Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, March 30, 2022

Official Report 992KB pdf

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Maternity Services (Moray)

The next item of business is a statement by Humza Yousaf on maternity services in Moray. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.

On a point of order, Presiding Officer.

Would you accept a motion without notice, under rule 8.14.3 of standing orders, to allow this item of business to be extended by up to 30 minutes?

There is precedent for such an extension. The Cabinet Secretary for Health and Social Care’s statement has serious implications. There are many concerns and questions that, understandably, people in Moray and across the wider north-east and Highlands want to hear being addressed. Therefore, I hope that you will view favourably my request that you accept such a motion without notice.

Thank you for providing me with advance notice of your point of order. At this stage, I am minded not to accept your request, but I will keep the situation under review as business proceeds. I will be happy to review my decision later on in proceedings.

You have up to 10 minutes, cabinet secretary.

15:38  

Thank you, Presiding Officer. I welcome the opportunity to update members on the Scottish Government’s response to Ralph Roberts’s review of maternity services in Moray.

As a result of the review, I am delighted to set out the next steps in the reintroduction of consultant-led maternity services at Dr Gray’s hospital in Elgin. The reintroduction will not be easy, but I believe that it can be delivered, with effort and targeted investment.

I understand the urgency and importance of the issue. It was, for me, imperative that I heard directly from the people who are most affected—namely, local people, the clinicians who work in Dr Gray’s hospital and Raigmore hospital and, of course, local elected members—before I made my decision.

I know that all members want maternity services across Scotland to be delivered as safely and as close to home as is practicable. The Moray maternity services independent review, which was commissioned by my predecessor, Jeane Freeman, was conducted using a thorough and consultative approach. I want again to record my thanks to Ralph Roberts and the review team for their excellent work.

I have not taken the decision lightly. I have taken time to consider the recommendations in discussion with a range of interested individuals and groups. I started that process in December when “Report of the Moray Maternity Services Review” was published, and concluded it last week with a visit to Raigmore and Dr Gray’s, where I met senior teams, clinicians, local people and elected members. I thank everyone for taking the time to provide their thoughtful contributions to the discussions, and I welcome the wide-ranging views that were presented to me.

Ralph Roberts’s team explored six potential models of service delivery for maternity services in Moray and made 37 recommendations for improvements to care. The report recommended that, in the short term, NHS Grampian and NHS Highland should move to provision of a community maternity unit in Dr Gray’s, networked primarily with Raigmore for consultant-led care, but with women who require tertiary maternity care or neonatal care going to Aberdeen. That is called model 4, in the report.

The report goes on to recommend that NHS Grampian undertake a review of the role of Dr Gray’s hospital and, potentially, move to a rural consultant-supported maternity unit there. That is called model 5 in the report. Mr Roberts also made a number of recommendations in respect of short-term changes related to leadership, culture, workforce and recruitment.

As I have talked to people over the past three months, I have heard the full range of very different opinions about the future for maternity services at Dr Gray’s: there are differences of opinion on the way forward. Today, I will set out the destination that we want to reach. In doing so, I will be up front about the scale of the challenge that is ahead of us.

I have concluded that we will progress with model 6—a full consultant-led maternity unit at Dr Gray’s—with model 4 as part of the development towards that final destination. I hope that that will lead to 80 per cent to 90 per cent of Moray births taking place at Dr Gray’s, after realisation of a consultant-led model. That will be similar to the numbers prior to the changes that were made in 2018.

I said at the beginning of the statement that delivery of a consultant-led service will not be easy. It will require significant investment—not only in infrastructure but in the workforce. It will involve us collectively having to find solutions to complex systemic problems that have challenged the Grampian region for many years, including in recruitment and retention.

The priority for women in Moray is that they have access as soon as possible to the widest range of maternity services that can safely and realistically be delivered as close to home as possible. Let me be clear: I expect work on model 6 to begin immediately. The first step on that journey is to work out the detailed timeline of what is required by when. That will be done with independent oversight and clinical input.

As I said, model 4 will be a critical component in the journey towards realising model 6, which is a consultant-led maternity unit. Model 4 includes enhanced specialist antenatal and postnatal care in Dr Gray’s in order to vastly reduce the need for women from Moray to travel to access those services. The additional infrastructure and the resource that will be invested to achieve that goal will act as a bridge to delivery of a consultant-led service at Dr Gray’s, and will accompany a wider plan for regeneration of services beyond maternity services at the hospital.

