Meeting of the Parliament

Meeting date: Tuesday, November 8, 2016

Official Report 927KB pdf

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Health and Social Care (European Union Workforce)

The next item of business is a debate on motion S5M-02355, in the name of Shona Robison, on Scotland values its European Union workforce and its contribution to health and social care.

14:59  

I am pleased to have the opportunity to debate this very important issue today. Every area of Scotland, and more than 60 per cent of voters, voted to remain in the EU. The Scottish Government’s priority, therefore, is to protect Scotland’s interests and to ensure that the wishes of the Scottish people are respected by the United Kingdom Government in a meaningful way.

We are firmly committed to ensuring that Scotland can remain in the single market, including retaining freedom of movement. Scotland values the citizens from other parts of the EU and the wider European Economic Area who come here to live and work and the contribution that they make to our economy and society. Today, I want to focus specifically on the citizens from other parts of the EEA who make such a vital contribution to our health and social care services. In doing so, I will focus on two of the five key interests that this Government wishes to protect: our economic interests; and our interests in social protection.

I pay tribute to all those who work in our health and social care services, regardless of nationality: your dedication and commitment is greatly appreciated and valued. I say to those European citizens from outside the UK: we want you here, we value your contribution and we will do everything we can to ensure that you can continue to live and work in Scotland without detriment.

Scotland has a long tradition of welcoming professionals from overseas to work in our health and social care services. Free movement of labour throughout the EEA has been hugely important in ensuring that we have the skilled workforce that we need to deliver services. As a member of the EU, free movement of labour has not required us to hold information on the numbers of non-UK EEA citizens working in NHS Scotland, other health services and the social care sector. We have estimated, however, that non-UK EU citizens account for approximately 3 per cent of the health and social care sector workforce in Scotland. In 2015, 3.8 per cent of the 3,113 students starting a pre-registration course in nursing and midwifery were from the EEA. That compares with 2.75 per cent in 1998, so it is a growing part of the workforce.

The General Medical Council registered just over 1,100 EEA-qualified doctors in Scotland as of December 2014, from a total of approximately 20,000. Around 1,400 of the non-UK EU citizens licensed to practise by the General Medical Council are currently registered in Scotland—approximately 6.8 per cent of Scotland’s doctors. We are currently working with the Scottish Social Services Council and the Care Inspectorate, and with employer representative bodies, to identify possible approaches to improving our understanding of the numbers and the contribution of non-UK EU citizens to social services in Scotland. Estimates from the annual population survey show that, in 2015, around 3.5 per cent of the workforce in the social services sector as a whole were non-UK EU citizens. We know that non-UK EEA citizens make an important contribution to our health and social care services.

As a starting point, we need to remove the uncertainty for all non-UK EEA citizens who are already working in our health and social care services. It is unacceptable that the UK Government has refused to give any assurances to those workers, many of whom now see Scotland as their home. We will, therefore, continue to press the UK Government for confirmation that workers from other parts of the EEA will be allowed to remain here once the UK formally leaves the EU.

We know the huge challenge that our health and social care services will face in future as demand for services grows. To enable us to meet that challenge, we need to have the workforce available to deliver those services. Our commitment to produce a national healthcare workforce plan will strengthen workforce planning and help us to train and grow the workforce that we need. However, the ever-increasing demands on our health and social care services mean that we will need to retain our ability to recruit and retain staff from inside and outside the EEA.

The uncertainty surrounding the terms of the UK’s withdrawal from the EU, in particular in relation to the free movement of labour, is already impacting on recruitment, with anecdotal evidence that it is making Scotland’s health and social care services less attractive to potential recruits. Unison Scotland recently shared these concerns:

“Unison Scotland is concerned that without free movement of labour, Scotland will face immense workforce planning challenges in the growing health and care sector. We are already unable to recruit and retain enough care workers to fill vacancies and the loss of EU nationals will exacerbate this, particularly in the private residential and home care sectors.”

We want to retain freedom of movement for Scotland, and we will continue to make it a priority in our discussions with the UK Government.

We need to ensure that we can attract and train our future workforce, and that means attracting students to take up training places. Scotland’s medical and dental schools are already concerned about the impact of the current uncertainty on their ability to attract the best students to their courses. We have an enviable worldwide reputation for the quality of the educational experience that we offer. However, the international recruitment market is highly competitive, and there is a real risk that we will lose many individuals if we cannot provide reassurance on tuition fees, free movement and future career opportunities.

We already have non-UK EEA citizens studying and training here. They make a real contribution to our services and they need to feel wanted and valued. I am pleased that we have been able to provide students who are already studying, people who are about to begin their studies and people who are applying to study here from 2017-18 with some reassurance that they will continue to enjoy free tuition for the duration of their studies at our medical and dental schools. Unfortunately, we cannot provide assurances about their future rights to remain here to train and work, and that could have an impact on their future career decisions.

The setting of medical student places is based on the workforce planning needs of NHS Scotland, but let me be clear that there is no cap on university places for Scotland-domiciled students—the Tory amendment is simply inaccurate. Although the Scottish Government sets the annual intake into medicine, the selection and recruitment of students admitted to study medicine is a matter for individual universities. As a result, the exact number of Scotland-domiciled students varies from year to year, but the evidence suggests—and we know this—that Scotland-domiciled students are more likely to stay and work in the national health service in Scotland. For that reason, we are taking measures to increase the number of Scotland-domiciled students. From this year, we have increased undergraduate medical school places by 50, with those places focused on the widening access criteria. The Scottish graduate entry medical programme will add a further 40 places from 2018, which will have a focus on general practice and rurality.

Cross-border mobility and freedom of movement are essential for our health and social care services. Alongside those, we need to have registration arrangements that ensure that our health and social care professionals are fit to practise, regardless of where they come from or where they are qualified. I have recently written to Philip Dunne, the Minister of State for Health, urging him to look closely at every option for maintaining parity of professional qualifications as he goes into negotiations.

That brings me to social protection. The EU has done much to protect and improve workers’ employment rights and to contribute to our vision of exemplary employer practices across health and social care. Examples of positive changes include the European working time directive, health and safety and equality and diversity legislation, and maternity and parental rights. Those things have helped us to deliver improved working conditions for staff, as well as to protect patient and public safety, and we see them as important protections to retain following withdrawal from the EU. We have given our commitment that we want those important social and economic protections to continue; we now need the UK Government to give us the assurance that they will not be removed or lessened following withdrawal.

I will touch on three other areas of my portfolio in which we have real concerns about the potential impact of EU withdrawal, and I turn first to medicine. Being part of the European Union provides us with an established and effective regulatory approval system, ensuring that UK patients benefit from medicines more quickly and that medicines that are researched and manufactured in the UK can be made available in the EU quickly. The UK Government must provide urgent clarity on how Britain’s regulatory system and the relationship with its peers in the rest of the EU will function after Brexit.

Scotland has a long-established international reputation for excellence in health research. A vibrant research sector is vital to addressing our health challenges, to continual improvement of our health and care services and to the development of our economy. In the parliamentary debate on the implications of the European Union referendum for higher and further education on 4 October, the Minister for Further Education, Higher Education and Science highlighted the importance and benefits of EU membership to the Scottish research sector as a whole. I echo those sentiments, which apply equally to health-related research.

The research sector in Scotland has benefited greatly from EU membership. Many researchers in Scottish universities are from EU countries, and Scottish universities have secured substantial funding from the EU’s horizon 2020 research funding programme.

The Scottish Government wants to ensure that Scotland can continue to play a full role in European research programmes and that researchers in Scotland will remain committed to collaborating with our European partners and attracting the best international talent.

Finally, I turn to EU-wide healthcare arrangements. We recognise the considerable benefits of having access to safe healthcare throughout the EEA, whether on a short-term visit, as planned healthcare or for state pensioners living in other parts of the EEA. Therefore, we will make it clear to the UK Government that our citizens must retain their rights in that regard and that those must be treated as a priority in negotiations on withdrawal when they finally take place.

Returning to the central theme of today’s debate, I repeat what I have already said today and on many occasions over recent months. It is a message to those who are working in our health and social care services: no matter where you come from, your work is valued and we want you to stay.

I move,

That the Parliament believes that Scotland’s interests are best served by protecting its existing relationship in Europe, maintaining membership of the single market; recognises the valuable contribution that health and care staff from across the EU, and beyond, make to Scotland; notes that around 1 in 20 NHS doctors in Scotland come from other parts of the EU; resolves to continue promoting Scotland as a welcoming place for Europeans to work in the health and social care sector; is concerned that the outcome of the EU referendum will make it harder to recruit and retain EU citizens to work in health and care services in Scotland, and to study medicine, nursing and dentistry here; deplores the potential threat that Brexit poses to social and employment protection, which are vital to NHS staff; demands that the UK Government stops using NHS staff from the EU as "bargaining chips", and calls on the UK Government to ensure that Scotland is fully involved in decision-making, and in all negotiations between the UK Government and the EU to protect the interests of the health and social care workforce in Scotland.

15:11  

Thank you, Presiding Officer. If I may begin with a general observation, although this is the first Brexit debate that I have participated in, as we all know, it is one of many; in fact, it is the 10th—we are now in double digits, with more to come. Mr Russell’s strained voice last week shows how these endless debates have taken their toll even on his oratorical powers. Maybe they will finally silence him.

