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Chamber and committees

Meeting date: Tuesday, September 28, 2021

Meeting of the Parliament (Hybrid) 28 September 2021

Agenda: Time for Reflection, Topical Question Time, Covid-19, Universal Credit, Environmental Standards Scotland (Chief Executive), Business Motion, Parliamentary Bureau Motions, Decision Time, Scottish Ambulance Service


Contents


Scottish Ambulance Service

I remind members of the Covid-related measures that are in place and that face coverings should be worn when you are moving around the chamber and across the Holyrood campus.

The final item of business today is a members’ business debate on motion S6M-01136, in the name of Jamie Halcro Johnston, on ambulance services across Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament commends the efforts of hard-working ambulance staff over the challenging period since the beginning of the COVID-19 pandemic; recognises what it sees as the importance of an effective ambulance service to rural communities and, in particular, to those remote communities in the Highlands and Islands region; considers that issues exist around staffing and recruiting of staff across Scotland; believes that a number of performance indicators for the Scottish Ambulance Service have been missed over this period, and acknowledges the view that there is a need for an effective strategic plan to support the Service to recover as Scotland emerges from the COVID-19 pandemic.

17:20  

I appreciate the opportunity to introduce the debate and I thank all members who supported the motion and made this evening’s debate possible.

In recent weeks, there has been a great deal of coverage of the challenges that currently face the Scottish Ambulance Service. The problem does not impact just the more rural parts of Scotland, such as the Highlands and Islands. The case of Gerard Brown, in Glasgow, shocked people across the country. The 40-hour wait for an ambulance, despite the efforts of his general practitioner and family, has rightly been recognised as appalling, and his subsequent death is a tragedy.

Gerard Brown was one of hundreds of people over the past year who were assessed as requiring an emergency response yet were forced to wait more than 12 hours for an ambulance. His GP called the situation, “third-world medicine”, and many more disturbing cases have come to light since then.

I hope that in the debate we can recognise the experiences of people across Scotland and acknowledge that there are problems that need more than short-term fixes, because one thing is clear: the underlying problems stretch back much further than just the recent months or even to the onset of the pandemic, and without credible work on long-term improvements, they will last longer than just this winter.

Last week in this chamber, Jackie Baillie quoted a paramedic who said:

“I am fed up reading and hearing in the news that the pandemic is causing the problems with delays. It’s true that it’s a contributing factor but this has been a disaster in the making for years.”—[Official Report, 22 September 2021; c 62.]

Another paramedic told me:

“It frustrates me that Covid is the excuse used to carpet over issues that were already there”.

A constituent wrote to me about his experience a few years ago, when his mother severed an artery in her wrist and bled almost to the point of unconsciousness. It took 30 minutes for an ambulance to arrive. That was not in some remote village but in the city of Inverness, with the ambulance dispatched to Inverness from Dingwall.

Another constituent spoke of their experience when, despite being referred by an out-of-hours GP, they were told that an ambulance might be available in four-and-a-half hours’ time but that there was no guarantee of that. He told me that his wife was forced to drive him, while he was “writhing in agony”, from Aviemore to Inverness, in heavy rain and wind. He had emergency surgery and remained in hospital for nine days. He praised the care that he received from the out-of-hours GP and the staff at Raigmore hospital and said that the only weakness was the Ambulance Service.

Let me be clear. Scottish Ambulance Service crews are remarkable. Their job is to save lives and protect the public. I am proud to have family and friends who work in the service. Unlike many public service workers, they come to people’s homes, streets and workplaces. They are the most front line of front-line staff and certainly among the most key of key workers. We owe our ambulance crews and support staff a huge debt of gratitude and our thanks.

That is all the more reason why the Scottish Parliament and the Scottish Government must ensure that ambulance crew have the proper tools to do their job.

Paramedics and other staff are under real pressure. Many have been unable to take rest breaks during long shifts. Unions have pointed to low staff morale and enduring fatigue. There is the risk of a mental health crisis in our Ambulance Service.

Scotland has always, by necessity, led the way in public medicine. The Highlands and Islands Medical Service is often cited as a forerunner of the UK-wide national health service. Our lower population density and relative remoteness has often been cited as a justification, at least in part, for the additional devolved funding that Scotland enjoys relative to other parts of the United Kingdom.