As Ralph Roberts’s report recognised, it is essential that a consultant-led service be developed within the context of a revitalised vision for Dr Gray’s. That development extends beyond maternity services to include increasing services at the hospital for the whole population of Moray. NHS Grampian has already outlined to its board plans for the development of a strategic vision and future plan for Dr Gray’s, which will be developed in collaboration with local communities in order to re-establish public faith in the sustainable future of the hospital.

However, that will not happen overnight. Local people understandably want the services back as quickly as possible. We are committed to investing in the staff and to delivering the required infrastructure to put the services in place on a secure and stable footing as quickly as possible.

Now that I have stated clearly our intention to restore a consultant-led maternity unit at Dr Gray’s, it is imperative that we develop deliverable timescales for interim service provision at Raigmore and—of course—for the full service at Dr Gray’s. Having listened to clinicians, I understand the importance of making changes in a phased manner in order to ensure safety for the women of Moray and the Highlands.

I also recognise that facilities in Raigmore and Dr Gray’s will need to be significantly improved to support that move. That is why, as a starting point, I will make £5 million available to invest in Dr Gray’s to support moving forward with the changes in Moray.

It is clear that clinicians in Raigmore have concerns about the current facilities in which they are operating. With that in mind, we have, within our capital plan, made initial provision of a further £5 million for redevelopment of Raigmore. That will allow plans to be brought forward to redevelop the maternity unit in Raigmore, which will provide an improved environment for the women of the Highlands and, in due course, for the women of Moray who choose to have their babies there. Once planning is more developed, we will look at what additional funding might be required. I repeat my commitment to providing the necessary resources to support the change. That is immediate investment of £10 million by this Government to enhance maternity services in Dr Gray’s and Raigmore.

The interim networked service will be developed with service users and will include delivery of the maximum possible amount of consultant-supported antenatal and postnatal services at Dr Gray’s, which will reduce to an absolute minimum the need for women to travel to Aberdeen or Raigmore, and will deliver continuity of care for women in Moray.

The clarity of a safe model 4 will enable us to focus on maximising the number of women who choose to deliver in Dr Gray’s, by building trust, confidence and understanding of choice. That has the potential to increase significantly the number of women who can give birth at Dr Gray’s. Women who need obstetrician-led care will have the choice of Raigmore or Aberdeen for their care, until such time as consultant-led services are returned to Dr Gray’s. The chair, chief executive and executive team at NHS Grampian have sought to assure me of their focus on, and the board’s unstinting commitment to, delivery of the model.

I know that there are concerns—I heard them clearly from campaign groups in Moray—that once model 4 is in place, there will be no desire for further change. I heard that not just from local campaigners but from elected members in Moray. Let me be clear: model 6—a consultant-led maternity unit at Dr Gray’s—is what we will deliver. No one has been left in any doubt about my decision. Implementing model 4 will be a key component in achieving a consultant-led service, not an alternative to it. In addition to providing choice for Moray women, it will significantly improve the birthing environment for Highland women.

NHS Grampian and NHS Highland have already started to pave the way for change. With a clear destination, they can start work immediately on progression of planning and development of implementation plans. A process of accelerated planning in relation to model 4 changes will begin now, and will conclude in the summer. We aim to have a clear timetable for the restoration of a full consultant-led unit as soon as possible thereafter. The plans will provide a timetable with milestones for delivery of model 4 and model 6.

In “Report of the Moray Maternity Services Review”, Ralph Roberts made a number of other recommendations on leadership, workforce and recruitment, and culture. I accept all those recommendations. Action to take them forward will begin—including, in particular, work to improve remote and rural staffing and work to support delivery of the staffing requirements for model 4 and model 6 as they emerge, through the commitment to providing the necessary funding to support delivery of the models. An external assurance process will be built around that, and it will include expert clinical input. I know how important that is to local community groups, in particular, and to elected representatives.

Having made the decision, we will waste no time at all. Work to progress implementation will begin immediately; we will urgently drive forward our work to restore consultant-led maternity services at Dr Gray’s. I will be happy to keep Parliament updated when I have more detail on milestones and timescales.