While none of us has any doubts about the constitutional importance of the events of 23 June, it is remarkable that, week after week, the Scottish Government insists that we debate motions relating to Brexit rather than on any legislation to improve the lives of people in Scotland. We were all elected in May inter alia to legislate but, half a year on, I have debated not one bill in this legislature.

That aside, I would like to begin by putting on record my recognition of the valuable contribution that staff from across the EU make to the NHS and social care in Scotland. Notwithstanding the challenges posed by Brexit, we must continue to promote Scotland as a welcoming place for Europeans to work.

The UK Government has committed to retain all EU employment protections post-Brexit by incorporating current EU law into UK law, and I note that the Royal College of Nursing’s briefing for this debate states that it is “encouraged” by that commitment.

However, let us not forget either that our own domestic employment law already protects workers who are employed in this country, regardless of their nationality: the law on unfair dismissal, the statutory instruments on transfer of undertakings, the array of trade union laws and, significantly, the Equality Act 2010 and the anti-discrimination legislation that it consolidates are all applied as domestic law, week in and week out, by employment tribunals across the land. I can assure the chamber, from firsthand experience as an advocate, that the rights of all workers are already enforced in our tribunals, applying our law.

Will the member give way?

Indeed.

Does the member accept that some good laws and directives, such as the working time directive, have come from Europe, and that many of us are quite concerned that if we are left to the mercies of our Conservative Government in London, working protection might not be so great?

I simply repeat the pledge that the UK Government has already made to retain all EU employment protections post-Brexit.

Let us keep things in perspective. It is important to understand the numbers involved: of all NHS doctors in Scotland, 5 per cent are EEA nationals. The current estimate is that in the whole health and social workforce, EU nationals make up 3 per cent of total employees. Drilling down to the health service alone, according to the annual population survey for 2015, 3 per cent of NHS workers are EU nationals, but exactly the same amount—3 per cent—are non-EU nationals. The number of EU nationals working specifically in social care, as the cabinet secretary said, is harder to estimate and much of the data is historic, but it is at least notable that in 2008 we were relying more on non-EU nationals in the care sector than on EU nationals. Context is key, so although we welcome the contribution of EU nationals, we should also put on record our appreciation of all staff, wherever they are from.

In preparing this speech, I gave thought to who in the SNP might best appreciate the consequences of Brexit for the NHS social care workforce and the EU nationals who work within it—a wise, seasoned political veteran, who might have overseen the whole health and social care structure while in Government for a number of years; a former health secretary, perhaps. Step forward Alex Neil MSP—except that, last week, we learned that he voted to leave the EU. He must have done so with some kind of understanding of the implications for EU nationals within the workforce. We also learned that he was not alone; at least six other SNP MSPs did the same, apparently.

To SNP members, therefore, I say that, before their usual moralising about Brexit begins, before they trot out the hackneyed line that this exercise in democracy was a reckless gamble, before they line up to call those passionate remain voters among us “born-again Brexiteers”, they should have a care and look around them. How many of their colleagues sitting in the chamber today are secret Brexiteers? The SNP’s supposed united front against Brexit has been well and truly shattered. Alex Neil and his loyal comrades are not just born-again Brexiteers; they were true believers on 23 June, along with approximately one third of SNP voters.

More important, the SNP must not use Brexit as cover for the existing health and social care workforce crisis. As I have said before, the severe staffing problems that we know exist did not suddenly come into existence on 23 June—the recent Audit Scotland report lays that bare. Scotland is 890 general practitioners short of the number that will be needed by 2021. Many staff are close to retirement and those who are left are overworked and under pressure. In social care, there are huge issues with morale and an ageing workforce. The health and social care workforce is in crisis because of nearly a decade of SNP mismanagement, so let us not hear the SNP blame Brexit for its problems or use it as a reason to not take responsibility.

There are positives. Scotland already allows doctors from anywhere in the world to come and work here in shortage specialties, and our exit from the EU will not change that.

I will briefly take the debate wider than just the workforce. Brexit provides opportunities in health. In September, the Health and Sport Committee heard powerful evidence from Annie Gunner Logan, representing the voluntary care sector. When asked about Brexit, she replied:

“When we started talking about Brexit with our membership, the issue that came up first was not the EU national workforce but whether our membership could follow different procurement rules, because people really want to be able to do that.”—[Official Report, Health and Sport Committee, 13 September 2016; c 21.]

One opportunity thus might be a reformed and easier procurement process.

Let us also retain a sense of proportion about other health-related issues. The cabinet secretary talked about the European health insurance card. Switzerland, which is outside the EU and the EEA, uses that card; it is not linked to EU membership. The UK also has similar reciprocal healthcare arrangements with other non-EU countries, such as Australia and New Zealand.

The true picture of Brexit is mixed, rather like in Mr Russell’s recent photograph of West Loch Tarbert, showing the sun’s rays illuminating a heavy Highland shower. That is the image that we should bear in mind—neither doom-laden storm clouds nor endless sunshine but darkness and light, risk and reward, challenge and opportunity. Just as it is incumbent on us not to overplay the advantages of Brexit, so it is incumbent on the SNP not to overplay the disadvantages. We are where we are and, to quote Alex Salmond, we must

“Play the ball as it lies”.

The RCN today calls on the Scottish Government to work together with the UK Government. Likewise, I call on the Scottish Government to engage positively with the UK Government to ensure that the interests of the health and social workforce in Scotland are protected as we exit the EU.

I move amendment S5M-02355.2, to leave out from “protecting” to end and insert:

“maintaining a close relationship with Europe; recognises the valuable contribution that health and social care staff from across the EU, and beyond, make to Scotland; notes that around 1 in 20 NHS doctors in Scotland come from other parts of the EU; resolves to continue promoting Scotland as a welcoming place for EU nationals to work in the health and social care sector; is concerned that, as a result of the ‘capped’ arrangement for Scottish university places for domiciled Scots, there are limited places available for these students to study medicine which, in turn, puts additional pressure on medical recruitment; recognises that the UK Government has committed to retain all EU employment protections post-Brexit and has stated the intention to protect the status of all EU nationals currently in the UK, and calls on the Scottish Government to positively engage with the UK Government to ensure that the interests of the health and social care workforce in Scotland are protected in exit negotiations with the EU.”

15:18  

It is no secret that the health secretary and I have had some disagreements on the management and delivery of our valued NHS, but on Brexit and the potential consequences for our health and social care sector, we are in broad agreement. We can all agree that big constitutional decisions have consequences, so I gently say to ministers that many of the arguments that we will all make today would apply in much starker terms in a debate on independence, but that is not for today.

I will focus on the areas where we have agreement and encourage constructive dialogue in the areas in which that can happen.

I put on record Labour’s recognition of and thanks to our amazing health and social care workforce, regardless of where staff come from. I pay tribute to their dedication and compassion as they go about their day-to-day job of caring for others. I say, directly to each and every single one of them, “Thank you.”

There are lots of uncertain areas, but I think that they fall into three broad categories, all of which were mentioned by the cabinet secretary. The first is staffing. An estimated 12,000 EU nationals work across the health and social care sector, and it is difficult to overstate the contribution that they make; indeed, their role in the workplace is even more important when we consider the extent of the recruitment and retention problems that face the sector.

It is important to note that even before the Brexit vote we were facing a workforce crisis in our NHS—that was laid bare by Audit Scotland. Although Brexit has not caused the workforce crisis, the reality is that it has the potential only to make it worse. There are 2,500 nursing and midwifery vacancies, one in four GP practices has a vacancy, and only a third of NHS staff think that there are enough of them to do their job properly. We know from the Audit Scotland report that that is having a direct impact on patient outcomes.

Therefore, any impact on the thousands of EU workers who are currently employed in the health and social care sector will undoubtedly make the current situation worse. I urge the cabinet secretary and the Brexit minister to continue to press the UK Government to give an absolute commitment to EU nationals who live and work here that their status and position are secure.

Given that the terms of our EU membership are still in place, it is also crucial that employers are given the confidence to continue to recruit staff from the EU and that potential workers can be confident that if they choose to live and work here they will continue to have the right to do so post-Brexit.

I would go further. Given the workforce difficulties that our health and social care sector faces and the importance of staff recruitment and retention, we should argue for special immigration arrangements to be made for the sector, to protect and enhance the NHS workforce.

I also flag up an important piece of work that needs to be done in Scotland well in advance of Brexit, which the cabinet secretary touched on. It is easy to monitor and highlight the staffing crisis in the NHS, but it is much more difficult to assess the situation in the social care sector. In a largely privatised sector, with fragmented data, it is difficult to get an accurate picture of vacancy and turnover rates. I urge the cabinet secretary to commit the Scottish Government to some early work on the issue, so that we can get an accurate and robust picture.

The second category is regulation. In important areas such as the working time directive, procurement and competition law, regulation of medicines and medical devices and regulation to provide for common professional standards and medical education between EEA countries, the UK Government needs to clarify whether its intention is to repeal EU regulations and replace them with UK-drafted alternatives or to continue to abide by EU law.

It is worth pointing out that there might also be opportunities to address the limitations that European procurement law—such as state aid rules and the posted workers directive—has placed on the sector. We must also accept that the EU made a mess of trade deals such as the transatlantic trade and investment partnership and the comprehensive economic and trade agreement, which we should rightly reject. I am concerned that Liam Fox is the individual who is charged with negotiating new deals for the UK.