However, the reality is quite different. Increases in funding in England have not led to similar increases in funding in Scotland. There has been a trend under the current and previous Governments towards similar healthcare spending in Scotland and England. In April, the Institute for Fiscal Studies pointed out that, at the start of devolution, healthcare spending in Scotland was 22 per cent higher than healthcare spending in England. Today, it is only 3 per cent higher. That is a tightening of funding by successive Administrations in Edinburgh that entirely fails to recognise the costs of delivering public services in this part of the United Kingdom.

There have always been unique challenges in providing ambulance cover in our rural and island communities. On the Orkney mainland, there is likely to be only one ambulance active at any given time. How long it will take a crew to reach a person is simply a question of who is in front of them in the queue and where the call-outs are on the islands. An elderly constituent in Orkney fell and was forced to wait two and a half hours with a bleeding head wound for an ambulance to arrive.

There are real difficulties in other places. It is well over three hours by road from the west of Skye to the nearest major hospitals, in Fort William and Inverness. However, we continue to see threats to local health facilities in more rural areas.

I have spoken many times in the chamber about Dr Gray’s hospital in Elgin and the downgrading of its maternity services. The alternative for many prospective mothers will be either Inverness or Aberdeen. Extensive travel to access services not only places a huge strain on patients and delays in emergency treatment; it redirects valuable ambulance resources to patient transport.

When the Cabinet Secretary for Health and Social Care presented his eagerly awaited NHS recovery plan in August, there were only two mentions of the Ambulance Service. We had to wait until last week to see something approaching a recovery plan for that service. Again, the service was not seen as a priority by Scottish National Party ministers. The plan was forced on them by the growing crisis.

Thankfully, in Scotland, we benefit from an additional safety net. The British Army and a number of other bodies are called in to assist. Scotland on Sunday reported at the weekend that, in the first half of this year alone, more than 3,000 calls were diverted from Scotland to control rooms in England under mutual aid provisions. That, and the additional funding that has been mentioned, are welcome in the short term, but they will not bring transformational change or greater resilience to the service for the future. We have seen pressures not only directly on our Ambulance Service but on call centres, in our accident and emergency departments, in our general practices and on local NHS services. Although some of the current crisis is symptomatic of wider failings and circumstances brought on by the pandemic, ministers have been slow to accept that those have largely exacerbated, rather than created, the problems. We must recognise that simply pulling back from the current crisis is not good enough.

It is welcome that the First Minister has, finally and belatedly, been forced to accept that there is a crisis in ambulance provision in Scotland, and it is welcome that the cabinet secretary is here today in recognition of the seriousness of the situation to listen to concerns that are being raised. I hope that he will take those concerns seriously and will recognise the feelings of MSPs and our constituents’ concerns.

This evening, we will hear the voices of patients and ambulance staff. For too long, those voices have not been heard by the Government. It is unfortunate that it has taken issues of such a magnitude for them to be amplified. I hope that ministers are at last really listening.

I call Christine Grahame. You have up to four minutes, please, Ms Grahame.

17:28  

I see that the clock is now operational.

I congratulate Jamie Halcro Johnston on bringing this important members’ business debate to the chamber. It follows a statement from and questions to the Cabinet Secretary for Health and Social Care, a debate, and questions to the First Minister on the performance of the Ambulance Service.

I know that we all agree that any issues that arise, particularly during the extended and continuing pandemic, in no way reflect on the men and women of the Scottish Ambulance Service.

Since the statement, questions and debates, measures have, of course, been taken by the Scottish Government. Funding of £20 million has been announced to deliver the assistance of more than 100 military personnel—88 drivers and 15 support staff; around 100 second year paramedic students to help in ambulance control rooms, which I will come to later; and more hospital ambulance liaison officers at the busiest A and Es. They are to increase from 11 to 20 to help to ensure the timely admission of patients at A and Es because of the knock-on effects on ambulances arriving. There will be additional help from the Scottish Fire and Rescue Service in the form of volunteer drivers as well as from the British Red Cross and private transport companies, where clinically appropriate. To go back to call centres, there will be additional senior clinical input in ambulance control rooms to assist and speed up decision making on mental health, addictions, falls, breathing difficulties, high-intensity users, and trauma.

