lives. Public service reform will be led by our health and social care services in the reform structures we want to see. Health reform is the first stake in the ground. Since the foundation of our national health service 80 years ago, both the demands we create and our expectations of the health service have changed. These are led by demographic changes. We have an aging population. people are living longer with more complex health conditions and we still have areas of deprivation across our country where health outcomes are poorer. So there is rising demand, change in expectations and rising costs and unless we radically shift course and our delivery of health and social care services, they will not be in the best position to respond to the needs of our people. Reforming the NHS is futurep proofing it for future generations to come. And the first step on this journey of reform is simplifying the structure of the National Health Service. And we will replace the current territorial health boards with two strategic health boards east and west. And this will reduce a necessary duplication and make responsibility much clearer. Beyond territorial boards, we will also build on the already planned reforms to further reduce the number of special health boards. Simplifying the structures gives us a a platform to allow people to access the care that they need quickly, safely, and with dignity. And we'll do this alongside continued investment in local community services like GP walk-in centers and hospital at home, digital transformation led by my care app and redesign services to ensure people receive the right care in the right place at the right time. And an example of this will be how we deliver a new national plan for orthopedics where simpler structures will increase access to elective procedures and eradicate long waits. People should not have to wait longer for an operation or procedure because of where they live and if there is capacity in our system then that must be used. So by streamlining structures in this way, we will empower our senior leaders to make decisions that benefit patients faster and in a more dynamic way. And as I've mentioned, we are committed to empowering communities. And we will enable bespoke solutions for our islands, including the implementation of single authority models where that is desired, local governance arrangements to enable decision making to be better tailored to the needs of the place. But let there be no mistake. This government is absolutely committed to the founding principles of the National Health Service. An SNP government will always be clear. Our NHS will never be for sale. And to safeguard its future, we must do more than reform structures. And that is why the program for government focuses on prevention, supporting people to live longer, healthier lives, and reducing demand on our national health service. So we must continue to make the shift from reacting to illness to preventing it. We already have wellestablished strategies and frameworks for this and we will continue to embed prevention across government and public services with investment in programs that prevent illness and detect diseases earlier including vaccination and screening. And that's why we are working with Chest, Heart, and Stroke Scotland to deliver new heart and lung MOTS. And we will strengthen action on healthy weight, physical activity, and the wider drivers of health. Work is progressing on helping people access practical help before health problems escalate, including our vital fight against Scotland's drugs deaths emergency. But prevention cannot be delivered by the National Health Service alone. It requires coordinated action across government, working in partnership with local government, business, uh the community and of course the voluntary sector. >> Of course, >> Willie Renie, >> the cabinet secretary will know that the Liberal Democrats secured extra support for long come CFD clinics, but those have not really advanced in the way that we would have liked. Can the cabinet secretary give us an update about when those will be implemented? Cabinet Secretary >> sign off. I'll certainly write to Mr. Renie in in detail of this. I certainly know in terms of some conditions such as uh long co and people have been writing to me very regularly on pots that there is uh I believe recurrent funding there but I'll go and check the detail and I'll write to the member um in greater detail. Besiding officer, these h preventive measures that I've mentioned uh should be more integrated with the services that treat people closer to home, avoiding the need for acute hospital care. And we've already made significant progress to increase activity and bring down long waits for operations and procedures. And our new health and care improving flow plan will see us create one connected system with simpler routes to care. It will declutter the landscape, ensuring we more effectively plan for unplanned care and improve the movement of patients through hospital and tackle delayed discharge. And we want people to spend less time waiting and more time receiving care. And this is our new contract with the public making clear what the public should expect in return for accessing care in the right place. Now I do not wish to open the old wounds in this parliament felt during the debates surrounding the national care service. However, social care must be central to our reforms going forward. And it is vital if we are to make headway in reducing delayed discharges and ensuring people are cared for closer to home. And our vision is clear. People should be able to live healthy, independent, fulfilling lives connected to their families, friends, and communities for as long as as possible. And that is why we will use the next three months to reach agreement with local government on the next phase of social care reform. Together, I hope that we can develop a model that delivers fairer and more consistent services. Above all, our approach will be shaped by the voices of those with lived experience. Thousands of people who access, deliver, and support care have shared their experience and insights with us in recent years, and their message has been consistent. Services must be easier to navigate and should be person centered and joined up. And our aim is to meet those goals. and our local government to work hand in hand with us to design an approach that works for people uh that we are all elected to serve and that offer also extends to to members across this chamber. I've already had some early discussions with the Greens Labor and Tories about their views on public service reform but my door will be very much open to those parties and to the Liberal Democrats too. It is important that members voices help shape the future of how our services are delivered. Presiding officer, this government will always look to find and create common ground in pursuit of a better Scotland based in fairness, compassion, and inclusion. And let me reassure Chamber that we will work closely with staff and trade unions from the outset of this process drawing on their expertise, leadership skills and capabilities required to design and deliver better services for our people and our communities. Government does not have a monopoly on good ideas. So we do invite leaders across local government, public bodies, trade unions and delivery partners to join us now in shaping a clear vision for [clears throat] the future and presiding officer. We make the most progress when we work together. Public sector reform, I think we all know, cannot be deferred. But the people of Scotland must be at the heart of this reform process. They are, after all, why we are all here. And it is with this in mind that we take forward this work to improve the lives of all who live in Scotland. Thank you. I call Helen McDade to speak to and move amendment 100003.5 up to seven minutes. >> Thank you, Deputy Presiding Officer. I move the amendment in my name so as I don't forget to do it later on. I'm sure we all share most of the vision that we've just heard from the cabinet secretary and so we're grateful for that and nobody disagrees that the NHS in Scotland needs reform. Indeed, the reform manifesto asked for an independent expert health and social care commission to look at the whole system um so that we could move this forward. But unfortunately, the flow plan is not a worked out plan. It's a distraction to fulfill the 100 days promise and sound bites with nothing underneath it. Not at the moment. I'll get started. Thank you. I'll start with the good bits. The app mycare.scot, we're glad to see that's come forward. Hospital at home has been successful and a roll out of that is good. The more use of the allied health professionals is something that many have asked for and we hel he heard this morning in the health committee that they have been already working in schools and elsewhere to improve outcomes. However, the flow plan sadly seems to be mainly PR. It starts from the bit of the NHS that most people see and the answer that SNP seems to have asked was what can we do about cues at the AAE and bed blocking corridor clear and the answer seems to be don't let folk into A&E and if they get in tell them they're going out in three days to the mythical care in the community. I welcome further on when it's been worked out that we hear where that is. So, there's some key phrases come out, jump out. Realistic medicine, self-care, care in the community. We've heard that one before. Stay at home with your loved ones. And at Ger, sorry, not Gerac. We do like a slogan getting it right for everyone. And the one I particularly like is waiting well, which I assume means people being told how to feel better while they wait for care to come. It does seem as though the SNP has not learned anything from the failure of the National Care Service Bill. There's been little consultation and the people who would implement it seem to think that this is not going to do the job that it wants to do. In fact, it is rearranging the deck chairs on the Titanic. I've spoken to many representatives of medicine and nursing and one almost in tears said after seeing this a flow plan will not cut it. Perhaps the cabinet >> certainly. Thank you very much. >> Cabinet secretary. >> I I would be very interested to know uh which of the actions the uh immediate priority actions the member does not that that she disagrees with in the flow pan. Um, does she not support uh rolling out delay discharge without delay programs right across the country? Does she not support the increased use of frailty units? Does she not support the expansion of care at home? All tangible actions about what will be done over this winter to improve the situation. >> Elate, >> thank you for your intervention. We support a worked out plan. We support where the money is going to come from to get that support in the social care sector which is not evident from this. And indeed as I was saying somebody on the front line very distressed when she saw this said this will not cut it. They are on their knees in the emergency services. There are over 800 excess deaths the emergency medicine Royal College think. And would there be less if they're waiting well at home? So this is a real emergency and I'll come on to where we should be going. What caused it? Scottish government give various reasons, older, more sick people. Um little mention of drugs and alcohol, but I welcome that the cabinet secretary did mention it. But there is an obvious impact. The Scottish population has gone up by 370,000 in 20 years and the beds in hospitals has gone down. And so that is one contributing factor. It may be that we have to build more hospitals but we need to look at the lessons of those what happens. If we have one hospital to replace three what happens when that hospital is in major ter tr trouble. This is also a time when healthy life expectancy is dramatically decreasing from 65 years to 59 on average. And so in emergencies staff are constantly on the red alert. Perhaps the Scottish government should consider building nightingale style hospitals for convolescent homes because it would free up some beds we do not have. But the Scottish government may not be keen on their building. Their record is not great on this. And I visited the Queen Elizabeth Hospital at the weekend. Not sure if the cabinet secretary's been since she was in post. Um I hope so. If not, I hope she's going soon. It was opened only in 2015 and it's in a constant state of disrepair. Scaffolding inside and out, cladding internally which seems to have been stripped. Empty unfinished doorways which are fire doors. And worst of all, the air may not still be fit uh for immun immunompromised patients and the water people don't trust it. So what third world country are we living in? The SNP Scotland have been in charge for 29 year, sorry, for 19 years. Brody's inquiry will report soon. We will see what happens. 