The third category is research. Collaboration across the EU has enabled the UK to further its scientific research agenda, through our ability to access European research talent and important sources of funding. Between 2007 and 2013, the UK contributed €5.4 billion to EU research and development; over the same period, we received €8.8 billion for research, development and innovation activities here in the UK. We know that many Scottish establishments, universities, companies and individuals play a leading role in research and development. The Scottish Government, alongside the UK Government should prioritise the issue in the forthcoming negotiations.

I am sure that a clear majority of members would rather that we were not in this position, but here we are. We must ensure that the Parliament and all its members are collectively doing all that we can to minimise the consequences of Brexit and to protect our health and social care sector. Scottish Labour is committed to playing its full part.

I move amendment S5M-02355.1, to insert, after “dentistry here”:

“, particularly as the health and social care workforce already face significant challenges, as highlighted in the recent Audit Scotland report, NHS in Scotland 2016, and considers that Brexit will only add to the pressures facing staff”.

We move to the open debate, with speeches of up to six minutes.

15:25  

I welcome the debate, because it is important to highlight that Brexit will have an impact not only on public services in Scotland, but on our quality of life in economic, health and wellbeing terms.

As the consequences of Brexit—especially a hard Brexit—become clearer, we will all be reminded that our lives are going to be affected in ways that, I am sure, many people did not expect. The NHS’s ability to function properly is one example.

The NHS featured in the referendum campaign, but it was a shame that it did so for all the wrong reasons. At the heart of the leave campaign’s misleading assertions was the notorious poster promising UK voters a spending bonanza of an extra £350 million a week on the NHS. That was one of the leave campaign’s biggest promises—one of the many that were abandoned soon after the vote. I note today’s reports that the Crown Prosecution Service south of the border might investigate whether the leave campaign’s assertions about the NHS led to undue influence and violations of electoral law.

Thankfully, in Scotland we voted to remain in the EU, and here we are today, after the UK voted leave and in the cold light of day, debating what leaving the EU means for families and communities the length and breadth of Scotland.

There is no bigger example of something that affects all our lives than the NHS—a precious service on which we all depend from cradle to grave. I expect that the 38 per cent of Scots voters and the 52 per cent of UK voters who voted to leave the EU did not decide to do so on the basis of the impact on the NHS, which, of course, is a pity. Today’s debate is not about focusing on the benefits of Brexit for Scotland’s NHS, because none of us can think of any; rather, it is about focusing on the potential threat now posed to our NHS if Scotland is taken out of the EU against our will, particularly if we lose freedom of movement.

The impact of Brexit on our vital NHS will touch most people’s lives. I often comment that when my two sons were born—one in Aberdeen and one in Elgin—they and my wife were cared for by NHS staff from around the world, including from many EU countries. It felt like the United Nations brought my sons into the world, because so many different nationalities were in the hospital theatres at the time.

I had cause to take one of my sons to Dr Gray’s hospital in Elgin earlier this year after he was sent home from school having suffered a knock to the head during his physical education class. He was treated by a Lithuanian doctor and a Polish consultant. I was grateful to all the staff who were there to care for my son; I was grateful that those doctors made the decision to live and work in Scotland and in Moray.

Each and every day, thousands of families are very grateful and lucky that so many talented and hard-working doctors and nurses from the European Union have chosen to live and work in Scotland. They have chosen to pursue their careers in the Scottish NHS—in our hospitals and GP and dental surgeries, where they can apply their expertise to heal and to care for our population.

If Brexit means that there may well soon be obstacles in the way of EU nationals moving to our country or working here for a period, it is no wonder that so many people and organisations are speaking out about the dangers of Brexit and what it will mean for the NHS in the years ahead. The UK must heed the warning of the Royal College of Nursing, for example, which in The Independent this week said:

“The NHS would struggle to survive if there was a mass exodus of staff as a result of a hard Brexit deal”.

That applies to Scotland as much as it does to the rest of the UK.

It is important to recognise that EU nationals want to work in the health service to develop their careers; it is also important that they feel welcome. There is no doubt in my mind that a hard Brexit will make it even more difficult to recruit medical professionals to work in more rural areas and in our smaller hospitals. It is already a challenge to attract staff to work in areas outwith our biggest cities and university hospitals without further reducing the pool of potential applicants.

I have been heavily involved in a number of issues at Dr Gray’s hospital. It has vacancies that have been unfilled for some time, although some of them have been filled recently by EU nationals from Poland and elsewhere. Like many people, I am concerned about a hard Brexit if desperately needed applications from EU nationals dry up.

Richard Lochhead talks about the dangers of a hard Brexit. Can we infer from that that he is in favour of a soft Brexit, and was he therefore one of the six?

I voted to remain in the EU for many reasons, including ensuring that there would be no impact on the NHS. The Conservative Party—particularly Theresa May, the UK Conservative Prime Minister—must accept that even the 38 per cent of Scots who voted to leave the EU did not expect a hard Brexit. They did not expect us to walk away from Europe; they did not expect us to inflict all the damage that the Conservatives seem happy to inflict on public services in this country.

We must send out a message to consultants, medical professionals and nurses throughout Europe that they are warmly welcome to apply for jobs in this country. I support the Scottish Government’s decision today, with the Lord Advocate announcing that the Scottish Government will intervene in the UK Government’s challenge in the courts regarding article 50 to ensure that the Scottish Parliament has a say over the triggering of article 50. We must protect Scotland’s interests and, in the context of this very important debate, protect Scotland’s national health service.

15:30  

We should all acknowledge the dedication and valuable contribution of all who work in our health and social care services, regardless of where they come from, and we should thank them for that.

Although we have again heard a lot of rhetoric from the SNP today, the UK Government has made it clear that, while the UK remains in the European Union, EU nationals living in Scotland will continue to have the same rights as they have now. The Prime Minister has also made it very clear that the UK Government wants to protect the status of EU nationals living in the UK. The only circumstance in which that would not be possible would be if British citizens’ rights in other EU member states were not protected in return. I am sorry to say that we have not heard any comment on that issue from SNP ministers today, nor have we heard how they are supporting the work of the UK Government to protect the rights of Scots living and working across the EU. The situation is clearly interlinked.

I will focus my comments on the specific issue raised in the Government’s motion regarding the impact that the UK leaving the EU may have on those who are looking to study medicine, nursing and dentistry in Scotland.

It is a bit rich of SNP ministers to shed crocodile tears for the future of our NHS workforce and to express their concerns for those who are looking to study in Scotland, given the SNP Government’s record. I refer specifically to its education policies, which, as a direct result of higher education funding structures, mean that Scottish universities have too little flexibility when it comes to the provision of places for Scotland-domiciled students. The cabinet secretary has said that that is not the case. Perhaps she does not read the Press and Journal. The University of Aberdeen has been forced to admit that it is turning down students because of the SNP Government’s policy. The chairman of Universities Scotland has called on the Scottish Government to increase the quota of Scots who are allowed to go to university in Scotland. The cabinet secretary might not want to call it a cap, but there seems to be a quota in the SNP’s world.

Will the member take an intervention?

Yes.

Cabinet secretary—sorry, I mean minister; I promoted you.

I thought you would eventually, Presiding Officer.

Will the member tell us whether any restriction on numbers applies to any medical courses in England and Wales? A yes or no answer will suffice. If there was no such restriction, his point would be fine; however, there is. What the Scottish Government does is what every Government does: it funds available places.

I thank the cabinet secretary for his intervention—sorry, I mean the minister; I, too, am promoting Mike Russell, and that is not something that I would want to do.

It is clear that the decisions that the minister made mean that universities across Scotland have to fund themselves by charging international students. He knows the consequences of the decisions that he made.

The fact that we are facing a crisis in the NHS workforce is because of—not despite—the mismanagement of the health service by the SNP Government. The political decisions that it has made have had consequences, both intended and unintended, for future NHS workforce planning, from the decision by the First Minister, when she was the health secretary, to cut the number of student nurse placements to the education policies that the Government has pursued, which have seen the number of Scotland-domiciled medical students decrease to a historic low of just 52 per cent.

I agree with my fellow Health and Sport Committee member Richard Lyle, who has continually questioned the reductions in the Scottish medical school opportunities that are offered to young Scotland-domiciled students. A direct consequence of the capping of the number of places for Scots students at Scottish universities is that an increasingly limited number of places are available for Scottish students to study medicine, which, in turn, is adding to pressures around medical recruitment. It would be helpful if, when he closes the debate, the minister could say whether the Scottish Government will review the situation.

Like many Scots who voted for the United Kingdom to remain in the European Union, I was disappointed with the result of the referendum—

Will the member take an intervention?

I am sorry—I do not have time.

However, as a democrat, I respect the result of the vote. Democracy is all about how we put our arguments to the people and the manner in which we live by their decisions. As we are finding out, many SNP MSPs privately voted to leave, and I hope that they now see the need to work together to make a success of the UK leaving the EU and to help to forge new relationships that work for Scotland and the UK.

From the discussions that I have had with those who work in our health service and their representative bodies, I know that they are clear in their belief that Brexit presents significant challenges, but neither they nor Conservative members will let the SNP use Brexit as an excuse for the existing challenges that our health service faces.