The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow about 20 minutes for questions, after which we will move on to the next item of business. As ever, it would be helpful if members who wish to ask a question press their request-to-speak button or place an R in the chat function.

I start by recognising the outstanding contribution made by the keep MUM—the maternity unit for Moray—group and the Moray and Banff maternity voices partnership, which have campaigned tooth and nail for the past four years to see the restoration of a consultant-led maternity unit at Dr Gray’s. That is how long this has been going on. Since 2018, we have been without that vital service in Moray. The last time that I addressed the issue with the cabinet secretary in the chamber, he accepted that that was unacceptable. My fear today is that we are still a long way from the restoration of that service.

That has a huge impact. Gill Skene, from the charity Let’s All Talk North East Mums—LATNEM—which is a maternal mental health group in north-east Scotland, said in the Press and Journal today, in relation to Elgin:

“I don’t actually know if I’ve met a mum who’s not suffering as a result of being very worried about childbirth or as a direct result of a traumatic birth from that area.”

LATNEM says that, of all the areas where it works, Elgin is the worst when it comes to mental health issues that pertain to childbirth and pregnancy.

That is obvious. Since Ralph Roberts and his team produced their report and we had the statement in the chamber that followed, we have heard more and more traumatic stories from Moray mums, many of which have been well articulated by the keep MUM group.

Alexandra Naylor’s story stands out from all the rest. She spoke of her horror and terror at having to give birth in a lay-by on the A96 while she was in labour and being transferred from Elgin to Aberdeen. She could not get to Aberdeen in time.

That is the situation that people are dealing with right now. As I mentioned to the cabinet secretary when he came to Moray last week, we are not talking about just a one-way journey; people have to come back again.

Presiding Officer, may I speak about my personal experience for a moment? I have spoken before in the chamber about how Krystle had to go through to Aberdeen to give birth. That was traumatic—it is something that I do not want any other mum or family to go through. Then we had to come back again. Our son was born at 1.45 am, and we were released from hospital at 9 am. We had to take an infant child, who was less than eight hours old, back to Moray. He had to sit in the car for two hours.

I have not spoken about this: shortly after he was born, James spent almost a week under the excellent care of the Royal Aberdeen children’s hospital, because he had breathing issues and chest problems. Ever since then, I have wondered whether that was because of the journey that he was forced to make as such a small infant. Did that contribute to his problems a few weeks later? Every time I saw him in hospital, being fed through a tube down his nose and getting oxygen pumped into him—so helpless—I wondered whether that could have been avoided if he had been able to be born in Elgin, just 10 or 15 minutes away from home.

Those are the issues. The worry is not just the birth but the return to Moray afterwards.

I welcome that the health secretary has confirmed that model 6 is his preferred option, but of course he confirmed that almost a year ago. He stood on a manifesto commitment to restore a consultant-led maternity unit at Dr Gray’s. It was a commitment that I made in the Scottish Conservative manifesto and was delighted to see in the Scottish National Party manifesto. We are where we were this time last year.

Model 6—the restoration of a consultant-led maternity unit—must be the focus and priority. The cabinet secretary is right, in that there is genuine fear that model 4, with more Moray women going to Inverness, will become the norm. That cannot be acceptable. How will the cabinet secretary reassure people in Moray that that will not happen?

As I have said in the chamber, clinicians from Raigmore have raised serious safety concerns. They said that the proposals in the Ralph Roberts report, in particular on model 4, are unworkable and unsafe. Has the cabinet secretary reassured those clinicians? Have they changed their position?

Will NHS Grampian fully support what the Government proposes today? How does the cabinet secretary answer the serious concerns. which are relayed in Ralph Roberts’s independent review, that there has been a lack of investment in Dr Gray’s for years? NHS Grampian has neglected our hospital for years and there are serious concerns that it is not fully behind the plans. As Ralph Roberts said, Dr Gray’s has not had the investment that similar hospitals have had elsewhere in Scotland. The issue must be addressed. I am interested in the cabinet secretary’s response to that.

What will the investment be at Dr Gray’s and when will it be made? When will the full, consultant-led maternity unit be up and running? We have no timescales or milestones. We need a date.