During the recent statement, we learned that, in August this year, only 21 per cent of calls were actually emergencies. Ambulance personnel are being called out for what one might term lower-level medical issues. That includes social issues: for example, someone sleeping rough, or passing out drunk or through drugs. That can take up a great deal of a crew’s time as they either take the person to A and E or try to find someone to look after them while they are in that state, because both the police and the Ambulance Service have a duty of care to that person and cannot leave them somewhere unattended. Sometimes, that can take up hours of a crew’s time. It is a complex mixture, which puts the service under pressure at any time, but more so during Covid.

I understand that staff are frustrated about wasting time at call-outs that should not have happened. That is why I raised with the cabinet secretary the issue of the information technology triaging system, which, in my view, needs to be refreshed to match the current circumstances. I understand that it was designed a couple of years ago and is highly automated. Call handlers—who are not at fault—run through questions, and the system tells them what to do next, based on the response. We need to revisit that, given that only 21 per cent of those call-outs are emergencies. Arriving at A and E must also take longer, because of the Covid processing of patients, tying up ambulance time as the ambulance is cleaned and as case notes have to be documented at that time and transferred into the system.

There will be regional variations. I cannot speak for the Highlands and Islands but, to date, I have not had any emails about cases in my constituency of Midlothian South, Tweeddale and Lauderdale. That may change after the debate.

The pandemic means that the Government and the public must look afresh at what we require of a modern ambulance service. There is a duty on the public to behave responsibly. Of course someone must call an ambulance, without hesitation, in an emergency. That is defined by the Scottish Ambulance Service as:

“Loss of consciousness ... Cardiac arrest ... Heart attack ... Stroke ... An acute confused state ... Chest pains ... Breathing difficulties ... Severe bleeding that cannot be stopped ... Severe allergic reactions ... Severe burns or scalds ... Major trauma, such as a road traffic accident or fall from a height”.

That can be checked out, if in doubt, on the SAS website. However, it may be that other medical advice should be sought first, such as from a general practitioner, pharmacist or optometrist.

I thank Jamie Halcro Johnston for raising again what is an important issue, and I add that much of what I have said came also from a paramedic.

Edward Mountain is joining us remotely.

17:32  

I thank my colleague Jamie Halcro Johnston for securing a debate on a subject that is so important, especially in the Highlands and Islands. We all know that every minute counts when it comes to attending a life-threatening situation. That is even more the case in the Highlands and Islands, where rural communities face long journey times to A and E—more than two hours, in some of the more remote areas. Ambulance crews’ ability to respond quickly is therefore, more often than not, what makes the difference between life and death.

During the pandemic, we relied heavily on our hard-working ambulance crews, as never before. As we faced the worst pandemic and health emergency in generations, they rose to the challenge, as did all the other front-line staff, and faced it with true grit and determination. However, the challenge that they faced has been made so much harder by the SNP Government, which has presided over an ambulance waiting time crisis.

It is always convenient for SNP members to blame all their failures on either Brexit or the pandemic, but it is simply not true. Those without selective amnesia will remember the shortage of ambulance provision in the Highlands and Islands region that I highlighted back in 2017. At that stage, there was insufficient ambulance cover for not only Skye, but Lochaber and Caithness. Shortages were addressed with sticking-plaster solutions such as the single crewing of ambulances, and it was not until 2018, when the GMB union threatened to take industrial action due to the lack of emergency ambulance cover in Caithness, that the Government almost woke up.

That shortage of emergency ambulances had a knock-on effect. During the same period, I had to assist care homes that had to organise their own patient transport due to the lack of ambulance cover to take patients to hospital. Our Ambulance Service has been overstretched for far too long and the situation has reached breaking point, with the average waiting time for ambulance crews now being up to six hours. That is shocking.

Let us put that into context and see what it means in an individual’s case. I quote a constituent who contacted me. They collapsed at home having a mini stroke, called for an ambulance and were told to wait for a call back. When that call eventually came, they were told to make their own way to accident and emergency because no ambulances were available. They wondered what they were expected to do: pop outside and wave down a taxi or perhaps even jump on a bus? Thankfully, that was not needed, because a friend was called, jumped to and took them to the hospital.

That is not where we should be. There are insufficient ambulances and not enough staff. There is nowhere for the Government to hide and no one is to blame but itself, because the crisis started well before the pandemic and Brexit.

The ambulance crisis is putting people’s lives at risk, especially in the Highlands, where there are much greater distances to travel. I am pleased that, following the Scottish Conservatives’ call, steps have been taken to bring in the Army and the Scottish Fire and Rescue Service to alleviate crew shortages. However, what we need in the Highlands, and what the Ambulance Service in the Highlands needs, is a long-term plan. That takes leadership and vision. Sadly, both seem to have evaded the SNP Government over the past 14 years.