I have listened intently to each of Mike Russell’s weekly contributions to the Brexit-themed debates. He recently accused my colleague Murdo Fraser of sounding like Pike from “Dad’s Army”, but Mr Russell is starting to sound increasingly like the Grinch.

I do not doubt that the UK faces very serious challenges. It is for that very reason that we must come together and work together as a United Kingdom. The question that people are increasingly asking themselves is this: when did the SNP give up on believing in the people of Scotland to face those challenges? Great countries come together to turn challenges into opportunities.

The Scottish Conservative amendment calls on the Scottish Government

“to positively engage with the UK Government to ensure that the interests of the health and social care workforce in Scotland are protected in exit negotiations with the EU.”

We will work week in and week out to make sure that that is achieved.

15:36  

The debate is arguably one of the most important debates that I have contributed to, yet I feel—in common with my Conservative colleagues—that it should not be necessary. It should not be necessary because we should be able to assume that those who treat us when we are sick are valued. We should also be able to assume that those who care for the disabled and the elderly are valued and that the contribution of our EU workforce to health and social care and to our society as a whole is valued, but the fact that we are debating the issue shows the challenge that we face in defending the new Scots who have come from other parts of the EU and made our country their home.

We are told that Brexit means Brexit, but what kind of Brexit will we have? As a pharmacist, I find myself wondering about the implications for drug development, research and access to new medicines. Will the reduced mobility of EU researchers into the UK reduce our capacity to do high-quality work? Will there be fewer opportunities to build high-level collaborations and to share knowledge? Will we still have access to EU-funded research facilities? What will happen to medicines regulation? Will our drugs still be licensed through the European Medicines Agency? Will the new clinical trials regulations that are set to be introduced in 2018 apply here? Will new drugs cost us more and come to us late because of our departure from the EU? Will the UK pharmaceutical and biotech industries still have access to European markets?

Six months on from the vote, we still have no clear idea of the answers to those questions. Six months on, the EU citizens who live here still have no clear idea about their future.

Of the doctors who work in the UK, 6.8 per cent gained their primary qualification in another country in the European Economic Area, 6.6 per cent of pharmacists did the same, and the figure for nurses is probably similar. When we look at social care workers, the numbers are much higher, particularly in care homes. Even more people come from outside the EU. According to some estimates, nearly half the people who work in our nursing homes are not from the UK.

Anecdotally, I hear that in the Highlands and Islands—the area that Donald Cameron and I represent—we are particularly dependent on European medical staff. The health boards have had recruitment drives in Spain and Holland to attract highly qualified individuals to work in places where it has been hard to recruit home-grown doctors. All the consultants in one Highland hospital are European, only one consultant in the Western Isles out of a total of 14 is a Scot and one in four of the doctors in Shetland is European.

I talk about anecdotes and I use the word “estimate” because we have little data. Until very recently, it did not matter where someone was born or did their training—if they were registered in the UK, they could work in the NHS. We did not count the foreigners who worked in each health board. I want us to remain that kind of country. I feel ashamed of what we have become and of the xenophobic rhetoric that I hear. I cannot believe that we now have to stand up to defend people who make such an obviously valuable contribution to our society, but that is the grim reality of the Brexit world.

Unlike my colleagues, I cannot detach myself personally from the argument, as I worked in the NHS until this year and have a great many friends from other EU countries who work in the NHS. This is a really important point in the debate for me, because those people are not strangers but our friends and colleagues and sometimes our families, and they are vital members of our communities.

One of my childhood friends is now a midwife. She travelled the world but came back to the Highlands to work first in a hospital and now as a community midwife and to raise her family here with her Dutch husband. I spoke to her when I was preparing for the debate. She reminded me that it is not just about the health professionals but about the healthcare assistants, the auxiliaries, the students, the ward clerkesses and the porters, many of whom are EU nationals and all of whom help our NHS to run efficiently. She told me about the Polish mums who she looks after, nearly all of whom work in care homes. It is not just the vital work that they do that we value; we also value the contribution that they are making to Highland village life.

The fact that those women and, in fact, my friend and her family are being used by Theresa May as a bargaining chip in the Brexit negotiations is not just wrong: it is offensive. I know that it seems incredible, but my Scotland-born friend is feeling uncertain about whether her family are welcome here; that is how it is. Theresa May must put an end to that uncertainty and provide EU citizens with assurances that they will be allowed to live and work in the UK following Brexit. The UK Government’s failure to give assurances is clearly damaging to the NHS and to the communities that we live in, and the UK Government must end that uncertainty.

15:42  

Sadly, the greatest lie of the referendum campaign was about investment in the NHS—it was the promise that leaving the EU would lead to investment of £350 million a week in the NHS. Most of us knew that that was fantasy the moment that it was spoken but, unfortunately, some believed it to be true.

Sadly, the term “post-truth politics” is now recognised as a modern-day concept. It means that people believe little of what politicians say, which demeans all of us. How can we empower people to make informed decisions but allow them to be fed misinformation? It is incumbent on all of us to inform people of the facts and convince them of our arguments on the basis of those facts and by explaining why we reached our opinion on that basis.

No politician has a crystal ball and politicians cannot know how things will change in the coming years, but they can be honest about how changing challenges change approaches. These weekly EU debates in the chamber show us that we are so intertwined with the EU that breaking the links will be difficult. There are also other problems to be faced that no one foresaw.

The remain campaign should have done more to make people aware of the challenges. During the campaign, Nicola Sturgeon called for a positive campaign. She told us to stop talking about the risks of leaving and talk about the benefits of staying. These chamber debates are now highlighting the risks of leaving the EU, but it is too late.

We hope that EU nationals who work here and UK nationals who work abroad will be allowed to continue to live where they are. EU nationals make a huge contribution to our country, which we value, and we want them to stay. In addition, we cannot make judgments about migrants who might come and work here in the future. Do we really want to lose their expertise as well?

Our health and social care services need those skills. NHS Highland has difficulty in recruiting consultants and general practitioners, and recently it advertised such posts in Holland. Inverness has daily flights to Schiphol, so it is easily accessible for Dutch nationals to work here and be accessible to their family and friends back at home. The last that I heard was that the approach was showing signs of success.

Our amendment adds to the debate by pointing out the challenges that already exist in health and social care service provision, as highlighted by Audit Scotland. Those services will face further problems if EU nationals cannot continue to work here.

Obviously, we hope that EU nationals will be able to remain and continue to make their homes here. However, we also need to be able to recruit workers from the EU and beyond, and we need UK citizens who live in the EU to be able to continue to make their homes there and have the same security as we wish to give EU nationals here.

We want EU legislation that protects workers’ rights to be enshrined in UK law, such as the working time directive, which has only just begun to protect junior doctors from being exploited in the NHS. When the directive became law, there was a degree of consternation as to how our NHS would fare without junior doctors working unbelievably long hours. Now, we all recognise that that system was wrong for both patients and doctors. The NHS workforce also benefits from other social chapter rights such as equal pay and paternity leave. We take those things for granted, but they will have to be enshrined in our laws.

We benefit from other aspects of working together and collaboration that go beyond workforce issues. We share knowledge of diseases and how to tackle them through the European Medicines Agency, which is to become a single point of entry for drug trials throughout the EU in 2018. The King’s Fund has pointed out that patients in the UK stand to lose out on new drug trials because of Brexit, which will delay access to new and innovative treatments. We will also lose out on the sharing of data and information at a European level and on the possibility of bargaining with large pharmaceutical companies on a collective basis in the EU.

Other members have talked about the European health insurance card. Our citizens will be affected by the loss of that, too. At present, they have the security of the card and can travel in Europe safe in the knowledge that they will get reciprocal healthcare wherever they are. The loss of that card will impact on many Scots when travelling abroad and especially on older people, who maybe cannot afford to take out travel insurance. That might prevent them from going abroad on holidays.

Given that the additional funding for the NHS that the leave campaign promised was at best a pipe dream, it is hard to see how our health service can benefit from Brexit at all. Brexit throws up challenges at a time when the NHS is least able to cope with them. It is important that both our Governments recognise that and do their best to support the NHS through these turbulent times, both with legislation and by attracting the best people to work here.

15:48  

Every picture tells a story, and a photograph that was published shortly after the EU referendum vote tells the story of the vital contributions that EU staff make to saving lives in our NHS. The photo, which appeared on social media, was taken by a surgical team at a hospital—it is a kind of giant selfie. Each member of the team is holding up a placard, and the placards say, for example, “Irish radiographer”, “German consultant anaesthetist”, “Spanish scrub nurse”, “Greek urology registrar” and “British Pakistani consultant urologist”.

For many people, that photograph, which was widely shared, encapsulates the contribution of EU staff in human terms. It was taken in a London hospital but, as other contributions to the debate have shown, those people in their blue scrubs could be from any hospital in Scotland or across the UK.

Mr Cameron implied in his opening speech that Brexit offers opportunities to non-EU doctors from overseas, but it seems to me that the rhetoric from other Conservative politicians has been not just about wanting to get rid of EU medical staff but about pulling up the drawbridge on overseas staff as a whole.

During the Conservative Party conference, Theresa May gave an interview in which she said that the NHS would be made self-sufficient in doctors. When she was asked about reassurances for foreign-born NHS staff, she replied:

“There will be staff here from overseas in that interim period until the further number of British doctors are able to be trained”.