What is happening right now to women and families who have to endure a blue-light transfer to Aberdeen and Inverness, and the staff who must go with them?

The cabinet secretary said that his aim is for 80 to 90 per cent of births to take place at Dr Gray’s. We all support that aim, but we need to know when it will be achieved. Will it be achieved during this parliamentary session? Can we get a date—a month, a year—when it will be achieved, so that we can hold the Government and the health board to account on the restoration of services that the people of Moray so desperately need?

I thank Douglas Ross for his questions, and I join him in praising keep MUM, the Moray maternity voices partnership and all the other local campaigners. I also praise the excellent cross-party campaign—and it has been genuinely cross party, as far as I can see.

Douglas Ross’s questions about pace and concern that model 4 will become the norm, with little work done on model 6, reflect a fear that I understand—a fear that I understand that community groups share. It is therefore so important for me and, I suspect, for campaigners and elected members, that we have an independent assurance process alongside any work that is done. I heard clearly about the distrust that local campaigners have towards the health board. They also, no doubt, distrust what we are saying here in government, to some extent. I want to give them an absolute assurance that I am committed to model 6 and a return to consultant-led maternity services. To give them additional assurance, we will have independent oversight, which will include independent clinical oversight.

I thank Douglas Ross for sharing his own personal circumstances once again. First, I hope that his son James fully recovers. I obviously do not have the clinical knowledge to say whether the journey back contributed to his breathing difficulties but, regardless of that, such a journey back, when the child is hours old, is not something that I would want for my child, and I suspect that it is not something that others would want for their newborn child either. I cannot imagine, even from a parent’s perspective, how tired someone would be after supporting their partner through birth or how tired the woman who has given birth would be. That journey would therefore be a difficult one. We absolutely want to minimise that.

Douglas Ross says that model 6 was something that we had committed to. Model 5 was also a rural consultant-led model. Model 6 goes that bit further, and that is why I have made the decision to go with model 6. It matches the aspiration of the community, and I can give him an absolute guarantee that that will be the focus.

Douglas Ross asked a couple more questions, which concerned Raigmore clinicians. As he knows, I met those clinicians—they spoke about their difficulty, concern and anxiety about the current facilities. They have written to me, as members know, as they made those letters public. I hope that they have some assurance from the fact that I have put investment on the table for an improvement in their facilities.

NHS Grampian fully supports the direction of travel. I have spoken to representatives of NHS Grampian, and they understand my expectation around model 6. However, I fully understand that the independent oversight will be exceptionally important to community groups and elected members.

On timescale, which was the subject of the last question, the reason why I cannot give Douglas Ross a date right now is that, if we did that, we would be plucking it out of the air. Now that I have set the destination, we can work backwards. What does it take to get to model 6 and to get Dr Gray’s that full consultant-led maternity service? What investment is required, what staffing is required and what needs to be done about some of the systemic challenges that Grampian has faced over the years?

I can promise Douglas Ross two things. First, I will keep him and the Parliament updated on the timescales. We will be open and transparent about them. Secondly—and I end on this—we will not shy away from our responsibilities for the investment that is required for model 6.

I join Douglas Ross in paying tribute to Keep MUM and the maternity voices campaigners in Moray, who have been calling for consultant-led maternity services. I welcome the promise to reinstate consultant-led maternity services at Dr Gray’s and the very much needed investment at Dr Gray’s and Raigmore, but I cannot welcome the short-term option. The cabinet secretary tells us that he is listening to what those involved are telling him, but he is obviously not hearing what they say.

Clinicians from NHS Highland wrote to the cabinet secretary in February, saying:

“The Board did acknowledge on this occasion that the staffing and built environmental requirements for Model 4 cannot be met in the timescale proposed by the Report”—

meaning in two years. That is of profound significance, as it confirms that model 4 is not an option for the short term. In addition, they said:

“Our lead paediatrician gave his opinion that our neonatal facility is at capacity and that any increase in birth rate at Raigmore before major upgrading to staffing and facility will put babies at risk.”

They went on to make the point clearly that model 4 is also not a feasible option because they are unable to fill current staffing vacancies and existing staff are facing burn-out. Many of those points were also made to the cabinet secretary by the chief executive and community campaigners in Moray at meetings that I also attended.