6 years and 31 million pounds down the drain and will there be prosecutions? One thing we do know is we should not be waiting for the report. Action should be taken on the Queen Elizabeth now. An apologies to the families. and what action will be taken. So my heart goes out to staff. This is not about staff. This is about people who struggle to pick their way round buckets to do their job. Ask about what all the other hospitals are also needing. So will you tell us what you're going to do about the third of the NHS Scotland estate which has major structural or maintenance problems and will you give a dis statement on the Scottish hospital's estate leaving out the Queen Elizabeth if we can't speak about that yet because of the inquiry. So looking at the health boards, the question was moving on to that cunning plan. It seems like the magic figure of two health boards is based on the subnational planning east and west. >> Yeah, why not? >> David London, >> Miss McDade for giving way. Um, I had the good fortune, you might say, I've been able to read the reform UK manifesto last night and it talks about establishing an independent Scottish healthc care reform. How much would that cost versus what the government's proposing which is to reduce the cost of health boards which are currently about 15 billion pounds. So all I'm seeing in the reform manifesto is commitments to spending more money not actual public service >> helmet me >> well it won't cost as much as doing the wrong plan and as getting further problems with these hospitals >> you don't have costings for this plan that you're putting forward and you're going to implement it. So I did say at the beginning of my speech that we had that health and social care commission request and important there would be independent however we are where we are and the question is about health boards. So if it's based on the subnational planning I heard about this from a senior surgeon quite recently. He was quite worked up about the fact that Inesse is in the west and Aberdine is in the east. And anyone who lives in these areas know that these two hospitals in those towns have worked together as time immemorial because of their situation. So that is something that needs looked at. And all around the country CEOs of health boards must be asking themselves, "Oh no, I'm near Greater Glasgow and Clyde. Am I going to inherit their potential legal liability? How will that joining up these health boards work? You don't deal with failing in institutions by joining them up with each other. We need somebody to be put in who knows how to recover failing things. >> Can you wind up please? >> Sure. Scottish government believes single authorities are fine for the islands. They want simplicity. Perhaps we could consider that for the rest of the Scotland. If you want to reduce costs, we could indeed think about that. But the SNP's answer is always to centralize and try to take control, which is ironic for people who want to get control nearer from Westminster. Perhaps you should practice what you preach. >> I now call Jackie Bailey to speak to move amendment 103.1. Five minutes, please. >> Thank you very much, presiding officer. How do you follow that? Um, we are now on our we are now on our fourth health secretary in as many years. Um, those that have tried to get a grip of Scotland's NHS in that time include Hamza Yousef, Michael Mat, Neil Gray. Some of course are now no longer members of this parliament. But what they all have in common is their failure to support Scotland's NHS and deliver for the patients that it serves. So, let's look at the facts as they are right now. Outpatient waiting lists have risen four months in a row. There are over 700,000 ongoing weights for tests and treatment in our NHS. The use of the private sector has increased exponentially. A&E waiting times this summer are the worst since records began. And we have 3,000 nursing vacancies. Delayed discharge continues to rise when the SNP themselves promised to abolish it more than 10 years ago and social care is on its knees. The cabinet secretary has inherited a mess from her predecessors and I have offered in the past to work with the SNP, but no one calls, no one emails, no one writes. So I look forward to that changing. I really do because too often the SNP's priority has been to protect its government from criticism rather than putting the health and well-being of Scots first. So I welcome very much welcome the damosine conversion to a reduction in the number of health boards. But the purpose of that must be about shifting the balance of care, not centralizing it. It must be about delivering the best standards of care, not making cuts. and the SNP do need to acknowledge that they were the ones creating the institutional clutter because after all they created the 31 health and social care partnerships, the 31 integrated boards 10 years ago. So this must be about improving accountability and local delivery of social care and not treating it as the poor cousin to the NHS because social care must have the same parity of esteem and priority for ministers as the NHS does. The National Care Service was botched by the SNP. They did spend millions of pounds on unworkable legislation that didn't deliver a single penny for care packages. And I really hope that this isn't an attempt to do it again by centralizing this under health boards. The immediate challenge though is resourcing. I said earlier that social care is on its knees. I repeat that again because those trying to deliver in the social care sector of course I am happy to give way. >> Minister, thank you. I'm grateful to Jackie Bailey for giving way. I'm interested in her line of argument about the arrangements for social care because what has driven the reforms the government has undertaken in the past has been the pursuit of integration. That's what the purpose of the integrated joint boards were. And I think all of us come to the conclusion that however well-intentioned that was that has not delivered the integration that is required. And I set out yesterday that while I'm not, you know, not setting out a prescriptive solution, I cannot see how we can deliver integration of social care without the National Health Service being in the lead. And I wonder what Jackie Bailey's view is on what is the model of operation for social care that would deliver the integration that I know she and I both want to secure. Jackie Bailey. >> Um I don't think it is about handing it back to the health boards though and I do think there is a model where you can revise how health and social care partnerships operate bringing more of those who actually deliver on the ground including particularly the third sector to deliver in a different way with local accountability and local service delivery. But but I have to say to you the problem is resourcing and that's what I'm going to come on to because those genuinely trying to deliver in the social care sector are not adequately funded. The staff are low paid. We've long demanded as you'll know 15 pound an hour for social care staff and we do so again. But commissioning itself is in desperate need of reform. Social care faced a 500 million pound shortfall last year. The cuts made impacted directly on care. Yet, when I study the program for government carefully, what I see is three months of a conversation making best use of money already in the system and achieving economies of scale. Nothing about closing the gap between the commissioning rate for a service and the actual cost of delivering it. Nothing about addressing the growing level of unmet need. And this isn't sustainable. Presiding officer, the scale of the task before the cabinet secretary is clear for all to see. But I want to end on what I hope will be a point of consensus. And I want to turn to the question of women's health because I think it has been sorely neglected. We are all familiar with the urgent issues at hand. Long waits for endometriosis diagnosis. It was 8 and a half years when the women's health plan was first published. It's now sitting at 10 years, the worst in the UK. The failures in maternity care we were discussing earlier, the postcode lottery for women experiencing miscarriage, the centralization of sexual health provision, the lack of access to menopause support, the waiting time for hysterctomies, four years in the case of one woman in NHS Lannshire, weights of over a year for more than thou 4,000 women for gynecology. Against this backdrop, it is disappointing that the first minister has removed women's health as the specific responsibility of one minister. But irrespective of that, his team now in health are all women. So I hope that this is a priority for that entire ministerial team. We may have disagreements and debates over the coming months, but above all else, we must put the health and well-being of the people of Scotland first. And I move the amendment in my name. >> Thank you. Thank you. And before we move to the next speaker, can I just remind colleagues that there are five people who say they wish to speak in this debate, but who have not yet pressed their request to speak buttons. Please do so now. Uh I call Kaylee Kenos Neil to speak to and move amendment 10003.2. >> Thank you, presiding officer. I also move this amendment and my name. Um, I really enjoyed hearing from Jackie Bailey on the opposing cuts because not that long ago we were up in uh when I was up in the council chamber, her party were also, you know, signing off on a lot of social care and third sector cuts no matter how hard we tried to stop them. Um, I know that yesterday's announcement on >> Sure, why not? Jackie Bailey, >> is this not actually just down to a lack of funding coming from the Scottish government to health and to local government? >> Kaylee Kenro, >> both things can be true. So I know that yesterday's announcement has caused significant concern among staff, patients and communities about the future of local healthcare in Scotland. Unison's Scottish Secretary Lillian Mer who spoke in today's health committee had said that you cannot just restructure your way out of a public service crisis. Now Greens love a little bit of radical change. All parties understand as we've heard the need for public sector reform. But this appears to be perhaps too brunt of centralization of services and a worrying change from how the frontline health care is actually delivered. We understand though that the program for government is not the full picture. But our job in opposition is to ask these difficult questions and get in early to make sure that reforms are delivered effectively, carefully and with the right people from the start. I want to first talk about general practice because to be clear if general practice fails the whole NHS fails. Primary care conducts about 90% of the encounters in today's NHS but it is being starved of funding. GPS spend far more of their time on chronic issues rather than those needing acute reactive care. The burden grows whilst the budget shrinks. And for those who may not know, GP surgeries aren't technically part of the NHS, but are independent businesses with one customer, their local health board. This profit partnership model has shown itself to be the cheapest, but is it the most effective? Can you imagine if surgeons were paid based on how many incisions they made at speed in terms of attraction, growth, and retention? GPS say that the priority of the NHS managers should be to stall the general slide towards specialism and reverse the growing lack of respect for generalism. I could go on with examples because we know that when a population gets older, gets sicker, gets more complex and intersectional, the cost on the NHS is much greater. Spending can't continue in the manner that it currently is. We need credible alternatives because the status quo is not an option. And this year, we need a clear understanding of what this will look like under this two board structure. And I do look forward to hearing the cabinet secretary and government's thought process on this. But like many others across the chamber, they're looking on with concern over [clears throat] what happens to be drawing a line down the middle of Scotland and hoping for the best. In reality, people just want to know, how will this actually get me an appointment with my GP today? How many beds will be opened up at my local hospital? How will this get a care package for my grand that's more than fleet and visits? How will this help me care worker who's burning out and struggling every single day to help our most vulnerable? My plea to the government is just not to keep us in the dark. I very much welcomed words this morning from the first minister in regards to no compulsory redundancies, but we must be exceptionally clear that this also includes compulsory redundancies by the back door. For example, when people are offered either redundancy or relocation to the other end of Scotland for another job. Health and social care workers have endured years of relentless pressure under staffing and uncertainty. We all know this. They should not now be forced to pay a price for a rush reorganization behind closed doors. The Scottish government must engage meaningfully with trade unions and the workers who understand our NHS better than us before decisions are made, not after the structure has already been decided. Workers must have a genuine seat at the table. Their terms and conditions must be protected and no one should be forced into worse roles or unreasonable relocation. The government should urgently publish the details behind these plans, including the responsibilities of the proposed boards, the future of integration joint boards, and how local services will be protected. Until then, NHS workers and patients are being asked to take an enormous leap into the dark. Presiding officer, I'd like to finish on local delivery. So as I alluded to I am a counselor in the city of Edinburgh and I know the difficulties faced by health and social care partnerships and integration joint boards of our capital city. I also know that local governments are the perfect vehicle in terms of governance keeping care in the community listening to local needs and incorporating crossdirector approaches for example in housing and environmental services. They just need the resources to do so. There is no point in tearing up your paper to shoddily glue it back together. We might just need to admit we need a new sheet of paper. I've also heard some hopeful whisperings, however, in regards to the two board system. This morning in committee, we were told that this could give us some flexibility and opportunity to enact policy intent on prevention and that would be great. This morning we heard that we need to get out of the quote repair shop mentality when it comes to health strategy and I welcome the focus on prevention and helping people before escalation is needed. We could also see better governance and work streams and boundary changes may make it easier to scale up good practices of intervention whilst learning lessons about the poorer practice. But for those struggling today, they just want to know and want us to say for the sake of the service, the workers and the users. I ask again of the government, please don't leave us in the dark. >> Thank you. I call Miles Briggs to speak to amendment 103.4. 