How insulting is that to the people who work so hard in our NHS? Our First Minister put it well—when she saw that interview, she tweeted:

“The arrogance of this from”

the UK Government

“is breathtaking ... like they’re somehow doing these doctors a favour by ‘allowing’ them to save lives here.”

That sentiment from the First Minister was echoed by Sarah Wollaston, who is a Tory member of Parliament, a GP and the chair of the UK Parliament Health Committee. She was shocked, too, and she said that Theresa May should

“unequivocally welcome our valued overseas health & care staff. We all benefit from their skills”.

In the European referendum, Scotland voted unequivocally to stay in the EU. That indicated support for European membership that was largely predicated on the desire to live in an inclusive society that is based on respect and rights for all workers, regardless of where they were born. Like the vast majority of people in this country, I recognise and value the immense contribution of EU nationals throughout Scottish society and not least the role of highly skilled European workers in the health and social care sector. There is widespread recognition of the valuable role that EU nationals play in Scotland’s social care sector specifically.

In the more rural areas of Scotland, such as my Dumfries and Galloway region in the south of Scotland, the challenges that we face in the recruitment and retention of health and social care staff to serve a highly dispersed and ageing population are, according to the Auditor General for Scotland, no different from the challenges that are faced across the UK. EU workers are not only welcome to be part of that provision in my part of Scotland but are in fact badly needed.

In its submission to the Culture, Tourism, Europe and External Relations Committee, which I convene, the Health and Social Care Alliance Scotland highlighted findings from a survey of its members. A significant majority of those who were surveyed—69 per cent of them—thought that Brexit would have a negative impact on health and social care in Scotland. Many respondents highlighted their concerns about the potential loss to the workforce. One response noted:

“It is hard enough now to find sufficient qualified staff and without EU migrants we will be struggling more.”

The British Medical Association has pointed out that the policy of freedom of movement and the recognition of qualifications across EU states allow health and social care professionals to work in the UK and vice versa. The mutual exchange of skills and staffing would allow us to secure future standards of living by growing our population and addressing the skills gap to support an ageing demographic.

The Royal College of Nursing outlined in its submission to the committee that Brexit could jeopardise the free movement of nursing staff from the EU. The European professional qualifications directive sets out the legislative framework for the recognition of certain health professional qualifications. Without that, Scotland might be unable to accept the qualifications of overseas workers who want to work in our NHS and elsewhere.

It is worth emphasising that, despite Scotland’s overwhelming support for continued membership of the EU, the Conservatives’ Brexit gamble has already damaged our devolved infrastructure by undermining staff who work in the caring professions. The reactionary rhetoric and deep political and economic uncertainty from Westminster will inevitably impede our efforts to recruit and retain EU citizens to work in Scotland’s care sector.

That is why I urge the UK Government to guarantee residency rights and to desist from Theresa May’s frankly repugnant policy of using EU nationals as Brexit bargaining chips or, as Liam Fox described them, cards to play with. Our European workers, who have made lives and paid taxes here, are not chips or cards. They deserve at least the courtesy of a reassurance that they will be able to continue to live and work in Scotland and elsewhere in the UK and, in the case of NHS workers, to continue to save lives.

15:54  

It was my privilege for most of the past nine years—with one small interruption—to speak on health matters in Parliament. I hope that I have contributed to a change both in the substance and the tone of the Conservative approach to health.

I became slightly concerned about the almost routine rhetoric of thanking health staff in the chamber because it came to me that many of them are far too busy to sit and listen to our thanks. What they want is action by Parliament to address the very many problems that exist in the health service. However, today I have no hesitation in thanking everyone who contributes to our national health service, from wherever they come and whatever role they perform. It should be the objective and policy of Parliament that they remain able to do so for as long as they wish to do so.

In those nine years, I was able to stand against three cabinet secretaries for health. I am sure that the current front bench and Bute House will agree that the most outstanding of the three was Alex Neil—a man of real intellectual rigour and capacity. I know that he would be dismissed by his colleague on the front bench now as a born-again Brexiteer. I understand that Mr Neil and six others—the seven samurai of the SNP—are now cutting through the seven veils of Scotland’s own Evita, Nicola Sturgeon. Perhaps they are better described as Alex Neil and six ninjas, because some of them have the courage of anonymity in respect of how they voted. Of course, we know that they could be any Tom, Dick or Harry—or, as we say in these parts, any Tom, Dick or Gil. However, I do not believe everything that I read in the newspapers, so I will leave it for them to say.

The minute that Mr Neil left office, the first staff satisfaction survey after he ceased to be health secretary showed staff satisfaction and morale plummeting across almost all the indices against which they were being recorded, so I thank him for the service that he gave.

I agree with Donald Cameron and Miles Briggs that workforce planning is a fundamental to the overall sustainability of our NHS. I also agree with Maree Todd—who made an excellent speech—that the place and importance of the international workforce in our NHS are fundamental.

It is interesting to hear members mention “bargaining chips”. I look to the independence referendum, when Nicola Sturgeon was asked what would happen in the event that Scotland did not have automatic membership of the European Union. She said that if Scotland was to be outside the EU, the

“160,000 EU nationals from other states living in Scotland ... would lose the right to stay here.”

What did that mean? What did it mean at that point? Was she threatening—as is implicit in that statement—that they would have to leave? I think not, but it is important that others recognise that the lazy rhetoric on this issue is deeply unfortunate.

Of course, a significant number of European nationals work in Great Britain. There are 3.3 million of them—173,000 are in Scotland, many of whom work in the health service. However, I am also concerned about the 1.2 million British citizens, including 120,000 Scots, who live across the rest of Europe. There are 309,000 in Spain, 255,000 in Ireland, 185,000 in France and 103,000 in Germany. None of the Governments of those countries has given a unilateral declaration that Scots who are working in health services across the rest of Europe will have a unilateral right to stay. We need a universal commitment from all the states of the European Union and the United Kingdom that wherever someone is currently working or living, they will be welcome to stay and welcome to continue to work.

Does Jackson Carlaw accept that one of the reasons for the uncertainty on both sides is the unnecessary delay in starting negotiations and the UK Government setting out its position?

It is important that that is one of the first issues that will be addressed when the negotiations begin. I understand that David Davis has made that commitment. I agree that the matter has to be resolved—and resolved as quickly as possible.

Why do we need so many people in our health service? I will not rehearse the statistics that were evidenced by Miles Briggs a short while ago and with which I agree. We have only to look at the demographics of Scotland for the next 25 years. It is estimated that the number of people aged 65 and over will double in the next 25 years, while the percentage of people of working age is expected to remain as it is today.

If the infrastructure of our public health services—all our public services—is to be sustainable and to succeed in the future, whether we are in the European Union or out of it we will have to attract into Scotland foreign nationals from across the world, as well as the EU, to assist us in that task. Any strategy or agreement that fails to do that would fundamentally undermine our ability to function as a country.

Mike Russell has written a letter to Joan McAlpine saying that he will attend a joint ministerial committee this week and he hopes that matters of substance will be discussed. When the Secretary of State for Scotland gave evidence to the Culture, Tourism, Europe and External Relations Committee, he indicated that market access will be one of the issues on the table. Unlike UK Cabinet ministers historically, Liam Fox and David Davis have both agreed to come to the Scottish Parliament to give evidence to the committee, so Parliament will be able to question them.

It is absolutely important to conclude, just as Shona Robison did at the end of her speech, with this clear sentiment: we, too, thank everybody from across Europe who works in our health service and contributes to public services. We want you to stay and we are determined that you will.

16:00  

I rise to offer the support of Liberal Democrats for the emerging cross-party consensus in most of the chamber that the EU workforce, whether in our health service, social care sector or any other profession, is welcome and, indeed, absolutely vital. Throughout the health and social care sector, they give us life-saving care, they make decisions with us about our continuing treatment, they tuck us in at night, they dispense our drugs and they stand by our bedsides at our most vulnerable times. Already, the Brexit vote—that multifaceted act of political vandalism—has resulted in interest in coming to work here among people in other EU countries fall off a cliff edge. Many people view being spoken about as a “bargaining chip”—that horrendous term—as a disincentive to a career and a life in Scotland.

That uncertainty and reluctance to come here could not come at a worse time. In many ways, we are facing a perfect storm in our health and social care workforces. By the end of the decade, we will have 850 fewer GPs than we require. Vacancies for social care nurses are at 28 per cent—almost a third of posts. There are issues with paediatricians, midwives, nurses, physiotherapists and child psychologists. The list goes on. Any of my opposite numbers in the other political parties will attest to the steady stream of representations that we receive from various arms of the health and social care sectors to tell us that the workforce is in crisis. However, at the Health and Sport Committee a few weeks ago, I twice asked the cabinet secretary whether there is a crisis and twice she denied that there is. According to the excoriating report from Audit Scotland, “NHS in Scotland 2016”, it is clear that the Government is wholly unprepared for the staffing crisis that is before it.

I am sorry that I am a wee bit hoarse. Can the member clarify where in the Audit Scotland report the word “crisis” appears? I have looked for it and I cannot find it?

That is exactly what happened in the Health and Sport Committee. That is SNP doublethink. The eyes of an entire profession are looking to the SNP Government for solutions to the demonstrable decline in the workforce across every health service sector, and people are finding the Government wanting. It is time to stop arguing about terminology and to take action.