17:36  

I thank Jamie Halcro Johnston for bringing the debate to the chamber.

The people who work in our Ambulance Service deserve our admiration and gratitude for the work that they do every day in responding to emergency situations—even more so for what they have done over the past 18 months of a global pandemic, when they have experienced pressure like never before. They have worked throughout lockdowns, putting others before themselves, and their contribution to our efforts to get through the pandemic cannot be overstated.

However, our thanks are nowhere near enough and do little to address the Government’s fundamental failure to properly provide health and emergency services. The problems that we see today in our Ambulance Service are not down to our workers but are down to Governments and ministers lacking the political will to intervene, invest and focus on issues that impact people’s daily lives.

The debate rightly considers our Ambulance Service workers’ positive contribution, but the situation that the service finds itself in now is serious. It predates the pandemic and reflects the Scottish Government’s inability to address issues with purpose in order to protect the services that thousands of people rely on every day.

Jamie Halcro Johnston’s motion notes the importance of having a well-connected Ambulance Service that serves rural communities such as his, in the Highlands, but the same is true in the South Scotland region, where ambulance waiting times can be lengthy, particularly for our rural communities. That adds to the existing problems that the Ambulance Service faces in other areas.

As I mentioned in a speech on ambulance services last week, neither expectation management nor improving media coverage should be the Government’s priority. Neither of those is acceptable for the woman from Ayr who waited four hours for an ambulance last month or for the families who have felt powerless as loved ones have waited as long as 40 hours. Those are personal stories and individual tragedies, such as that of Rebecca Stevenson from Paisley, who, aged 85, sadly died after waiting eight hours for an ambulance. It should not have taken that much for the Scottish Government to sit up and listen.

People are not asking for much. They are asking their Government to focus on the matters at hand—to address the fundamental issues in our health and emergency services, to deliver ambulance services that support incredibly hardworking staff and to ensure that there is confidence across our communities that they will be well served in emergencies.

I will support the Scottish Government in its efforts to resolve the issues that our Ambulance Service faces, but I will not sit back and accept commitments of investment that will take years to make any changes. The situation can by no means be rapidly sorted—indeed, several years of mismanagement have ensured that—but, with the political will and with the correct investment, focus and urgency, it can be turned around.

Underfunding, understaffing and a lack of resources have led our Ambulance Service to the difficult position that it now finds itself in. Workers have gone way beyond expectations during the pandemic, and the strain on them has been significant. It did not have to be this way, and it must not be this way again.

This evening, we are here—rightly—to highlight the importance of our Ambulance Service and its incredible workers, but that will do the service, its workers and our communities little good if we do not hold to account the people who are responsible for the serious issues that the Scottish Ambulance Service faces.

I will support the Scottish Government in its efforts to deliver change, but no more time can be wasted. The situation is urgent, and urgent action is needed because lives depend on it.

17:40  

I, too, congratulate Jamie Halcro Johnston on securing the debate. Indeed, I recall holding a similar debate about a year ago. On that occasion, my aim was to build cross-party support for a campaign to pay student paramedics during the course of their studies. Although sympathetic, the minister at the time was not for budging, I recall. Earlier this month, however, those starting their paramedic course will have received a grant for the first time. I therefore encourage Mr Halcro Johnston not to take whatever the cabinet secretary has to say shortly as the Government’s final word on the matter.

The crisis that our ambulance service is currently facing has rightly been the subject of much debate in the Parliament over recent weeks. That is understandable, especially when we see the Army and firefighters being brought in to help. The case around capacity is one that I have been making in relation to Orkney for some time. Having a single ambulance to cover the whole of Mainland and linked south isles is simply not enough. That lacks resilience. Figures that I obtained from the Scottish Ambulance Service show that the Orkney Mainland was twice left with no ambulance cover at all in 2019 due to a lack of staffing. That is on top of the 168 occasions when the ambulance was called out and was therefore unavailable to respond to other incidents.

That lack of resilience and sometimes cover has many consequences. It puts additional stress on hard-working ambulance crews, who are doing their best to keep their community safe but are denied the tools that they need. It puts doctors in an invidious position, as they feel that they need to respond out of hours, often to incidents for which they are not properly trained. Ultimately, it puts the public in Orkney at greater risk.