5 minutes, please. >> Thank you very much, presiding officer. Um, as the cabinet secretary stated, yesterday's program for government was build as being the biggest change in how we structure our public services in Scotland since the advent of devolution. The questions being asked by ministers on what size and what structures we need as a country and how we can make our public services adapt and respond is critically important. And if ministers get these answers wrong, it will have profound effects on how we deliver public services in this country in the future. Now, I agree with the first minister when he states he wants to see a shift towards an outcomes-based approach for our public services. For too long, process has been the focus on how public services are being delivered, and what matters to people, families, and communities is often not reflected. So, Scottish Conservatives will approach these proposals and these reforms in the spirit in which they've been outlined by the first minister and the cabinet secretary and offer constructive suggestions. What I believe is important is that we place at the heart of any reforms how local accountability and decision-making can be delivered with real understanding of the distinct challenges which face communities across our country especially our rural and island communities. Now I don't know where the Scottish government's rationale for two strategic health boards has come from. I personally would have started with the three Scottish cancer regions which operate well-developed pathways for cancer treatment and well planned services and it's clear um as has already been outlined by the cabinet secretary that the integration of health and social care has not delivered the outcomes in visage. So we need to see a new model of delivery and I look forward to some of the more detail on what that can look like. But that is not going to be easy and I hope ministers will start with the opportunity to significantly reform pallet of care something all parties committed to undertake in our manifestos at the recent election. Now I'm disappointed the program for government did not better reflect the strength of feeling behind improving palative care that did emerge towards the end of the last parliamentary session. I believe this can be the first test of how the NHS and social care reform can deliver improved care pathways and outcomes and shift towards a hospital and hospice at home model that meets the demographic challenges we face as a country. Now I welcome that the program for government reiterates a commitment to deliver pay parity for hospice staff over the course of this parliament. However, there remains uncertainty still around funding settlement for 2728. What is now needed though is for a new national funding framework for hospice care. And this first committed to by the government in 2023 remains an essential part I think of protecting our hospice services and providing the stability and support they need as we take forward health and social care reforms. I therefore hope the cabinet secretary will engage further with me on my proposed right to palative care bill to look towards how we can improve hospice care. Now I very much welcome the recognition of the campaigning efforts of the family of the late Anthony Bundy and the announcement yesterday by the first minister that he wants to see the delivery of a 247 thctomy cover regardless of geography in Scotland. I'd personally like to pay tribute to my friend and colleague James Bundy for his campaigning on this issue. But I've been pressing ministers for many years on this and it is a prime example of the postcode lottery which we see in our health service because here in NHS Lotheian today we are lucky to have a stroke service that between 9 to5 Monday to Friday if someone has a stroke and there's a decision to treat a patient they can access a throbectomy. They can't at a weekend but 9 to5 Monday to Friday they can but we need to see that 247 national service delivered and I hope and my understanding is the government intends to provide more detail later if I can get the time back. Yes. Yeah. >> First minister >> I'm grateful to Mr. Briggs for giving way because I think his example of the 24/7 thrombary service is a very good example about why we need to consider certain issues of a very specialist nature such as that service on a national basis where in which healthboard boundaries can often get in the way of delivering such a service across all localities. So I think the point that Mr. Briggs makes has a valuable point in exemplifying why the government is taking the policy course that is proposing to parliament. >> Miles Briggs and Miles before you respond just to remind you that time for interventions is not taken from your speaking time. >> Thank you presiding officer and I thank the first minister for for that intervention. Um to conclude it is critical now that we see also an improved investment in digitalization. It's something which wasn't mentioned but I I do think that digital health services and digitalization need to be moved forward and and finally our NHS presiding officer is a cherished national institution important to all of us in this chamber. Reforms are desperately needed but ministers m must take these forward with parliament patients and perhaps most importantly with our NHS and social care workforce to shape a better future. And I move the amendment in my name. Thank you. >> Thank you. I now call Adam Harley to speak to move amendment 103.3. 5 minutes, please. >> Thank you, presiding officer, and I move the amendment in my name. Um, I think this is actually the first opportunity I've had to properly welcome the cabinet secretary to her new role and to wish her all the best. So, I do that now. Uh, the government's motion today provides a lot of warm words and big plans, but warm words by themselves won't cut waiting times or the care bottleneck. presiding officer. We should of course be ambitious about reforming public services. We should be looking at how we can deliver better care, reduce waiting times, and move more care into our communities. But there's a very simple test that should sit at the heart of any reforms. Will this actually make life better for patients and for the people working in our NHS? Because if you ask patients what they want, the answer isn't particularly complicated. They want to call an ambulance and know it'll arrive quickly. They want to turn up at A&E and know they won't be sitting there for hours. And they want to get the operation that right now they may have been waiting months or years for. And if they or their loved one is struggling with their mental health, they want to be able to ask for help and get it. NHS staff want something pretty straightforward, too. They want to provide good quality care, to finish their shifts when they're supposed to, and to go home in the knowledge that patients have received the care they need. That is what NHS reform should be about. And there are obviously parts of our NHS that desperately need that change. Now it's clear that the Scottish government have been reading the Lib Dem manifesto again because there are positive commitments in this program for government. We have long been championing joined up person centered care provided closer to where people live and tackling delayed discharge. So I welcome all that. There is a difference though between putting these commitments down on paper and actually delivering them. And I do worry that the government is once again reaching for a very big structural solution to problems that are fundamentally about capacity. And we've been here before with the proposed I'll take the intervention. >> Very grateful. Um I actually said in my speech that structural reform alone won't be enough. But in terms of the very good point about capacity, I wonder if the member would agree with the principle of removing unnecessary geographical boundaries to ensure that we can use capacity so patients can be treated and also bolster fragile services in our more rural communities. >> Adam Harley, >> so right now there is actually no detail on whether any of the government's plans would do that and we know that these things can drag on for years. Right now there are issues in the NHS that need addressed and I worry that the upheaval, the administrative upheaval this could cause would actually distract from the issues that are happening today in the NHS and we have been here before. Um, so I'm instinctively deeply skeptical about the idea also that this doesn't constitute a a huge centralization. And Liberal Democrats believe that decision-m should set as possible to local communities as possible and that matters particularly to people in rural and Ireland and remote parts of Scotland who already feel really removed from decision-m but patients right across Scotland will also look at these proposals and reasonably ask, will this actually improve care for me or for my loved ones? And right now that brings me to my amendment. Um because right now um we know that there's people who are radically u medically ready to leave hospital but they can't because there's no care package to receive them in the community. And that's leading to patients being treated in corridors. And if the government is serious about eradicating corridor care, we actually need to know exactly how much of it is happening. We need to accurately measure it. Throughout the summer, we know that patients have been treated in corridors even long before winter pressures have hit. So, I hope the government and the parliament will support our amendment today. Um, before I finish, I' I'd like to finish by talking about something that you'll hear me and the Liberal Democrats mention a lot over the next 5 years in this chamber, which is mental health. Right now, people are asking for help far too often. They're being turned away or forced to wait for years. Not because the people working in the system don't care. They care enormously. But because the system itself simply doesn't have the capacity to help everyone who needs help. And sometimes you only get one chance to help someone. A brief window when someone finally feels able to ask for help. When that moment comes, we need a system that's there for them that doesn't exclude people. We believe that that help needs to be close to home and embedded within GP practices and I do welcome some of what was in the government program for government on this in terms of the locality of mental health care and I I very willing to work with the government where we can find solutions. I'm a wee bit offended that I'm the only party that hasn't had a sit down with Angela Conson. So I look forward to that. Um I'm not actually of course [laughter] I have you know what you're right I have had a sit down with you I was brief how could I forget it made my day it made my day now what I mean is I sat down on the issues that you mentioned at the beginning of your speech as you mentioned you've met with every other party apart from the Liberal Democrats. So, I'm looking forward to sitting down. We'll always work constructively together. As Willie Renie's mentioned many times in this chamber, um it's crucial that we get all of this right for the benefit of our constituents when it comes to social care, when it comes to corridor care, when it comes to mental health. We want the government to succeed on this. We're willing to work with them constructively, but we'll hold them to account as I told her before when we had that sit down. Thanks very much. >> Thank you. We now move to the open debate. Uh the first speaker is Lloyd Melville. Five minutes, please. >> Thank you, presiding officer. Scotland has changed enormously since this parliament first reconvened in the last months of the 20th century. Medicine has advanced. Industries have changed. Technology has transformed how we live and work. And the expectations placed on government have changed, too. But too much of the way our public services are organized has not kept pace with those changes. And that is why the renewal and reform of our public services must be one of the central focuses of this parliament in the next five years. The first generation of devolution was about building institutions and this generation has to be about making them work better. And the scale of that ambition in this program for government matters. 