Workforce planning was cited in the Audit Scotland report, which bemoans the fact that in this country we do workforce planning over five years, although it takes seven years to train a GP. Five years ago, that workforce planning cycle led to decisions being taken by the then health secretary and now First Minister, Nicola Sturgeon, to roll up training places and to cut midwifery training places by more than half. As a result, we are facing a workforce planning crisis because of retirement.

Given that European citizens make up such an indispensable part of our workforce across the health sector—for example, they make up 6.8 per cent of GPs, as Maree Todd said in her excellent contribution—we should not only try to protect their status in this country but aggressively try to recruit others from their countries of origin.

There is a human cost to the workforce crisis, and European citizens can and must form part of the solution. Last week, I spoke at length about George Ballantyne, who is a constituent of mine. I hope very much that he will return home tomorrow after 150 nights in hospital following the point at which he was declared fit to go home. On the three previous occasions when he was told to prepare to go home, his social care package failed—through lack of staff and lack of availability of care—and he remained in hospital. The reality that is the 28 per cent rate of vacancies in the social care workforce has a material impact on our efforts to eradicate delayed discharge from society. I share the cabinet secretary’s desire to eradicate it. When Mr Ballantyne goes home, he will go to Ladywell medical practice in Corstorphine in my constituency, which is already on its knees through a shortage of doctors.

The evidence is that the European Union has provided us, time and again, with hard-working, compassionate and dynamic individuals, who are a credit to their countries of origin and to the professions that they serve. We should all be justifiably proud of the contribution that they make to our society and of the fact that they have chosen to settle in this country. As such, we must protect them and we must encourage more of them to come here.

16:06  

I am happy to speak in today’s debate about how we value our fellow Europeans who work in the health and social care sector. Some issues that we can consider this afternoon are specific to that sector, but there are other points that we can make on the broader issue of EU employees in Scotland.

There are a number of reasons why it is beneficial for workers to be able to move freely across borders. The most obvious reason is that a country such as Scotland is short of workers for the long term because of, for example, an ageing population, and it needs to bring in people to supplement its workforce. That point has already been made in the debate.

Secondly, needs vary in different countries at different times; for example, the German population is expected to fall while the UK population is expected to rise. Health and other workers might be needed in one country at one point in time and needed in another country at a later or earlier time.

Thirdly, we can benefit from different experiences and practices from other countries. We hear of the benefit of workers coming from other countries to work in a range of sectors in Scotland or the UK. One of the groups that I have spoken to most recently is the Federation of Master Builders. Its experience has not been merely that a Polish worker can fill a job, but that bringing a number of Polish workers into a business can change the whole ethos of the business through new ways of doing things and a better work ethic. Schools also talk about their experience of young people and families from other cultures coming in with a hunger for learning.

There is every reason to think that the health sector is the same. We have great Scottish staff and a lot about our NHS is great, but we must not be narrow nationalists, as some of the British are. We can learn to do things better and, in restricting workers coming from elsewhere, we are in danger of losing out on their expertise.

Fourthly, linked to that is that many health professionals want to gain experience for the benefit of their own careers by working in different countries. I have one friend who works as a GP and also specialises. He has had spells working in Australia, Scotland and England and is looking at working in Sweden for some specific experience there. That is not so unusual these days. We live in a world in which young people, especially, think in an international way and look to work in a variety of settings for career and general life experience.

Those are some of the reasons why it is a good thing for people to be allowed to have flexibility in working across borders. Other questions that we face today include how many non-UK EU citizens work in health and social care in Scotland right now. How dependent are we on them? Can we continue okay if all or some of them leave? The answer seems to be that we do not know. I think that it is worse to know that we have a problem but not to know the extent of it than it is to know the details of the challenge that we face.

In their briefings for today’s debate, Unison and the RCN say that estimates of staff numbers from EU countries are not reliable. I find that uncertainty about the figures to be very concerning. How can we really know the impact and the challenge that lie ahead if we do not clearly know how many EU folk we have?

There is more to the matter than numbers, however. This morning, the Economy, Jobs and Fair Work Committee heard that the message that the UK is sending out is important, too, whether it is to students, academic staff, construction workers or health and social care workers. That is the point that the RCN makes in its briefing when it says that

“EU staff may choose to leave the UK due to the uncertainty created before new rules are put in place.”

The briefing continues:

“It is important EEA health and social care workers continue to feel valued as we enter this period of uncertainty.”

Are we saying, “Yes, you are very welcome here and we really want you to work here, send your kids to school here and be part of society,” or are we saying, “Technically, you’re entitled to stay here or to come here and work, and our economy and public services really need you, but actually we’re inviting you grudgingly, because we don’t really want you to be here and we certainly will not be doing anything to make you feel welcome.” There is a big difference between those attitudes, and that feeds into the problem with the Conservative amendment today. It says that the UK Government

“has stated the intention to protect the status of all EU nationals currently in the UK”.

Those words look reassuring but, behind them is still the sense that those EU nationals are not wanted.

Others have mentioned the good moves on the part of the EU, including the European working time directive. The hours that junior doctors have had to work, which Rhoda Grant referred to, have been absolutely scandalous. I very much fear for the direction of employment law in the UK without our European friends and colleagues keeping an eye on us.

We can debate the numbers and technicalities for a long time, and I am sure that we will do so in the coming months. However, today, I hope that we can send a message to all those who work in our NHS and beyond that we hugely value their work, whatever their nationality, and that we very much hope that they will stay.

16:12  

Like a couple of members of other parties, I regret that we do not, as the gloom gathers outside, have the colour of Alex Neil to add to the debate. As a former health secretary, he could have brought to the debate a wealth of experience. Further, given his recent announcement that he was belatedly a Brexit supporter, he could have brought a different perspective.

I do not have a tremendous issue with what Alex Neil said about Brexit, although I do not agree with it. He at least reflects the reality of the fact that 36 per cent of the SNP’s voters voted to exit the EU. The reality across political parties is that although all our members belong to one political party, there tend to be disagreements. It would be good if we are entering a new period of SNP glasnost, as we see things beginning to open up. That could only help the debate.

It is right that members have welcomed the positive contribution of NHS staff—and of EU staff in the NHS. After all, there are 181,000 EU nationals in Scotland and, as the motion notes, one in 20 NHS doctors is from an EU country. There is a real element of sharing. People come here and make a contribution to the Scottish economy, not just in the health service but elsewhere, but they also benefit from the fantastic staff that we have in the health service and other services. That is something to be celebrated.

However, it is also important that, as last week’s Audit Scotland report noted, the national health service in Scotland is stretched. That the NHS has failed to achieve seven of eight of its key performance indicators shows that there are serious issues to be faced. The growth in the number of outpatients on waiting lists from 234,000 to 275,000 also indicates that there are issues.

We must question what benefit cuts, at NHS board level, of nearly £500 million will give to the service. One example is Lightburn hospital, which provides a service—a dedicated Parkinson’s service in particular—to many pensioners in the area. If the hospital closes, that will be detrimental to the overall service.

There is another aspect to the debate. People are right to compliment the NHS. In an excellent speech, Richard Lochhead celebrated the way in which the NHS has been beneficial to his family, and the contribution of EU nationals to that. The Government sometimes downplays the impact of Brexit on its areas of responsibility. There are some real issues coming down the line in relation to health aspects of the Scottish budget. Yesterday’s report from BDO LLP indicates that inflation will continue to rise, which could undermine growth in the Scottish economy. We are getting more powers and an opportunity to raise more through taxes, but lower growth could lead to real pressures if tax revenues go down. The NHS budget makes up 40 per cent of the overall budget, and 55 per cent of that is wages, so there is the potential for prices to rise faster than people’s wages.

People are right to celebrate the NHS and the contribution of EU nationals, but we must also look at the issues coming down the line in the Scottish budget and the impact that they will have on the NHS. If the service continues to be stretched, as the Audit Scotland report noted, and the older demographic continues to grow, there will be real challenges.

People are right, in debates on the EU, to voice their concerns about Brexit and the UK Government’s approach, but we need a more comprehensive debate on the response of the Government and Parliament to the issues that confront us directly. I hope that members bear that in mind for future discussions.

16:17  

Like many in the chamber, I woke on 24 June to discover that the UK as a whole had voted to leave the European Union and that Scotland had overwhelmingly voted to remain as part of the EU. The lack of a coherent plan by those who had led us a merry dance towards an economic cliff edge quickly became apparent to all. The major players on both sides of the debate quickly exited the stage and questions about what happens next were met with “Brexit means Brexit” and little other explanation.

Perhaps the cruellest thing to happen since the vote has been the upsurge in racial attacks on our European brothers and sisters who have made this country their home—thankfully, much less so in Scotland than in the rest of the UK, but one attack is one too many. To compound that, EU citizens have become bargaining chips in a game of brinkmanship yet to be played out between the Westminster Government and the EU. They are left with no certainty about their future here and about whether they will be welcome to continue to build their lives here. That is just plain wrong.

We face challenges in recruiting and retaining staff in our health and social care sector. At last week’s Health and Sport Committee, we heard evidence from a number of sources about recruitment and retention in the health and social care sector across Scotland. Unison Scotland alone estimates that it has 6,000 members who are EU nationals, many of whom work in home care or care-at-home settings. Those workers care for some of the most vulnerable in our society, ensuring that our older adults can remain at home; giving respite to carers so that they can have some quality of life while still looking after a loved one; and helping families with disabled children so that those kids and their siblings can have parents who are not exhausted and drained by the circumstances in which they find themselves.