Since I first started raising the issue, I have been told repeatedly of the need to await the outcome of the demand and capacity review. The Scottish Liberal Democrats recently secured the review document through a freedom of information request, and it makes for worrying reading. In response to publication of the review’s findings, ministers have insisted that they are committed to recruiting around 450 more ambulance staff. Whether that is new staff and additional money remains unclear, but what is clear is that it is long past time that Orkney had the staff to operate two ambulances not just for a few hours a week and not just on the basis of existing staff volunteering to work overtime, but all of the time.

Like so many of the issues that our health and care services face right now, the lack of ambulance capacity in Orkney predates the pandemic, and there is now a perfect opportunity to address that long-standing need. Whether or not ministers choose to do so will be the true measure of the Government’s commitment to rebuilding and of the priority that it attaches to post-pandemic recovery.

I thank Jamie Halcro Johnston again, and I give the cabinet secretary fair warning that, as with the funding for student paramedics, this is not an issue on which I intend to take no for an answer.

17:43  

I thank my colleague Jamie Halcro Johnston for securing this important debate.

The problems in our Ambulance Service have struck a chord with the nation, following the 40-hour wait that led to the tragic and unnecessary death of Gerard Brown in Glasgow. As usual, for those of us who represent rural constituencies in the north-east or the Highlands, it takes a tragedy in the central belt before anyone sits up and takes notice. This shocking story has been an all-too-familiar tale for too long and for too many of us—and there are too many failures to list here.

There are also many who have suffered in silence or whose accounts are languishing in a ministerial inbox. Bill Ritchie waited an hour while having a heart attack before a single-crewed ambulance arrived, only to have to call another unit with two crew members to take him to hospital. He survived, but others have not.

Susan Donald’s 81-year-old father waited seven hours in agony after falling and breaking his hip. He died three days later in hospital. Pam Anderson, a care home manager, got an ambulance but—again—there was only one employee in the vehicle. A two-crew team drove 30 miles from Tomintoul to take her, but Pam died on the way to Aberdeen. The ambulance in Braemar was removed in 2007 and the community is still waiting—14 years later—for a replacement. That is 14 years of SNP Government failure. The local SNP councillor resigned from the party in disgust, and I credit Geva Blackett for her principled stand and lead on the issue locally.

Emergency vehicles should not be despatched with single crew members. NHS Grampian and the Scottish Ambulance Service work round the clock to keep the north-east safe, but they have been failed by the lack of rural ambulance provision in Deeside and elsewhere. If two people have the same urgent care needs, the person in a rural area will not get the same level of service as someone in an urban area. That is unacceptable.

Ambulance delays are the worst on record, but the delays have underlying causes. Although others raise the issue of patient flow through A and E and admissions to hospital, our rural emergency provision has far more fundamental flaws that need to be addressed. In the north-east, we are fortunate to have Helimed 79, the second of Scotland’s charity air ambulances. However, charity seems to be the only route left for rural communities.

Other solutions that have been put forward in Braemar include piloting a joint protocol similar to the one in Victoria, Australia, which enables better use of the fire service and upskills their co-responders; fundraising for a helicopter emergency landing pad; making sure that co-responders are properly booked on to the Scottish Ambulance Service system; fundraising for a 4x4 ambulance to replace the existing co-responder van; and basing an advanced practitioner in Braemar to support primary care and respond to emergency calls. I hope that, after the tragedy and the continuing failures, the cabinet secretary will finally do the community the courtesy of looking into those options. However, I am still awaiting a response to my letter of February.

To see the health secretary grinning front and centre at a photo opportunity when he has had to call in the British Army to cover his incompetence insults those families whose tragic stories have been recounted today. It is plain to everyone here, and to the families of those who have died or who have seen their lives irrevocably changed, that solving this crisis is not the health secretary’s priority. Those heartbreaking stories of people dying and suffering in agony while waiting for an ambulance must be a wake-up call to the SNP Government, but the truth is that it remains asleep at the wheel.

17:47  

I, too, thank Jamie Halcro Johnston for bringing this important issue to the Scottish Parliament. We have heard from the south of Scotland, the Highlands and Islands, which I represent alongside Edward Mountain, and Orkney in the northern isles about the range of issues that are affecting constituencies and regions across Scotland.