14 health boards down to two. Public bodies brought together where functions overlap. resources shifted away from duplication and bureaucracy and towards the services that people actually use. We cannot enter the 2030s with public services designed for a different age. And ultimately, I agree with much of what has been said. People will judge these changes by whether they make their lives better. In Angus, that means whether people can get an appointment, whether they can get treatment sooner, whether they can get care closer to home. And that is particularly why I welcome the confirmation that our broth will be home to one of Scotland's new GP walk-in services. For people in my constituency, that means another route to care open 7 days a week as part of a national network that will expand in the next 3 years. And alongside that, this program commits more than 530 million pounds to a new deal with GPS focused on recruiting more family doctors. And the ambition behind our wider NHS changes is clear. Simplify the system, cut duplication, and improve care. That ambition is matched by a clear commitment on what patients should experience. By the end of this parliament, nobody should wait more than 26 weeks for treatment. That is an outcome people can measure and it is an outcome that will improve lives. And renewal is not only about how services are organized. It is about acting earlier. Too often, government intervenes when the problem is harder. The choices are narrower and the cost is greater. We spend more because we act later. We achieve less because we wait longer and the person at the center pays the highest price of all. So prevention cannot simply be the paragraph that we all agree with, but the budget line that nobody owns. And that's why the new prevention unit and the Scottish prevention investment framework matter. More health care delivered in communities. Earlier action to prevent homelessness. Support to overcome barriers to work before those barriers become permanent. A public sector that is looking ahead rather than catching up. Presiding officer, this program protects free university tuition. It builds on the Scottish child payment. It expands support with everyday costs. An action being taken by this government is expected to keep 100,000 children out of relative poverty this year. That is what focused government can achieve when it decides what matters, puts its weight behind it and delivers. And over this parliament, that same determination will deliver. The national roll out of two pound buses and legislation which will improve our bus network. Those are political choices. choices about whose side government is on. And when some tell us that the years ahead can only be about difficult choices, I see something else as well. An opportunity to focus and to deliver, to protect what works and to change what does not. Presiding officer, there's a a wider point here about Scotland's future. The case for self-government has never simply been about where power sits. It is about what we can do with it. Our responsibility is to use every power we have now to improve lives and to prepare Scotland to use the full powers of independence. Because the more decisions we take here in Scotland, the more we can shape our economy, our public services, and our future around the needs of the people who live here. The work of building the Scotland we want does not begin on Independence Day. It begins right now. and independence will give us the full powers to take that work further. The challenge now is to bring that ambition to how our public services work. We should not be attached to structures. We should be focused on outcomes. Presiding officer, Scotland has moved forward and it is time our public services moved forward with it. [applause] >> Thank you, Katie Hagman. Five minutes, please. Thank you, presiding officer. I am genuinely excited to see and have prevention at the heart of government policy. And thanks to the Scottish government's ambitious and bold program for government, we're doing just that. Public sector reform should never just be about cutting funding or slashing the workforce or reducing services. That would not be reform. That would be simply callous and destructive demolition. And it's important to note that should that approach ever be taken, the hope of improving the outcomes for our nation would be lost for generations. So today, I'm wholeheartedly welcoming the commitment to renew our public services through prevention, integration, and reform. I welcome that the first minister and his government are leading with hope and optimism. And yesterday I listened very carefully to the choice of words used as he set out his bold program. Phrases used and echoed today by the cabinet secretary secretary included putting individuals at the heart of changes. What are the needs of our citizens rather than what are the needs of our existing structures and about citizen centered delivery. On Monday, I met with the director of the South Asia Health and Social Care Partnership. I heard firsthand the positive preventative work already happening. Their aging well strategy is in place and I heard how well-being pledges are changing lives. This is about putting people at the heart of decisions. I would like to think that across this chamber, we are all individuals who care deeply about our communities and the people we serve. Of course, we have different opinions and views on what that looks like, but fundamentally I would hope that we can all agree that care and keeping people at the heart of our decision making is the right thing to do. Change is never easy, but we must face the task ahead. And we must confront the impact of decades of damage caused by successive UK government driving austerity and the continuing pursuit of damaging Brexit. We can see that damage in our communities and in reaction some of the wonderful work already being started and delivered in those communities to address this fallout. I recently met with Kumnik Junior's community enterprise and I heard about the vast array of projects being delivered including their new youth ambassador project focusing on prevention of drug misuse. And also in the summer I spent time at the river garden at Oken Cru, an incredible place that describes itself as a recovery community helping people rebuild their lives after drug and alcohol addiction and importantly where the wider community are part of those journeys. Where we are today and where we need to get to isn't going to be easy. People may get uncomfortable and structures that have been built up over the years may need to come down. But radically changing our approaches and being creative in finding solutions is not a choice, it's a necessity. Tackling health inequalities is a must. And according to Public Health Scotland, women living in the 10% most deprived areas have a healthy life expectancy of 44.2 years. While women living in the 10% least deprived areas have a health expectancy of 70.9 years. That's over 26 years of healthy life difference between the most deprived areas and the least deprived areas. This inequality in health is completely unacceptable and exactly why we must move into health prevention space. Hopeful and optimistic. That's what I see from the program for government and our communities are ready to work with us. So let me share a final example from my constituency. At the start of the summer I attended my very first new comenick development trust fitfest an interactive day to inspire the local community to live healthier lives. And it was a great day out and thankfully I got the all clear and my blood pressure was all good. So in closing, I want to thank the Scottish government for being bold, for being brave, and ensuring people and communities continue to remain at the heart of all we do. [applause] >> Thank you, Joe Long. Four minutes, please. Thank you. And I refer to my register of interest, which showed I worked as director of a socialare organization until May. I'm delighted that the motion today recognizes the need for investment in preventative community-based support. I believe we reached a cross party consensus on that in the early weeks of the session as we did about the need for proper support multi-year funding for the third sector which often provides those community-based services. We are 15 years on from the Christy Commission and the shift to prevention in visits then cannot be delayed any longer. I note the first minister's comments about social care governance yesterday. It is true that integrated joint birds integrated joint boards are not functioning well. So I hope that whatever structure we end up we can have that culture shift to the ethical collaborative commissioning envisaged by the file review of social care in 2021. For social care to thrive it needs to be recognized as a sector in its own right not a poor relation to health on integrated joint boards nor some kind of subsidiary of the NHS which seemed to be hinted at yesterday. While the NHS will not perform better without improving social care services will not be improved by treating that as their only role. Social care must be about providing a good life well-lived in the community. And that includes those who have lifelong support needs, not just those who are experiencing delayed discharge from hospital. For a sustainable social care sector, we must see a properly recognized, trained, and rewarded workforce. The real living wage for social care workers doesn't address the considerable disparity we see now between the paying conditions of those in commission services. Those employed directly in local authority services and workers of equivalent skill and responsibility in the NHS. Not to mention the fact that social care employees have to compete with those in retail and hospitality. Commitment to the 15 pound an hour advocated by trade unions and promised in Labour's manifesto warrants consideration if we are to see professionalized highquality services that will reduce the need for acute health or mental health admissions. I look forward to the mental health and well-being delivery plan and the muchneeded focus on the issue. I welcome both the investment in triage cars and the investment in community mental health hubs which were also included in the labor manifesto. But while initiatives like these are truly welcome, a joined up approach shouldn't neglect our acute clinical services. In many places, it currently requires quite acute crisis to be referred from primary care to clinical mental health support. Last year, a quarter of consultant psychiatrist posts were either vacant or covered by locals. These clinical services require proper workforce planning that's currently lacking across much of our NHS. And finally, in 2021, the Scottish government promised a learning disabilities, autism, and neurody divergence bill to address the unmet needs, rights, and poorer life outcomes of highly marginalized communities. Stakeholder groups, professionals, people with lived experience spent several years contributing to its development. 877 responses received for the official consultation in 2024. Those people who have given their time, told their stories, and in many cases relived their trauma will be feeling deeply let down by the Scottish government's decision to abandon the bill, communicated to stakeholders by letter yesterday, just a couple of hours after the first minister failed to answer my question directly on it in FMQs. They are feeling that they've been marched up a hill and left stranded. Yesterday's program for government didn't mention the accountability mechanisms, mandatory training or statutory statutes statutory strategies that were sought by that bill. If this government is serious about delivering for all of Scotland, it will need to rebuild trust with those marginalized and excluded communities and it will need to meet their needs in a way as hitherto failed. We cannot wait another 15 years for meaningful change. >> Thank you, David Lindon. Five minutes, please. very much indeed presiding officer. Um and I'm glad to offer my support to the government's uh legislative agenda and program for government. Um last night I had the um enormous privilege and pleasure of spending the evening debating with Daniel Johnson and Comrade Offford on the television and I was quite struck by the fact that actually in the course of that entire debate it seemed to me that um Mr. Johnson and Mr. were offered were kind of fallen over themselves to say how much largely they agree with this but they just don't think it's going to go ahead with it. And it actually felt at certain times that in many respects that the labor and reform foxes had been shot. Um that's shot noted. Um but what I did want to say is that I think it's important that there will be politics in this chamber. People will say it's about claiming credit but what was in people's manifestos. But actually when you go and you have a look at the manifestos for example um in uh Mr. are offered parties manifesto. Um there were no named bodies uh just a general commitment to abolish quangos but when you look at the program for government yesterday the Scottish government's put it money where its mouth is. It talked about merging sea nature Scot Zero waste Scotland potentially Scottish forestry. It makes a very clear commitment to bring in transport Scotland back in house as well. And I've already beat a path to the cabinet secretary though this morning to tell him that I think there are plenty of other um opportunities to bring things in house as well. So when you look at the actual manifestos, there's