Those are areas in which we need to grow our workforce, not contract the pool of workers from which we can draw. The current uncertainty around the status of EU nationals does not help with growing the workforce to the levels that we require. We heard evidence from professional bodies, trade unions and health and social care providers. When we asked them about the effect that Brexit could have on their sectors, we heard warning after warning and profound concerns about the effect that it could have on our health and social care workforce.

There are concerns from others that Brexit is already impacting on recruitment and retention in the health and social care workforce. There have been reports of EU citizens looking to move back home or to other EU countries for work. Highly trained health and social care professionals are in great demand worldwide and there is no shortage of opportunities for them. There are also reports of a major national organisation closing its recruitment office in continental Europe following the sharp downturn in people trying to access healthcare employment in the UK.

In my constituency of Rutherglen, I was recently approached by a constituent who holds a senior management post in a local care home. My constituent expressed grave concerns about the impact that the vote to leave the EU has had on a significant section of his workforce. Nationals from several EU countries are employed in various caring and support roles at that local nursing home. They are worried that they may not be allowed to stay in this country, a place that they have called home for many years, but the impact of any change in their circumstances runs much deeper than that.

Many of my constituent’s colleagues are long embedded in their local communities, with children attending nurseries and schools, involved in clubs and local activities, learning and passing exams and working towards contributing to our workforce and society in the future. Through no fault of their own, those people are now faced with a level of uncertainty that is unfair and, quite frankly, cruel. Many are contemplating the prospect of having to leave Scotland and possibly uproot their families. Given that the Health and Sport Committee was told only last week that the health and social care sector will have to recruit up to 60,000 care workers to meet increasing demand in the future, we can ill afford to lose a significant number of the dedicated workforce who are already in place.

I do not wish to sound as though this is a one-way street, where we are interested only in our own selfish needs to have our hospitals and care homes staffed. Yes, it is imperative that we address the challenges that the sector faces in attracting staff to meet health and social care requirements in the future. However, that will involve ensuring that jobs in the sector are valued and attractive roles for everyone; that there are adequate training and development opportunities for staff; that staff are paid at least the Scottish living wage; that we strive to eradicate exploitative zero-hours and nominal-hours contracts from the sector; and that we have fair and equitable terms and conditions, including sick pay, travel time and annual leave.

Sadly, the Health and Sport Committee took evidence that indicates that in some cases workers’ rights in the sector did not meet what we would regard as basic entitlements. Of course, many core rights and protections are guaranteed by EU legislation. A Brexit solution that drags us out of the single market threatens those protections and, coupled with the lack of assurances on the status of EU nationals in the sector, seriously undermines our ability to recruit to our requirements.

EU nationals in the health and social care sector make a valuable contribution to our society. They care for us and our families, they benefit our economy and they make our society rich and diverse. Our message to EU citizens is simple: Scotland is your home. You are welcome and your contribution to our economy, society and culture is valued. We also have a simple message for Theresa May and her Brexiteers: stop undermining our public services by using our EU brothers and sisters as bargaining chips in your bungled Brexit games, and give them the assurances about their status that they deserve.

16:24  

Like my colleagues, I recognise and pay tribute to the fantastic work that those in the health and social work profession do and the valuable contribution that staff from Scotland, the EU and beyond make. We must continue to make the Scottish NHS a welcoming and attractive sector in which to work for both EU nationals and those born and bred here. To do that, we must acknowledge and act on the difficulties that the NHS currently faces, which I will set out.

There is huge excitement in East Lothian, because after 10 years of waiting East Lothian is finally starting to see the new £70 million community hospital take shape. However, that excitement has been curtailed by the wait itself and the absence of an accident and emergency department. That, combined with an ageing population and the Scottish Government asking for 10,000 houses to be built in East Lothian, makes it crystal clear that further services and more staff will be required to meet demand. A wait-and-see approach is not good enough.

East Lothian and Scotland are used to waiting for improvements to the NHS. For years we have identified a workforce shortage, low morale in general practice and an inability to cope with an ageing population and its long-term health implications. Those concerns have long been apparent, but we have yet to see any real solutions or effective implementation of measures to deal with them.

A new hospital is much needed, but we also require people to work there. Staff retention is a growing problem in South Scotland. An Audit Scotland report that was published last month found that a consequence of recruitment and retention problems, plus the pressure to meet waiting time targets, is the rising cost of temporary staff. That was felt nowhere more than in the Borders, where the largest increase—14 per cent, or £8 million in monetary terms—was found. The Scottish NHS spent £23.5 million on agency nursing and midwifery staff, which is an increase of 47 per cent compared with 2014-15. NHS Borders was one of five boards that saw spending double.

That level of increased spending is simply unsustainable, and evidence suggests that Borders general hospital is one of those hardest hit. The level of spending on temporary staff means that such staff are vastly more expensive than permanent staff; that, too, was detailed by Audit Scotland. The cost of agency nursing staff is more than twice the cost of permanent staff. Action needs to be taken to regain control, because the current situation is simply out of control.

A constituent recently contacted me because they had found it impossible to make an appointment to see a GP. The struggles that face general practice have been debated in the chamber before—we have all recognised that GPs’ workload is far too big to manage and that morale in the profession is low. In a survey commissioned by the BMA last year, 69 per cent of GPs said that workload had a negative impact on their commitment to a career in general practice and 92 per cent of GPs said that their heavy workload has negatively impacted on the care that patients receive. It is clear that what is in place is not working for either the patient or the GP. That was only reinforced by Scottish Conservative research that found that Scotland is 830 GPs short of the number needed. No wonder it is difficult to make an appointment—we do not have enough cover.

Those issues are present now, and action needs to be taken now. The number of Scottish students applying for medicine courses has dropped by 11 per cent. Again, that is a clear sign that current practice is not working. When we associate that figure with Audit Scotland reports that there is a chronic shortage of staff across the board and that many staff are soon to retire—

How will the chronic shortage of staff that the member describes be improved by the Brexit situation?

I thought that you might ask me that, Maree—

Could you use full names, please?

Yes. I thought that you might ask me that. On the ways to increase staff, I think that in a way you are—

Can you also make sure that you do not use “you” all the time? I am sorry—on you go.

Okay. Thank you, Presiding Officer.

I think that the member is using Brexit as an excuse for the workforce crisis. If the SNP could look to ways of working with businesses and universities to bring down current migration rates so that we keep the brightest and best of our medical staff, to upskill our own people, and perhaps to increase the current limit on student medical places, it might have a positive impact.

We hear much in the chamber about how best to effectively address Scotland’s ageing population and the long-term health conditions associated with age. Action has been agreed in the Parliament, and we all support the integration of health and social care that will see a shift from hospital care to homely, community-based settings. However, there have been reports of difficulties in that regard, too. Independent auditors have found that NHS Borders has highlighted the governance arrangements in terms of roles and responsibilities as a risk. There are visible problems in the introduction of integrated health and social care that need to be resolved, and we need to ensure that they are addressed now before they escalate.

The evidence says that there is a severe problem with recruitment and retention in Scotland, and it says that the issue is present here and now—before Brexit. It was here before the vote on 23 June. Indeed, the problems have been debated in the chamber time and time again, and we have seen little action to alleviate them. Nowhere is the problem with recruitment and retention felt more than it is in the Scottish Borders. I have outlined the huge spend that was made to fix the staff shortages. These are serious issues that must be addressed now. It does a disservice to Scotland and the Scottish NHS to blame these problems on Brexit. It does an even greater disservice to have the audacity to pretend that the problems with recruitment and retention are due to Brexit.

Before I call Emma Harper, I say to Colin Smyth and Liam Kerr that they now have seven minutes each for their winding-up speeches because there is time in hand. I know that you will be excited by that.

16:30  

“Haben sie Schmerzen?”, “Ti senti male?”, “Gdzie jest ból?” or even “Are ye sair?” in Scots are the basic “Where is the pain?” questions that I taught myself to ask in several languages during my career as a theatre and recovery room nurse. If we can imagine the confusion and disorientation of coming round from an anaesthetic, it makes sense to try to ask a patient such simple but vital questions in their own language. It is comforting for them and often, in that initial confusion, it is the best way of obtaining important information.

Those words and other relevant patient care phrases were taught to me by my friends and colleagues from across Europe and further afield, and they work. One of my patients, a Polish lorry driver, said that he hoped that I would be on duty when he was due to return to the operating theatre for another operation because I could speak a few words to him in his own language. We have an international workforce in our NHS and we treat plenty of patients who are not originally from Scotland, even in rural Dumfries and Galloway.

Looking back, it was my experience of working as an economic migrant in the American health system that led me to be so concerned about being able to communicate effectively with people when they are at their most vulnerable. I spent 14 years working in California, including time at Cedars-Sinai medical centre as a transplant nurse. It would be difficult to find a more multicultural and cosmopolitan workforce. Multiculturalism leads to better and safe patient care. This Galloway lass learned a lot from medical professionals from all over the world. That experience was incredibly valuable to me; it led me to accept other cultures and people on the basis of their knowledge and skills rather than their country of origin. That went to such a point that I am dumfoonert that we are having this debate.