Will the cabinet secretary therefore reconsider model 4, because it is simply not safe? Will he outline what he is going to do in the short term to keep mums in Moray safe?

As far as I am aware, neither Rhoda Grant nor I are clinicians, so she is right to put forward the views of clinicians at Raigmore. Just before the meeting that I had with Rhoda Grant in Moray last week, I had a meeting with clinicians from Dr Gray’s, and almost all the clinicians in the room—certainly all the ones who spoke—supported model 4, so we have a difference in the clinical input.

I understand that Rhoda Grant talked about clinicians at Raigmore. I accept that they have a concern, and I hope that they will be reassured by the £5 million that I am committing immediately and putting on the table. That is also why a timetable is exceptionally important. As I said in my statement, I will return in the summer to give a detailed timeline for model 4 and say what milestones will be achieved by when. I reiterate that that will have clinical input from the clinicians at Raigmore and Dr Gray’s, of course, but also independent clinical input. Timetables and timescales are absolutely important.

I hope that the investment that I am putting on the table for Raigmore, as well as the investment for Dr Gray’s, will give the clinicians assurance. I will continue the conversation with clinicians from Raigmore that I had last week.

As the cabinet secretary has set out today, safety is the absolute priority in ensuring enhanced services in Moray. Will he outline how NHS Grampian will support staff training and development across the multidisciplinary team?

I will be brief and say that that was part of my discussion with the chair and chief executive of NHS Grampian. It is one of the issues that we have to grapple with when it comes to model 6 but also, in the interim, with the bridge model 4 solution. We know that there have been changes since 2018, and there is a question or a concern about making sure that staff are appropriately trained, as they have not done certain procedures since 2018. That is all part of the consideration, but I have had an absolute commitment from NHS Grampian that that training element will be core to the development of model 6 and model 4 in the future.

Given the Scottish Government’s hope that a version of model 4 will be delivered in two years and that, as Douglas Ross rightly highlighted, there is no indication yet of how long model 6 will take to deliver, it is likely that there will be a considerable on-going reliance on the transferring of maternity patients to hospitals outwith Moray for the next few years.

However, the cabinet secretary did not answer Douglas Ross’s question on blue-light transfers from Moray, and the Scottish Ambulance Service was not mentioned once in his statement. Can he advise me what impact the on-going need for patient transports relating to maternity services will have on the Ambulance Service, which is already under pressure? What discussions has he had with the service on any additional support that it will need to undertake the role in the longer term?

That is a very good point. I ask the member to forgive me—I tried to take a note of as many of the questions that Douglas Ross asked me as possible.

There have been conversations with the Scottish Ambulance Service on that point. It is under extreme pressure, which is why we are investing in additional recruitment, and it announced yesterday that it had a record year of recruitment in the previous financial year.

The Scottish Ambulance Service will be critical to part of the solution. We hope that, when we implement the full model 6, there will be much less reliance on the Ambulance Service. However, members should remember that, in my statement, I mentioned that 80 to 90 per cent of births will take place at Dr Gray’s when model 6 is up and running so, even once it is in place, the Scottish Ambulance Service will potentially still need to be involved. It will be critical to the discussions that take place about restoring consultant-led maternity services at Dr Gray’s.

The increased investment in services at Dr Gray’s and Raigmore is very welcome. Will the cabinet secretary outline the improvements in Raigmore that the new investment is expected to deliver? Can he offer any reassurance to those at Raigmore who might be concerned about capacity issues during the interim model 4?

I visited Raigmore and spoke to some of the consultants, nurses and midwives who were in the unit at the time. Anybody who has been to the maternity ward there will have seen clearly the constraints under which the staff are operating. We have provided money as part of the redevelopment of that infrastructure—there is clearly a need to improve the capital infrastructure—and we are also looking to increase staffing, because we know that there are challenges in that regard. It is not only about recruitment; we are working with NHS Highland—as we will with NHS Grampian—on retention. That will be very important as we move forward.

I know that there are concerns about the infrastructure at Raigmore. I hope that the investment that we have put on the table will give some hope and reassurance to people that not only are we taking the matter seriously, we are putting our money where our mouth is.