not a lot of detail in the reform manifesto and what you saw yesterday was detail actually down on paper about how we want to move forward. But the same is true of the Scottish Labor Party as well because I looked at their manifesto. It says reduce Quango's external public bodies by at least a third, but again doesn't name any of them. But whereas yesterday and I see Bailey's getting [snorts] come on in >> Jackie Bailey. >> I am conscious that there we go. I am conscious that uh Mr. Lindon is one of the new MSPs, but had he been here over the last 10, 15 years, we have been naming them and making suggestions to government that they have so far rejected. But I of course welcome anybody who changes their minds. >> David London, >> my mind is very much set in place. It's just a shame that Lord Sarwar changed us and joined the House of Lords. Um, but can I say to Miss Bailey that I think it's important because I'm going to come on to a couple of things where I think actually the Labor Party in Glasgow set up quite a lot of external bodies and there's a real opportunity for us there when it comes to um public service reform. But again, I was looking at the the Labor Manifesto. It talks about annual reviews of government working groups to scrap and active task forces and quote a team for government efficiency inside a new Scottish treasury. That sounds an awful lot like me presiding officer to setting up more organizations which is the last thing that we need because it's about decluttering uh the public sector landscape. Now I think that the the focus clearly yesterday was on the issue of health boards. Um we spend roughly about 15 billion pounds on the 14 territorial health boards. So I welcome a commitment to move it to two. Um I want to give two very practical examples of why it's important that we reform health boards. One is during the campaign I met with Community Pharmacy Scotland. They spoke about a number of issues of bureaucracy that exist in terms of the the invoicing, the charging and the processing for prescriptions across health boards. That puts it in in there. The second issue was I visited HMP L Moss only a couple weeks ago and heard a harrowing story of a woman who's moved from one part of the female prison estate to another part of the female prison estate but because she was moving over health boards the the cancer scale that she had was not picked up and therefore when she transitioned to the other health board she went down the list that's a practical example of how this massive bureaucracy is causing problems. The last point that I want to raise, presiding officer, because it's in relation to Miss Bailey, who I think tried to lay a lot of the blame for the cluttered public sector landscape at the door of the SNP. Um, but unfortunately for her, I'm a Glasgow politician and have a very long memory of the mess that the Labour Party in Glasgow created when it set up white elephants such as city property, city parking, and Glasgow life, which has absolutely um covered the city with lots of problems. So I think there's a real opportunity when it comes to local government reform to start looking at the the role of some of these alos as well. There's one other issue. Um I'll go on. Why not? >> Jackie Bailey. >> It is a matter of fact that the SNP created the 31 health and social care partnerships and the 31 integrated joint boards that the cabinet secretary referred to. Are you denying that? >> David Lindon. >> Facts are on the record in terms of IGBs and the same be true of ADPs as well. But Miss Bailey be aware that I'm talking about alios which is one of the things that is absolutely cluttered the local government landscape that needs to be looked at. I very much support a move to reduce from 32 local authorities in Scotland. Um and I think that that gives us an opportunity to deal with a lot of the alios that cause so much trouble in Glasgow. Um there are a number of other things that I think that we can be doing. Um, my kind of parting message in this debate to the government is to be bold to to stick to your guns because I actually suspect that for all of the hot air last night in the television, most of the parties in here actually agree with the need for public service reform. After all, they've said it was in their manifestos. So, that's when um the push will come to shove that when the the bill that is in front of us in terms of the year one bill for public sector reform comes, parties now need to vote for that because the election's over, folks. We've been sent here by our constituents to deliver public service reform. We've been sent here with a message that they want fewer chief executives. They want fewer communications departments. They want more teachers. They want more nurses. They want more social workers. And that's what we should deliver. >> Thank you, John Black. Five minutes, please. >> Thank you, presiding officer. Uh this program for government demonstrates the SMP's commitment to placing prevention at the heart of public services and ensuring that government acts proactively to improve outcomes for people across Scotland as was eloquently voiced by Kaylee Kin Ross O'Neal earlier. I welcome the proposal to reduce the number of NHS boards because in a constituency like mine that falls in between two health board areas, I regularly see the consequences of a fragmented system. It causes confusion and frustration to constituents and can lead to inequitable outcomes. And while welcome progress has been made in reducing waiting times, despite the government's best intentions when it comes to delivery from our partners, patients in some areas, such as those awaiting cancer treatment in NHS Grampion and Orthopedic Surgery in NHS T-side, they continue to wait far too long for care. By strengthening integration, these reforms offer an opportunity to deliver more consistent, efficient, and patient centered services and hopefully less of a postcode lottery. And the government's commitment to ensure that no one waits longer than 26 weeks for treatment by 2031 demonstrates the ambition underpinning these reforms. Since NHS boards were directed last year to strengthen regional collaboration through the NHS Scotland east and west structures, we have already begun to see the benefits of greater work partnership working and more strategic population-based planning. However, as these reforms progress, it is absolutely essential that place-based planning remains at the heart of decision-making and looking forward to discovering the detail of I'm I'm looking forward to discovering the detail of the new structures. The health care needs of someone living in the Angus Glenns, for example, can differ significantly from those in towns or cities, and any strategic health structures must therefore retain the flexibility to respond to these local needs. as unfortunately that flexibility has not always been evident within the current territorial board model demonstrated by the fact that hospital at home services in NHS Grampion have not been expanded to my constituency because of the distances involved from Abedine. That is a clear example of how a one-sizefits-all approach can fail rural communities and why future reforms must reduce rather than reinforce inequalities in access to care. And I do hope that the new model does this. And the commitment to invest 200 million annually to expand elective capacity is very welcome. As ministers take forward this work, I do urge them to recognize the important role that Strachathro Hospital can play in reducing waiting times and supporting the delivery of planned care in Angus, the Mers, and across the Northeast. And to ensure that the resource for the maintenance of the infrastructure is also committed to keep this facility open. Furthermore, I welcome the Scottish government's recognition of the need to shift further towards community-based health care. Commitments to expand diagnostic capacity and improve access to hearing, vision, dental, and mobile health care services will be particularly important for rural communities where access to care can often be much more challenging. The popularity of pharmacy first amongst my constituents highlights the importance of this approach. By enabling people to access advice and treatment quickly through their local pharmacy, it allows them to access the help they need without always having to go and try and get a GP appointment or even travel to the GP surgery. And we need to make it as easy as possible for patients to access the support they need across the board. And as reforms continue, it's vital that the new NHS structures address the persistent ambulance handover delays such as at Abodine Royal Infirmary. Too often, ambulance crews are left waiting outside emergency departments rather than being able to respond to more patients in the community. In June alone, the Scottish ambulance service lost 768 hours due to handover delays at ARRI. And as uh the cabinet secretary acknowledged in her statement, at the heart of this issue is not simply the pressure within hospitals, but the wider challenge of delayed discharge. Too many patients who are medically fit to leave hospital remain in acute settings because the necessary social care packages, community support or suitable accommodation supplied by health and social care partnerships are not in place. And this reduces bed capacity, delays admissions from uh emergency departments and con contributes to the bottlenecks that are placing increased strain on the NHS and ambulance service. And I hope that this reform process will strengthen collaboration between the NHS and the HS HSCPs so delayed discharges become much less commonplace. So I welcome the cabinet secretary's intention to continue the reform of social care services. And I also echo Jackie Bailey's comment on women's health. Too many women are dismissed and disrespected when intend attending doctor's surgeries and this culture needs to change from the top down. So I hope that will also be taken forward. But that said, overall this program for government is a positive and ambitious ambitious vision for our country. And while I believe that Scotland will ultimately fulfill its potential as an independent nation, this program demonstrates how we can use the powers of devolution that we have today as outlined by my colleague Lloyd Melville to strengthen our NHS for the future. >> Can you wind up please? >> Yes, just finishing presiding officer. I'm pleased to support it and look forward to working with ministers to ensure that its ambitions are translated into real and lasting benefits for the people of Angus North and Mans and for Scotland. Thank you. Thank you, Steven Bonner. Five minutes, please. >> Thank you very much, presiding officer. I welcome the program for government and its commitment to renewing Scotland's public services through prevention, integration, and reform. It is a wide-ranging program, but I want to focus my contribution and hopefully some minds on one particular issue. If we are serious about improving lives while delivering for Scotland, then the test must surely be a simple one. What difference will we make to people's everyday lives? And I want to focus on those who live with a disability and on something that perhaps does not always get the attention it deserves. The provisions and equipment that allow disabled people to live independently. We're not talking about luxuries, but essentials. Wheelchairs, communication aids, specialist equipment, adaptations, and technology. Equipment that can determine whether somebody can leave their home, go to work or college, participate in their community, or simply live an independent life. The Scottish government already recognizes importance of prevention and early intervention in providing equipment and adaptations including the role they can play in avoiding hospital admissions and reducing need for more intensive care at a later stage. I think there is an opportunity in this session to perhaps go even further. I recently asked SPIE to look at wheelchair provision in Scotland. I was prompted by significant changes that have been introduced in France. Since last December, the French government has moved to fully fund wheelchairs, whether purchased or through long-term rental through its national health system. The principle behind that reform is powerful. Mobility and the ability to live independently, should not should be a right, not something that is determined by an ability to pay. Now, I'm not suggesting that Scotland should simply copy the French system. Our circumstances are very different. We are a much smaller nation and as Spice has highlighted to me, we lack some of the Scottish data. We would need to properly understand what such an approach would cost and the level of unmet need it could address. Spice estimates that a comparable approach could cost between 11 million and£34 million a year. But its research also identifies something that I think should concern all of us. We do not have a centralized up-to-date picture of wheelchair provision usage or expenditure across our nation. And that presiding officer, I think, is a good place to start. Are people getting the right equipment they need? Are they getting it quickly enough? Does the support available depend on where in Scotland they happen to live? And are we recognizing the long-term savings that can come from providing the right equipment early rather than waiting until someday reaches a crisis point? because it isn't simply about spending more money or indeed saving it. It's about using our money better. And