I have raised the issues at the national level at First Minister’s question time, but I want to use this opportunity to raise some of the concerns that I have received from constituents in Moray. I say to Christine Grahame that she is extremely fortunate not to have had a single email or piece of casework about delays for her constituents—[Interruption.] I say in all sincerity that she is extremely fortunate, because some of the emails and contacts that I have had from constituents have been harrowing. In a moment, I will go over just one of those cases.

Jamie Halcro Johnston was right to highlight the issue with transfers. I would not be doing my job as a representative of the Highlands and Islands, which includes the Moray area, if I did not take the opportunity to mention the downgrading of the maternity unit at Dr Gray’s hospital. The report on that by Ralph Roberts has now been delayed until November. Will the cabinet secretary give a firm commitment that, as soon as the report hits his desk, he and his ministers will meet local campaigners and representatives to discuss the issue? We need the full consultant-led maternity unit at Dr Gray’s to be reintroduced.

On the issue with transfers, I was in that situation earlier this year. I had to wait in Dr Gray’s with my wife, who had just been told that she could not be treated locally through the stages of labour. She was ready to be transferred to Aberdeen, but we had to sit and wait and wait as her labour progressed, and as she got more uncomfortable and needed more and more support. However, we could not even leave the hospital, because the ambulance was not available. Ultimately, it came, several hours after it was first called for, and she had a very difficult journey to Aberdeen, because her labour had progressed all the time that she was waiting.

I will briefly mention the case of another Moray family. They have asked not to be named, but they asked me to explain the details of their case to show how difficult the situation is. The case involves a woman who was 31 weeks into pregnancy and who had tested positive for Covid. She was able to remain at home for some time, but her symptoms got worse, so she had to go to hospital to be looked after—originally to Dr Gray’s and then through to the Aberdeen maternity unit. There were delays in getting her from Dr Gray’s to Aberdeen. The ward at Aberdeen expected her far sooner, but it took four and a half hours before she arrived and was taken through.

That is, however, not the most troubling aspect of her case—I say to Christine Grahame that this is one example that I have been unable to get my head round. At one point during her stay at the Aberdeen maternity unit, she required a scan and had to go from the unit to Aberdeen royal infirmary and, because she was Covid positive, she had to get an ambulance. I know that Covid complicates things but, according to Google Maps, going from the maternity unit at Aberdeen to Aberdeen royal infirmary is a four-minute journey. She was not able to eat in advance of her scan and, after she had received it, she had a five-and-a-half-hour wait for an ambulance. That was to take a woman who was 31 weeks into pregnancy from Aberdeen royal infirmary back to the Aberdeen maternity unit, which is a four-minute drive. That is unacceptable. Pauline Howie from the Scottish Ambulance Service replied to me last week agreeing that it was not acceptable.

Cabinet secretary, none of those examples is acceptable—[Interruption.]

The member cannot take an intervention, as he is about to conclude.

We have heard so many experiences from across Scotland of people who are not getting the service that they deserve. I hope that we hear from the cabinet secretary the resolution to many of the issues that we are seeing right across Scotland.

17:52  

As is customary, I thank Mr Halcro Johnston for this evening’s debate. Although we have had discussions, statements, debates and questions to the First Minister, it is important that Parliament keeps reiterating the issues that are faced by our NHS and Scottish Ambulance Service.

Although there has been a fair bit of debate, along with discussions and questions, around the Scottish Ambulance Service over the past couple of weeks, it is fair to say that the particular issues that members have raised in relation to rural, remote and island communities have perhaps not had quite that airing. It is therefore helpful that Jamie Halcro Johnston lodged the motion. Although I do not agree with all of it—I will come to that in a second—much of it focuses on issues of great importance to those rural, remote and island communities.

Before I go into the detail, I will address some of the points that members right across the chamber have made. Specific issues were raised that affect remote and rural communities. We just heard from Douglas Ross in relation to the issues around Dr Gray’s. I am not surprised that he raised that issue, as I know that he raises it at every opportunity that he gets, and rightly so. I also note the good cross-party campaign on that. He has my assurance that, when the report from Ralph Roberts lands on my desk, I will meet community campaigners and cross-party MSPs, MPs and any other elected members who have an interest.

I thought that Liam McArthur was going to give Jamie Halcro Johnston the lesson that people should always trust the Scottish Government. I am afraid that that did not quite pass Mr McArthur’s lips, but I am pleased that we worked not only with him but with the fantastic campaign for paramedic bursaries to launch that scheme earlier this year. The scheme will make a big difference to recruitment to, and retention on, the course.