We know that there are already significant pressures on the existing workforces in rural health boards, including NHS Grampian, and that the board is struggling with staff recruitment and retention. Will the cabinet secretary tell us what plans he has to remedy existing staffing difficulties? Why should Parliament trust that the Government has the plans in place to ensure that its actions on workforce-related recommendations will have an effective and lasting impact and will deliver for the services and those who rely on them?

The reason why people can trust us on staffing is that, under this Government, we have record staff numbers of staff in our NHS—we have 28,700 more whole-time equivalents than we had in 2006, which is a 22 per cent increase. Therefore, people can trust that we will grow the workforce.

However, as I said a moment ago, it is not just about growing the workforce; retention is hugely important. There will always have to be a multiagency approach to retention, which is why I will be working not only with the health board but with the local authority on accommodation and schooling for families who wish to move to Moray. I spoke to a couple of consultants who moved their families to Moray. When I asked them their reasons for doing so, lifestyle came up as almost the number 1 issue for them both. We should capitalise on that, but we must ensure that the appropriate support is in place for people who uproot themselves from other parts of the country to move to Moray. It is an attractive place to work and there are great opportunities there, and now that I have announced model 6, there is a really attractive vision for the future of Dr Gray’s, which they can be a part of.

It is very welcome that the voices of families and service users in Moray have been listened to throughout the process. Will the cabinet secretary set out how continued stakeholder engagement will be delivered as the service is developed?

I commit absolutely to the investment that is needed and to keeping Parliament updated. We will invest in the staffing and in the infrastructure. We are talking about Raigmore and Dr Gray’s, but I am having conversations with NHS Grampian about whatever needs to be done in Aberdeen, although we know that the facilities there are excellent.

Although I am leading on the matter, we are taking a cross-portfolio approach and I am speaking to the transport secretary and others about making improvements to make the journey easier for those who have to travel.

Before calling the next speaker, I will return to the earlier point of order. Given the number of members who still wish to ask a question, I am minded to accept a motion without notice, under rule 8.14.3, to extend business by up to 30 minutes. I invite Douglas Ross to move the motion.

Motion moved,

That, under Rule 8.14.3, business be extended by up to 30 minutes.—[Douglas Ross]

Motion agreed to.

There will be consequential implications for the rest of today’s business, including decision time.

The issues at the heart of the review are not unique to Moray. Expectant mothers in Caithness currently face a 100-mile trip to Raigmore to give birth. Sometimes, they make that journey in the snow and in the dark. Will the cabinet secretary commit, here and now, to a similar independent review of Caithness maternity services. If he will not, can he explain to expectant mothers in Caithness why they cannot expect the same level of service as mothers in Moray?

The member knows, I am sure, that the best start north review was commissioned jointly by NHS Grampian, NHS Highland, NHS Orkney and NHS Shetland to look at the challenges facing maternity services across the north of Scotland. The review is being carried out in consultation with local people to develop the best possible sustainable model for maternity services in the future and includes services delivered from Caithness. Changes to Raigmore—and the investment that comes with those changes—will improve the services for all women in NHS Highland who travel to Raigmore to give birth, as well as accommodating women from Moray.

I agreed publicly, when I was asked about this the last time that I travelled to Moray, to meet the campaign groups in Caithness. I understand their concerns about the current situation but I hope to reassure them that the issue in relation to Caithness is being considered and is part of the current review.

Karen Adam, who joins us remotely, has the next question.

We know that a number of factors contribute to making it more difficult to recruit staff to work in rural areas. Can the cabinet secretary outline whether there will be fresh approaches to recruitment and contracts, such as hub-and-spoke models with larger hospitals, to ensure that specialisms can be delivered in Dr Gray’s?

That absolutely has to be part of the solution. We know that we have to make posts attractive and it is absolutely correct that that might include, for example, working on different sites. It might also be about mixing a clinical role with an academic role. We will explore whatever we can do to make these posts more attractive.

I join colleagues across the chamber in recognising the hard work of community groups such as keep MUM, which has kept Moray maternity services on the agenda. I welcome the announcement that the Scottish Government will progress model 6, which will see a return to a full consultant-led maternity unit at Dr Gray’s, and its commitment to recruiting more specialist staff to deliver that. How will the cabinet secretary engage with stakeholder groups to monitor progress on the project?