that brings me presiding officer to integration. For someone who needs specialist equipment, health and social care, housing, education, and employment can all be relevant. But a person does not experience their life as a collect a collection of separate public services. They experience it as one life. And that is why joined up assessments, decision making and delivery matter. There should be consistency. so that where somebody happens to live does not determine whether they can access the equipment that they need. But there is also need to be flexible and to recognize individual circumstances and individual needs because reform should not simply make the system easier for us to administer. It should make the system work better for the person who needs it. And if prevention is to be the heart of public service reform, then providing the right equipment at the right time is a very practical example of prevention. A wheelchair power assist device can allow somebody to remain active and independent. An adaptation can allow someone to remain in their own home. A communication aid can allow someone to participate in their education, employment, and society as a whole. And the right technology can prevent someone reaching much more intensive and potentially much more uh expensive support later on. So we should think uh about disability uh equipment uh not simply as an expenditure. It is an investment in people's independence, dignity and their ability to live their own lives and any reform undertaken through the program for government must be shaped with that and for the people who actually use the services. Disabled people's organizations in the third sector have enormous expertise and they should of course be at the heart of that conversation. So I believe we have an opportunity in this parliamentary session to build a clearer national picture of provision, waiting times, unmet need and geographical differences and then with the disabled people themselves consider whether we can go and and find better ways of funding and delivering that support. Access to the right equipment is a practical test of the ambitions contained in this program for government of prevention of integration of inclusion compassion and equality. Independent living isn't a abstract policy objective is being able to leave your home, communicate, work, study, see your family and participate in your local area. And sometimes the difference between being able to do those things and not is simply having access to the right piece of equipment. For some that equipment is the difference between isolation and participation, between dependence and independence. And if we can make that system work better, use public money more efficiently, and give disabled people greater choice, dignity, and control over their own lives, then that is exactly the kind of practical differences this program for government should seek to deliver. >> Thank you. [applause] We now move to closing speeches. I call yo turvy three minutes please. >> Thank you presiding officers. I think that most of us if not all of us here hear daily from their constituent that they struggle to get the care they need for their health and we all probably agree that changes need need to be done for the NHS and social care to operate and improve people's life. Like my colleagues Mile Ricks, Adam Harley and Don Black all say from both side of the chamber, we shouldn't have a post lottery in Scotland where we know have the right urgent care you need depending what day of the week it is or where you live. But I'm also mostly frustrated to see grand plans on hell board announced with little or not feedback from us, the people representing people here in this chamber. We the liberal democrats are all about local decision making but communities cannot be empowered if they are not given the resources to deliver and if decision are made further away from them. As my colleague Kelly King Rosson says, you can just restructure to get out of a crisis and we need creative alternative. But I would add, we need to look at and be inspired by other successful health care systems. The minister has spoken about prevention. But what is this involve? One of my skills I try to use to solve people's problem here is to be able to benchmark across across the world's best system to deliver and help resident and sorry but by comparison we are behind by decade you know prevention and restorative health care a leaflet of exercises doesn't replace planned antinatal and postnatal physio classes which are all troubles later in life and invasive and inexpensive surgery more physio and urgother theapy to help our elderly to be back to be themsel self after surgery or injuries will alleviate the need and the length of home care and better health. Fixing your kids teeth instead of pulling it out when they are unfortunately damaged will help with speech, jaw growth and healthy food habits. I welcome the commitment to strengthened primary care. But I really also hope the minister can confirm that in addition to extensive work with our GPS, this government finally catch up with the other of European country by working with the 14 allied health professions which are absolutely critical to prevention. Supporting healthier communities and keep people out of hospitals. Treating more patient within community setting will require fixing social care. My colleague Adam is very clear. Ending corridor treatment is a huge challenge but the lims always fight for policy challenge in healthcare. So we are ready for it and hope and look forward to work with you on that. Thank you. >> Thank you Murdo Fraser. Five minutes please. >> Thank you presiding officer. As my colleague Craig Holly pointed out yesterday, there's a large gap at the center of the program for government. And that is how the Scottish government is going to deal with the looming 5 billion black hole in the public finances. We might reasonably have expected the first minister yesterday to tell us how the Scottish government were planning to address that issue because potentially will have a huge impact on the delivery of public services. But we heard next to nothing about it. But what we did see were announcements around public service reform which at the margins may start to make a difference and this proposal to reduce the number of territorial health boards to just two was at the center of the announcements made yesterday. Now, in the area I represent, I doubt many tears will be shed for the end of NHS T-side after the LGL scandal or indeed for NHS F after their disastrous handling of the Sandy Peggy case. But there are a number of unanswered questions about how these health boards will operate and I've tried to tease some of this out from the cabinet secretary earlier. Where what will be the lines of accountability? What say will there be if any for local communities? And just to give an illustration of why this matters, there was a report just uh two weeks ago in the Courier newspaper which disclosed there had been private discussions within NHS T-side about the closure of the emergency department at Perth Royal Infirmary. And this provoked serious concerns being raised with me by local residents. And if we were seeing a health board with even less connection with local people, it's understandable why issues like that uh might uh be raised and cause concern. So I think it's essential that under whatever new structure we have, we do see local accountability and we also see local services being protected close to the people that they serve. And I don't think we can expect significant cost savings when it comes to reorganization. Of course, we await the details, but if if all we're doing is losing a few very well- paid senior executives who will then have to be redeployed elsewhere because they cannot be made compulsorily redundant, that's not going to deliver much in the way of savings. So, I don't think scrapping health boards in itself will make significant savings when it comes to a 20 billion pound NHS budget. Public service reform is vital if we're going to address both the financial challenges facing the government and also improve the quality of service to people. And in that respect, I've got three constructive suggestions I want to make to the cabinet secretary and I hope she will take these in the spirit in which they are given. So firstly, firstly, it is time we change the antiquated NHS appointments system. If I make an appointment with my dentist, I can choose a time and date that suits me. I get an email confirmation. I get an email reminder the week before. I get a text message the day before reminding me of the appointment. I then have to reply yes or no to say whether I'm actually going to turn up. And as a result, the level of no shows at my dentist is absolutely minimal. But in contrast, if I go and see my GP and I'm referred to the doctor, I have to wait weeks before a letter arrives through the post that somebody has printed and put in an envelope with a date and there are no reminders. If that date is not suitable, I then have to phone up and ask for another appointment and then wait until another letter arrives that somebody has put in an envelope and posted offering me another date sometime into the future. And it's no surprise that this very inefficient system sees so many no-shows at NHS appointments. And that could so easily be fixed because the technology already exists to do that and surely could be done at lower cost than somebody physically printing letters and using the postal service to send them out to individuals. My second example is the NHS app which has existed in England since 2019. Now we're just seeing now my care.scot uh appearing but the functionality of that is less than it is for the one south of the border and again the technology exists. Now we know because uh it came out of freedom of information from Scottish government documents that there was concern being expressed at the political optics of adopting an English solution. I don't think people really care about political optics. They just want an app that works and one that comes timelessly. And thirdly, presiding officer, it's beyond the point where we should be looking at annual health checks for the over 50s. Now, we've seen recently high-profile individuals like both Sir Chris Hoy and Jeremy Clarkson highlighting the risks of prostate cancer for men of a certain age, and I declare an interest uh presiding officer. Uh and yet we know many men are reluctant to make appointments with the GP. If we had annual health checks offered routinely for both men and women, we'd identify at a very early stage cancers, heart disease, risk of stroke, and other serious conditions. And >> up, please. >> And not only would the implementation of these annual checks save the NHS considerable sums of money, but more importantly, it would deliver much better patient outcomes is a win-win. So, I hope the cabinet secretary is listening. I hope we do see public service reform. we can actually get some of this done and make Scotland a better country for us all. >> Thank you, Lorna Slater. Six minutes, please. >> The Scottish government has put public sector reform front and center of its program for government. And from my reading of that document, it will be three main strands. The NHS, local government, and then everything else. uh reform of the NHS is going to affect every single one of us as parliamentarians representing our constituents as well as personally since we all are users of the NHS. As my colleague Murder Fraser just pointed out, I'm sure we can all think of ways that the NHS could be more efficient when we get letters in the post for procedures 14 months in the future that we stick in the bottom of a drawer, for example, with no reminders or digital appointment interface available. Dentists, as Mr. Fraser points out, and even local restaurants are able to remind us of appointments by text or email. It is way overdue that the NHS have the power to do something similar. My colleague Kaylee Kin Ross O'Neal will be leading for the Scottish Greens on NHS reform. I'm very pleased to see that the Scottish government is open to significant reform on local government. Getting this right is important. Local government is where people experience politics. It is bins, social care, and high streets which make the difference as to whether people experience politics as something they have a say in or as something that is done to them. All of that happens at the sharp end of local government. We hope that the Scottish government will hold their nerve with their intentions here and will make significant changes even in the face of I anticipate howls from opposition parties who continually call for change but have a tendency to block it from happening when it actually comes to it. I hope that the Scottish government will go further actually and reform council taxes and non-domemestic rates as well as part of this overhaul. Putting councils on a fair and sustainable financial footing needs to be a part of this process. My colleague Christopher Leis who is also a councelor in Orcne will be leading for the Greens and working with the Scottish government on local government reform which leaves me as the portfolio lead for public sector reform to look at all the rest of it. I was pleasantly surprised by some of the level of detail that was in the program for government. I'm sus specifically talking about the section of the PFG on simplifying and decluttering delivery. Dismantling transport Scotland is a project I can get behind. That's a good