On the specific issues on Orkney, I speak to the chair of NHS Orkney fairly regularly—for example, we spoke a few days ago at the end of last week—and I will continue to raise those issues.

I echo the cabinet secretary’s comments in relation to the student paramedic campaign.

In his conversations with the chair of NHS Orkney, I am sure that, if the subject was touched on, she would have reinforced with him the importance that NHS Orkney attaches to increasing staffing in the Ambulance Service. At the moment, the demand is falling on out-of-hours GPs who, as I said in my remarks, are finding themselves dealing with situations for which they are not trained.

The member is right: Meghan McEwen has raised those issues with me, and I promised to take a look at them again. Equally, I am happy to look at the issue about Braemar that Alexander Burnett raised and at other local issues that members raised during the debate.

I reject the assertion that the Ambulance Service was not performing well pre-pandemic. Of course there were issues—I do not doubt that for a second—and of course there were cases in which the wait for an ambulance was too long, which members will have raised with my predecessor. However, I am afraid that I cannot agree with the assertion that the Ambulance Service was not providing a good service pre-pandemic. I could provide lots of figures, stats and detail in that regard, but I will not do so as I have a lot of points to make.

Is it the cabinet secretary’s target to return the Ambulance Service to the standard that it was at pre-pandemic, or is he looking for more improvements, given the concerns that constituents, people who work in the sector and other organisations have raised about performance pre-pandemic?

It is the latter. We want to do better than we did previously. However, I do not agree with the assertion that the Ambulance Service was performing poorly pre-pandemic, albeit that there were challenges.

I also do not agree with the assertion that a number of members made that the Government has not funded the Ambulance Service. Staffing and investment in the Scottish Ambulance Service have increased greatly under this Government; since 2006, there has been a 62 per cent increase in staffing. Carol Mochan said that there has been chronic understaffing, but that is the position that we inherited, and the Government has improved on it. Paramedic staffing is up by 26 per cent, ambulance technician numbers are up by 48 per cent, and even before the current challenges we had invested an additional £20 million to help to recruit 300 additional staff. I repeat: that is to recruit additional staff and not just to replace staff because of staff turnover. Liam McArthur asked about that.

That is not to say that the current challenges, which members rightly raise, do not deserve immediate action, and I make no suggestion that that is the case. They absolutely deserve such action, which is why the Government has set out significant measures. Christine Grahame provided detail of those measures. It is not just about the excellent service that the Army is providing—I again thank the Army for being so responsive, so quickly—and the excellent additional support that the Scottish Fire and Rescue Service, volunteers, the British Red Cross and private taxi companies are providing. As well as that, we have the additional recruitment and increased investment in control centres, with clinical leads being placed in our control centres and the appointment of hospital ambulance liaison officers.

Will the cabinet secretary give way?

I was just about to come to the member’s point about information technology. I am happy to take an intervention.

The dreadful cases that we are hearing about must be of concern to all of us. We must also be concerned about the fact that 79 per cent of calls in August were not emergencies. Paramedics are turning up to places where they should not be, when they should be dealing with cases such as those that have been described in the debate. Can the cabinet secretary give more detail on how the system operates across various regions and say why crews have been sent out to cases that were not emergencies? That is another issue that we must consider carefully. Seventy-nine per cent of calls in August were not emergencies.

I am happy to provide members with details of different categories of call-out. Calls are judged by the level of acuity, from high acuity right through to low acuity.

When I talk about the pandemic exacerbating challenges—that is the phrase that I tend to use; I do not say that the challenges emerged because of the pandemic—I mean that we know that people who have not presented to GPs or hospitals are now coming to ambulances first; they are sicker and have more complex needs and are taking up more hospital beds.

That takes me to the point on which I will end. It is of course right that, in today’s debate, we concentrate on the Ambulance Service, but there has to be an understanding that this is a whole-system issue—and I think that all members understand that. That is why the Government is acting, from investing in primary care at the front door to doing our best to mitigate and solve the issues to do with delayed discharge at the back door and investing in social care.

I reiterate the point that I have made several times over the past two weeks. I thank our hard-working ambulance staff for everything that they have done and I give them an absolute assurance that the Government will continue to invest to ensure that the Ambulance Service is well staffed for the challenges ahead.

Meeting closed at 18:00.