I will continue to engage with all stakeholders, from clinicians to elected representatives to the local community. In fact, I am due to speak to keep MUM and the campaign groups straight after this item of business, although that might be slightly delayed, given the extension to business.

I will continue to engage with local community groups and be absolutely involved in the process. I hope that the transparency that we are providing will give elected members plus local community groups reassurance in relation to what they can expect and by what time.

The cabinet secretary mentioned that model 4 was a bridge to model 6, but that in itself could take up to two years to establish. As the cabinet secretary will know, and as we have heard already today, getting to model 4 will require substantial investment in both recruitment and the existing workforce.

Given the existing and long-standing recruitment and retention issues in the health boards, what immediate steps will the cabinet secretary take to ensure that the workforce is in place in time? Importantly, can the cabinet secretary confirm that the two years for the establishment of model 4 is the very limit of the time that it will take and not a target?

I would say that that is precisely why we want to introduce a timetable in an open and transparent way. I would not expect it to take longer than two years, but it is important to get that work on the timetable done, to get that clinical input and to update Parliament on it.

I do not think that there is a difference in what we all want. It sounds as though all of us who have spoken want a return to a consultant-led service in Moray and we all want it as quickly as possible. I have to be guided by the clinical view on how to do that safely, because I certainly do not intend to be the health secretary who makes a decision that puts women at risk. I completely accept the point that there is risk in the current model, as people have been saying.

We want to improve the situation as best we can, and making employment sustainable is, of course, absolutely part of that. I hope that the investment that I have put on the table and that the Government is bringing forward is an indication of our commitment. That is the initial investment; I suspect that there will be further investment in the years to come. It is an initial commitment to restoring consultant-led maternity services at Dr Gray’s.

A number of colleagues have pressed their request-to-speak buttons since the motion without notice was taken. I will take a couple of them, but I am not minded to take all those who have pressed their buttons since then, as we need to move on to further business.

I, too, want to ask about recruitment challenges. The Scottish health service has seen a reduction in the number of qualified staff from Europe applying for positions in it since Brexit, which impacts rural services such as Dr Gray’s. What discussions has the Scottish Government had with the United Kingdom Government to enable us to put in place migration policies that are better suited to the needs of our maternity services and the women who use them, particularly in rural Scotland?

As members can imagine, we have had conversations with the UK Government across portfolios on the impact of Brexit on various workforces. I am keen to ensure that, from an NHS Scotland perspective, we take a co-ordinated approach to international recruitment. That will, of course, include European Union recruitment.

I recently visited NHS Fife’s Victoria hospital, for example, and I met nurse recruits from India, the Philippines and the United Arab Emirates. We need to take a co-ordinated approach, because Scotland, the Highlands and Grampian are exceptionally attractive places to work in. We need to ensure that there is wraparound support for everyone who comes here, and we should target particular countries, including those in the European Union. I am not expecting additional help on that from the UK Government, but I will continue to push it in that regard.

The cabinet secretary said that £5 million will be made available to NHS Grampian to support moving changes forward in Moray. What will that funding be used for? As has been outlined throughout this statement session, families that are being transferred to Aberdeen face significant challenges. What additional support will be provided to those families when they are in the granite city, especially with regard to accommodation?

The £5 million will be there to support the restoration of the service—that is clear. We will come forward in an open and transparent manner with further detail about how that money is being spent.

I will look at Miles Briggs’s request for additional support. I have heard from a number of parents who have had to make the journey, and I do not think that that is an unreasonable request. Where we can provide additional support for accommodation or any other purpose, I am open minded about doing so.

Yesterday, we had a very important committee debate on perinatal mental health. In the intervening period and while the changes are being implemented, what reassurance can the cabinet secretary give that the perinatal and postnatal mental health of mothers will be protected and they will get the support that they need?

I have spoken to NHS Grampian and NHS Highland about that very issue: perinatal and postnatal mental health. That is a key consideration, particularly as we move towards model 6. The interim option of model 4 is to provide as much postnatal and perinatal support as we possibly can, and that includes mental health support.

That concludes this item of business. There will be a brief pause before we move on.