start. I have some other suggestions. I'm hoping that assess the potential to simplify the management of our cultural national cultural assets is a precursor to dismantling historic environment Scotland. As we watch Hollywood Park burn for the second time this summer, as my former constituents in Lithgo head into another decade of their lovely lock being too polluted to allow children and dogs to swim in, it is clear that Hees are simply not coping. A different set of expertise, a different allocated allocation of resources, and a different structure is needed. Naturally, I'm somewhat wary of the idea of joining all the environment and nature agencies. This could go well or it could go very, very wrong. Scotland is one of the most naturals. A new mega environment body must have the powers to implement the Scottish government's biodiversity strategy, the circular economy roadmap, and a climate change plan that actually gets us to our targets. I can potentially see the advantages of a single point of contact on the environment and nature. Among the challenges I faced as a regional MSP in the last term was helping constituents understand the limits of what sepha could do. For example, with the pollution of Lunlith Golok, but also when we had oil spilling into the riveresque, a single agency that could undertake investigations, enforcement, cleanup, provide guidance and community engagement might get us away from the impression that the Scottish government doesn't care about pollution incidents and that is powerless to do anything about them. If we are going down this route though, I'd like to see the Scottish government take the licensing and biodiversity responsibilities off the marine directorate and incorporate them into this new mega body. It just doesn't make sense for licensing and biodiversity to be split by things that are dry and things that are wet. They should all be part of the same licensing and biodiversity strategy. I'm hoping that the mention in the PFG of the work of the committee on the SPCB supported uh body landscape means that the CABSE is taking seriously the proposal of that committee to give the Scottish public body ombbudsman own initiative powers which would be a substantial step to improving public services and preventing failures making the ombbudsman's role proactive rather than reactive which I think is in line with the cabinet secretar's prevention agenda. I am a bit skeptical that undertake reform activity within the National Records of Scotland and the Registers of Scotland will actually do anything to complete Scotland's land register until we know who owns what. We waste thousands of pounds trying to establish this every time we want to build major infrastructure or indeed even minor infrastructure. I know of charities, for example, that struggle to set up premises because they can't find out who owns the ransom strip uh next to their next to their property. We need to know who owns Scotland. Until we know who owns what, we can't design efficient public services or effectively undertake things like landscape scale flood management. And until we know who owns what, we are going to struggle to reform grant funding and land-based taxes in a way that are fair and transparent for everyone. There seems to be a consensus across the chamber that substantial public service reform is needed. We cannot allow the changes to be driven by the wealthy and powerful, by those who deny climate change, by those who believe that profit is more important than people or planet. We have this chance to get it right and is it it is with all of us to see that we do. >> Thank you. I called Joe Fagan. Five minutes please. >> Thank you presiding officer. Can I refer to my register of interest? I'm a councelor in South Lannshire. Now this parliament was shaped with the promise of new politics. It was to extend democracy and improve accountability to be more representative of the nation. Power was to be shared not hoarded at the center. and consensus was to be valued over confrontation. High expectations, noble ambitions, a progressive character, but a spirit that was lost long ago, and we've got to bring it back. Because as the scale of the challenges facing this parliament have grown, our politics has become smaller. Now, central to the program for government and the wider public service reform agenda is the principle that prevention comes first. that social determinants of health and inequalities are driving demand for public services and that public spending is too reactive and less focused on the early intervention that can change lives. And I agree. But this isn't new. The principle was well established by the Christy Commission 15 years ago. A powerful report, a comprehensive report, and one backed by evidence and consensus. But our small politics failed to deliver the systemwide shifts towards prevention Christy demanded. And it's not the only example. The Parliament debated how to address the size of Scotland's prison population just before the summer recess, but there was very little debated then that wasn't debated 18 years ago after the Scottish Prisons Commission report. And our prison population has surged to a record high. The program for government promises action on delayed discharge over a decade on since a previous first minister promised to eradicate it and a housing emergency was declared. Yet 10,000 children will go to bed tonight in temporary accommodation. The rewiring the state is about so much more than restructuring the architecture of the state which has been a recurring theme today. um as important as that is, it's about the reform that produces better outcomes, transformative outcomes and more equal outcomes. So if this time it's going to be different, then this time we have to rediscover that spirit of new politics which gave the parliament life, a collaborative politics, an accountable politics, a self-aware politics, and a progressive politics that is serious about change. And it's in that spirit I echo what Jackie Bailey said yesterday. We will work with the government where we can. We will challenge them to go further where we believe they must and we will hold them to account. And if I could turn to the Labor amendment and give an example, we believe in the importance of a properly funded health and social care system and with a workforce that is fairly paid and valued. Now, in response to budget pressures in previous years, the Scottish government removed a 38 million pound package to better support uh conditions for social care staff and set back fair work in that sector. Those missing millions should be reinstated and the promise of sectoral bargaining should be kept and government should work towards closing the gap between conditions in the commission sector and the public sector to strengthen health and social care. Now before uh coming to parliament I led South laner council it was one of three marmet places in Scotland a council working with public health Scotland and university college London to develop evidence p evidence-based policy in this field early intervention family support shifting the balance of care building local power and wealth that's how we liberate communities from inequality and it's how we liberate public services from the costs of inequality in a society in which as the population health framework says in which 80% of what affects people's health happens outside the NHS better health means better social outcomes and better social outcomes means better health but it takes investment social investment and spending to save and my warning to the government is I think it's in spending that the program falls down because reform that is driven by job cuts or on unachievable targets is going to cost us more in the long run. And this is where I think the government have to produce more information. Austerity is the very reason that some of these inequalities we are grappling with are so profound. So with trade unions threatening strike action, with the IPR saying the Scottish government's workforce reduction target already risks Scotland slipping into austerity, the Scottish government has to confront an essential truth. Reform driven by headcount reductions and spending restraint will fail. Only reform driven by evidence, investment, and social change can succeed. A program that is developed with the workforce. A program that rises to the challenges our small politics has neglected. That's the fork in the road for Scotland. Neither path is easy, but only one is right. Our responsibility is to build a progressive consensus and turn it in to progressive action. Thank you. >> Thank you, Max Spanerman. Seven minutes, please. >> Thank you, presiding officer. I rise to support the amendment to this motion in the name of my colleague Helen McDeade. Every MSP representing the Highlands, Murray, and the islands have healthc care at the top of the inbox and the top of the post bag. Failures in the delivery of health care services have been a recurring issue for so long that many of my predecessors from all parties have attempted to tackle the government on this. So we're still here trapped in a toxic cycle of downgrading services, restarting them again, but still with that lingering threat of a downgrade yet again or in the case of the far north falling on death ministerial years that local services should be restored so that kithmas moms can give birth at home rather than in in Bernese. Now yesterday in this chamber the first minister answered my question about the pause of pediatric services at Dr. Grace Hospital in Elgen by quote addressing the structural arrangements of health boards referring to the 14 territorial health boards being a constraint on the delivery of care. In his own words, the proposals in the program for government would help deliver care as close to home as possible for Murray residents. I want to quote back to the government what one of my constituents whose newborn baby was affected by that abrupt halt in pediatric services that Dr. Grace wrote to me. I fully appreciate that not every specialist service can be delivered in every hospital and patient safety must always come first. However, the continuing centralization of services away from Murray appears to place an enormous burden on families while potentially creating substantial transfer costs for the NHS. I think this speaks to the motion we are debating here today for two reasons. Firstly, we need to understand that behind the bureaucracy, the only focus should be on the outcomes of patients and their families. Secondly, I genuinely fear the government is confusing genuine reform, which I would have which would have our support with the sticking plaster of reorganization. By centralizing its way towards fiscal rationalization, the government is simply replacing 14 silos with what seems to me to be two super silos. How does that deliver better outcomes for people who rely on Cathus General, Dr. Grace or the Belelfford Hospital? So, the recess has just come and gone. It's a good opportunity to go home and take the pulse of local mood. A regular feature of my surgery tour was speaking to people in forest finick and loss who said to me that they can't understand why they're forced to into appointments in Aberdine because the territorial extent of NHS Grampion extends west almost to Ner rather than have the option and I do stress the option of planned procedures at Rigmore Hospital in Inesse. So when the first minister talks of territorial constraint, I agree with him that this is a problem. But what is a new east-west access of two health boards probably run from Edinburgh and Glasgow going to do for people in the north? That is the challenge and the question I would pose to the pose to the cabinet secretary and it needs an answer. Likewise, yesterday the first minister made a commitment on from Beckami and I welcome that commitment, but I would like to see how far that geographic commitment extends and that will apply to the far north too. So looking to the broader national picture, can I push the government for an answer on duplication? It says it wants to remove duplicate top heavy management structures. A question I would pose is, do we really need to have 14 directors of public health in 14 territorial health boards when that function is already fulfilled nationally by public health Scotland? Surely there's scope for a review to see whether those functions could be consolidated. And on workforce, the fiscal sustainability delivery plan promises a half% reduction each year. The IFS assessment on that has been quite blunt. The in aggregate, there's been no progress. Deolved public sector employment in the first quarter of this year was 0.6%. 6% higher than a year before. The entire net increase was in the NHS, up 1.6%. So I do have a degree of sympathy for the cabinet secretary of public service reform because he's already been kneecapped by the first minister who says that there will be no compulsory redundancies. I look forward to hearing how he will square that circle. Perhaps a good place to start would be by asking Audit Scotland to review the government's homework and report back to this parliament. Finally, presiding officer, we were elected to be a party of opposition, but a responsible opposition who turn up and engage seriously. So, in good faith, I reference what the first minister said yesterday when he hoped that I would engage constructively with this debate. I had hoped that this was evidence that he's changed his mind away from attempting to create a sort of uh quai iron curtain or tartan curtain that would stop democratically elected MSPs in this parliament from engaging with the government. But Miss Constance, I'm afraid to say earlier in her remarks confirmed to us that this wouldn't be the case, which is very disappointing indeed. So, I'll just say to the government that my colleagues and I will continue to engage in good faith with the government as they set out their legislative agenda. But, as I said in my first speech to this chamber, it will not be on the back of a centralizing agenda to the detriment of our constituents. Thank you. >> Thank you. I call on Ivan McKe to wind up the debate. 10 minutes, please. Cabinet Secretary. >> Thank you, Officer. It's been an interesting and reflective debate in part. So I'm going to cover some of the contributions before I embark on the substance of my uh the main remarks. Um there was um from both reform and from the conservatives there was a it was interesting. I reflected back on their manifestos and the reform manifesto was shut down the quangos and turn their powers to democratically elected ministers which was the complete opposite of what Hela McDade was was proposing. Um, and meanwhile, the Conservative Manifesto, reduce bureaucracy in our NHS, improve productivity, reduce the number of Quangos by at least a quarter, and tackle Scotland's cluttered quango landscape. So, um, I think that we're obviously taking forward those steps. Um, at pace and and of substance, we're not far away from even just what we announced yesterday in terms of taking that quarter out and there's a long long way still to go with regard to uh consolidating public bodies. Um, in terms of some of the other contributions, I think there was some really important points made by Kaylee Canos O'Neal and by Adam Harley about how the impact on service delivery actually translates into what uh the changes were making help to support that. And they're absolutely right. The changes, the purpose of them that we're implementing in health and more widely is to improve that service delivery. It's about getting money to the front line. It's about making best use of capacity across of the whole system. So, but removing silos that stop effective delivery and uh both David London and Don Black highlighted examples where that currently is the case where individuals don't get the service that they should be getting because of those bureaucratic hurdles that are that are in the way. um had some um uh constructive contributions from Murdo Fraser um and he talked initially about how are we going to bridge the gap and then he proceeded to the fiscal gap and then he proceeded to give us a long list of areas where it would help to um bridge the fiscal gap. So he's absolutely right. There are many places where we can save money and improve service delivery at the same time. And that is exactly what the PSR program is about to be able to close that gap by improving services and making them more efficient using many of the the the interventions that he he talked about. Um the um Lorna Slater's contribution I thought was um was very um helpful and constructive. um highlighted the need for change in local government um and the centrality within that of empowering local communities which is absolutely core uh to the empowerment agenda that sits at the heart of our public service reform work. Um, and she also highlighted a whole range of opportunities across public bodies, which I'm not going to have time to cover off now, but very much look forward to engaging with the Greens on this wider agenda in that very constructive uh way. And I think we'll find many other opportunities to both improve services and make them more efficient to get that money to the front line. uh and Lloyd Melville made a a hugely important point about public services uh being fit for the future um but also being uh laying the foundation for the independent state that we are working to uh to deliver um and contribution from Joe Fagen thought was um was in most parts constructive um and he made the point about rewiring the state and it's not just about um the structures and I absolutely understand that it's also about rewiring how money flows through the system how we do budget budget and particularly preventative budget. It's about rewiring how data flows through the system to make sure it's joined up and is used more effectively. And it's about rewiring the culture, how people look at the the uh the the the program and how they provide leadership across it. So, in all of those regards, it's important to recognize that rewiring the state is is very broad and this government is very much in the business of rewiring the state. Public service reform underpins the priorities of the government driving economic growth, eradicating child poverty and tackling the climate crisis. And most of us absolutely recognize the criticality of public services to this type of Scotland we want to be to deliver a fairer future with the opportunity for everyone to flourish. Recognizing the democratic and fiscal challenges, but facing into those and dealing with those. Public services are an asset and an investment in that future. And we must invest wisely and take the bold choices that we have done this week and will continue to do so to protect service delivery in the here and now and ensure that fiscal sustainability for the future. I think this government has shown this week that it will make those choices. We will ensure the improvement and sustainability of the services that people need. This is not the same of course as sustainability of corporate structures. Public service reform is about changing how services operate to fit around the people who use them. Not expecting people to fit around the boundaries of the individual organizations. The PSR strategy that we published last year is our blueprint and foundation for change. I've always been clear that empowerment is core to that agenda. Recognizing the strengths of people and places across Scotland, empowering the front line to deliver for service users. Um empowering workers within public services to come forward and offer suggestions as to how things can be done better and they've got the best perspective and the best ideas in that regard. Designing services with communities and making sure they're focused on what is important to people. Outcomes improve when solutions are tailored to local needs and circumstances. Building on our democracy matters work, we will deliver greater empowerment of communities so people can better influence local decision- making and ina in many cases some decisions will be best taken by communities in the places they live and call home. And at the same time, we have a huge opportunity to empower regions by building on the existing work of regional economic partnerships to act at a more strategic level to drive growth right across Scotland. I recognize the importance of ensuring that approaches are tailored to Scotland's regional and community strengths and reflect our unique geographies. And this will include, of course, our commitment to working with our island communities and authorities to delivering single authority models that suit their needs. Fundamentally, this is about ensuring the right decisions are made at the right level, be that national, regional or community to deliver for people. We will change the governance of Scotland to get that right. And the program for government sets our intention to engage an intensive dialogue over the coming months with local government, with parliament, with trade unions, public sector partners, and of course third sector partners to agree a shared direction for reform of local governance in Scotland. The cabinet secretary for health and social care has already set out the opportunity that a form of health boards offers and a focus on prevention. There is considerable work to support and enable prevention by driving preventative budgeting to invest early to address challenges earlier and with greater effectiveness and to ensure we realize profound benefits, better lives, less pressure on services and enhanced fiscal sustainability. Health and social care are of course closely linked, an issue that's been raised by many around the chamber. And this change provides us with a new opportunity to reform social care so it is consistent and high quality right across the country. As I set out in the PSR strategy, partnership is key, but partnership is not code for slow. We need to move at pace, but we need to work with our partners right across the landscape. with a clear and robust set of changes in public bodies including health and with a clear direction of travel for regions and communities. In the coming three months, we will engage with local authorities, trade unions and beyond to agree the future of local governance and the future of social care. We will start implementing changes to the public body landscape underpinned by our year one public service renewal bill. And in the public service reform strategy also set the commitment to ensuring the right delivery landscape. The current landscape across public bodies and government is cluttered and of course there are areas of overlap. We will not shy away from the fiscal challenges and need to drive efficiency every opportunity. Change is necessary. We will uh establish a new integrated environment body to help meet the climate, nature and economic challenges of the next 20 years taking on the functions of SEPA, Nature Scot, Zero Scotland and potentially Scottish forestry. Um and it was very helpful to hear Lorna Slater's perspective on that which I look forward to engaging on the detail on that. Um and I don't see this as the one and only list. This is just the start. We will undertake the work required to make changes right across the public body landscape and we'll identify more opportunities as arise bringing in other relevant bodies as we develop this program. give way to >> will there any >> has the minister looked at the example of the inspectorate for education being merged in with education Scotland and subsequently been separated is there a danger that by putting sea in potentially with the forestry arrangements that we might be repeating the same mistakes of the past >> cabinet secretary all of these proposals need to be considered in that regard and that's why we'll engage with partners to understand um what the optimal solution is um it it doesn't mean that we won't change. It doesn't mean that we don't recognize the need to do so at pace, but of course we'll consider all of the the issues that are raised by partners as we take forward what is a long list of of potential improvements across across the landscape. I think everybody would agree that the landscape we have at the moment is not optimal to deliver efficient and fiscally sustainable public services for our citizens. Present officer, I've set out the foundations that need to be in place to drive change through our strategy. First amongst those is leadership and culture change and I will publish a leadership statement shortly developed in collaboration with colleagues across public services. Uh to deliver our ambitions, we must work together to hold a stronger and more coherent approach to leadership to enable and support the collaborative leadership that drives prevention, strengthens place-based working and delivers reform across boundaries. And I've been very struck by the willingness of colleagues across this chamber and local government and third sector and public bodies and beyond to engage with this approach. We have a huge opportunity and responsibility in this parliament to make decisions now to fundamentally change our system of public services to improve people's lives as we deliver changes. These changes people will see improvement in their public services and their lives services will be fit for today and for the future. We will deploy new technology, change our ways of working and make sure these services are more accessible and more responsive. Thank you, Sign Officer. [applause] Thank you, Cabinet Secretary. And that concludes the program for government debate, improving lives through delivering for Scotland. The next item of business is consideration of business motion 984 in the name of Jamie Hburn on behalf of the parliamentary bureau on the program of business. Members wishing to speak to the motion should press the request to speak button now and I call on Jamie Hburn to move the motion. Move presiding officer. Thank you. No other member has asked to speak. The question is that motion 984 be agreed. Are we all agreed? >> The motion is agreed. The next business is consideration of five parliamentary bureau motions. I call on Jamie Hburn on behalf of the parliamentary bureau to move motions 985 on committee substitutes, 986 on designation of a lead committee, 987 on designation of a lead committee, 988 on designation of a league committee and 1014 on parliamentary recess dates. Move presiding officer. >> Thank you. The question on these motions will put at decision time to which we now come. There are eight questions to be put as a result of today's business. If the amendment in the name of Hel McDade is agreed to, the amendment name of Jackie Bailey will fall. The first question is amendment 10003.5 in the name of Helen McDade which seeks to amend motion 10003 in the name of Angela Constance on program for government improving life living for Scotland be agreed. Are we all agreed? >> The pal is not agreed. Therefore, we'll move to a vote. There will be a short suspension to allow members to access the digital voting system.