I support the motion in the cabinet secretary’s name whole-heartedly and without reservation. The assurances in the motion are fundamental and just should not be necessary. However deplorable I find the need for it, the fact is that the reassurance is necessary now and we absolutely need to say to our friends and colleagues in the NHS who have come from other countries that their contribution is valued, appreciated and welcome.

Will Brexit make any difference to the critical level of GPs that we have in South Scotland, particularly in Stranraer? Why has the Government not been able to address that problem up to now?

When I met the chief executive officer of NHS Dumfries and Galloway, he assured me that the board was doing everything that it could to attract GPs to the area, and that multiple issues need to be dealt with. [Interruption.]

I can hear folk shouting across the chamber; I am coming to the point. Our radiology department could not function without the Czech Republic supplying radiologists to NHS Dumfries and Galloway. We need to value the contribution of our EU NHS workforce. Those people should feel at home here in Scotland.

We have seen the unedifying promises of lists of foreign workers and reductions in the NHS’s reliance on foreign staff once we have trained more British doctors and nurses. I accept that there have been U-turns on both those promises, but the damage that was done by raising the prospect of such measures should not be underestimated.

In Dumfries and Galloway royal infirmary, many EU nationals are working in many departments. While I was listening to the start of the debate, I listed, just off the top of my head, 13 countries that are represented in the operating room, where I worked. It did not matter in the slightest where our radiology department doctors came from until the Tories decided to put the issue front and centre. In an operating theatre, the patient on the table has no nationality. When we open the abdomen, the organs do not tell us which country they are from; they tell us only that the person is a human being.

The fact of there being multiple nationalities in the surgical team can facilitate innovation, creativity and the pooling of global knowledge, to make modern surgery safe, effective and successful every day.

Someone who has not been in an operating theatre is probably not aware that before every procedure staff take a time-out—a pause in which we double-check safety issues. The technique is promoted by American neurosurgeon Dr Atul Gawande, to enhance best practice. It is the moment when the whole team pauses to check absolutely everything, before the scalpel touches the skin, and it is one of the great strengths of our NHS that we embedded the time-out concept in our world-leading patient safety programme.

I particularly endorse the line in the motion that asks that the Parliament

“recognises the valuable contribution that health and care staff from across the EU, and beyond, make to Scotland”.

It is a great strength of Scottish society that we are prepared to accept and welcome people from throughout the EU. Let me offer a prescription, even though I was not a prescribing nurse. To the politicians in Westminster, to Prime Minister Theresa May and to the media, who whipped up a storm against foreign workers, I say that before they continue to bash foreign workers they might like to implement Dr Gawande’s time-out.

Thank you very much.

Now, this is not a rebuke to Emma Harper, but, just for information for new members, let me say that before you use a language other than English, even if it is just a short phrase, you must seek the Presiding Officer’s consent. That is in rule 7.1 of standing orders, for members who want to know that. I did not expect everyone to know, but that is the point—it is for the Official Report.

16:37  

Presiding Officer, you will be pleased to know that I very much intend to speak in English, albeit with a bit of a Doonhamer accent.

For the record, I declare an interest in relation to the debate. When I was elected in May I was employed by Parkinson’s UK; that employment ceased at the end of May. I am also a local councillor on Dumfries and Galloway Council.

Our national health service remains our nation’s most treasured possession and is, without question, Labour’s greatest achievement. In government, we created our NHS, and in the Scottish Parliament and throughout the country, we will be unflinching in defending it. However, the credit for the enduring success of our nation’s most precious institution lies not with politicians but with the often heroic actions of its greatest asset: our health and social care staff. Those public servants care for our loved ones as if they were their own, and we should never stop thanking them for doing so.

It is appropriate that so many members have talked about the “dedication and commitment”—as the cabinet secretary put it—of health and social care staff, even though those staff might be a little too busy to listen to the debate, as Jackson Carlaw said.

In particular, the debate has provided members with an opportunity to put on record our thanks to the EU migrants—the doctors, the nurses, the midwives and the care workers—who work day in and day out to save lives and care for our families across Scotland and the UK. Joan McAlpine mentioned the photo that is circulating on social media, which shows staff from Britain, Ireland, Germany, Spain and Greece.

As Rhoda Grant said, during the EU referendum campaign we were all fed propaganda by the Brexiteers. The poster on their big red bus told us that the NHS would receive an extra £350 million a week if we left the EU, and we were told that our public services would be saved if we barricaded ourselves in against a flood of migrants. The truth is that there is no £350 million extra per week for the NHS and that if we go to hospital we are more likely to come across a migrant caring for us than a migrant lying in the next bed.

It is estimated that Scotland’s health and social care sector employs about 12,000 EU nationals. We all know that parts of the sector simply would not function without their contribution, yet today’s debate has shown that the fundamental question of what will happen to each and every one of the EU nationals who work in the UK remains unanswered. Will existing staff have to leave if they do not earn enough to meet an income threshold in order to renew a visa? What restrictions will there be on recruiting new staff? Our chronic staff shortages will become worse without immediate access to the pool of qualified staff from other European countries. As Maree Todd said, it is nearly six months since the UK voted to leave the EU and we still do not know the answer to those questions.

What about patient care? The financial challenges facing the NHS are, as Audit Scotland described last week, “unprecedented”. In its report, “NHS in Scotland 2016”, Audit Scotland stated:

“NHS funding is not keeping pace with increasing demand and the needs of an ageing population.”

Health boards had to make savings of £291 million in 2015-16, and the savings to be made this year will rise to £492 million. As James Kelly said, there is no doubt that the economic shock of the vote to leave the EU risks plunging the health and social care sector into a financial crisis that is even deeper than the one that it currently faces. The economy is slowing and tax income is lower as a result, so public sector spending could well be squeezed even further. Indeed, just today, the Institute for Fiscal Studies warned that the UK’s public finances have deteriorated by £25 billion since the March budget.

Although those are the immediate concerns over Brexit, members have raised other issues in the health and social care sector that we need to start to plan for now. The cabinet secretary rightly highlighted EU standards in professional regulation and employment law, particularly the working time directive; she also rightly emphasised the need to maintain and retain the reciprocal healthcare system that allows UK citizens to be treated across the EU.

There are also the wider public health impacts of the loss of EU environmental and food regulation, not to mention the loss of research funding and opportunities for research collaboration. As Anas Sarwar said, we should be concerned about the approach that the UK Government might take to trade deals. If we think that the EU made a mess of TTIP and CETA, imagine what ministers such as Boris Johnston and Liam Fox could do.

What can we do here in Scotland to best protect our NHS and our social care sector? I have said that, even before Brexit, our NHS and our social care sector were facing staffing and financial challenges, and it would be remiss of the Parliament today not to at least acknowledge that, given that it is less than two weeks since the Audit Scotland report came out.

Last week, in her statement to Parliament in response to Audit Scotland’s report, the cabinet secretary said that Audit Scotland made several recommendations that the Government “accept in full”. The amended motion that was agreed to following the health debate later that day stated:

“That the Parliament welcomes the publication of the Audit Scotland report”.—[Official Report, 2 November 2016; c 99.]

Labour’s reasonable amendment today simply asks that we place on record what we all know: that our health and social care workforce faces significant challenges, as was highlighted in the Audit Scotland report. If we accept Audit Scotland’s recommendations in full, there is no reason for us not to accept Labour’s amendment today.

As Anas Sarwar said, we know that staffing levels are under pressure: there is a shortfall of 830 GPs just to take us back to 2009 levels, and there are 350 consultant and 2,500 nursing and midwifery vacancies. We are struggling to fill posts with access to all EU nationals, so recruiting the additional 65,000 health and care staff that the sector will need by 2022 will be even more challenging. Therefore, we need to redouble our efforts in valuing our health and social care workers for the job that they do.

When I made my first speech on health in the Parliament in June, I said that,

“As someone who was instrumental in ensuring that ... Dumfries and Galloway Council became the first council to gain living wage accreditation”,

I very much welcomed

“the commitment to pay the living wage in the social care sector.”—[Official Report, 7 June 2016; c 60.]

We need to complete that unfinished business and make sure that payment of the living wage is extended to all care workers, including those who carry out sleepover shifts, and then build on that achievement with not only fair pay, but training and adequate time to care. Indeed, I commend Unison’s ethical care charter as a template for the fair and ethical employment practices that we would all like to see.

It has been clear from the debate that Brexit creates considerable threats for the health and social care sector—a sector that we know is already under considerable pressure.

16:45  

I would like to say, at the outset, what a fascinating, illuminating and novel debate we have had this afternoon—but I cannot. This is the 10th in a series of debates. As my colleague Oliver Mundell lamented in closing last week:

“It is essentially the same debate ... the Government has cut out the word ‘environment’ and inserted the word ‘justice’. ... As members have said, it is becoming a bit like groundhog day.”—[Official Report, 1 November 2016; c 62.]

The point is as valid today as it was last week.

It would not be so concerning if the quality of contribution from the Government seats was not so weak. Last week, at portfolio question time, in one of the classic sycophantic exchanges that the Scottish Government enjoys, Graeme Dey cued up Keith Brown, who replied:

“In addition to the jobs and financial benefits that we have received, we benefit massively from being a more rich and diverse country because of our membership of the European Union.”—[Official Report, 2 November 2016; c 6.]

Let us just think about that answer. It is not “membership” of the European Union that makes Scotland a more rich and diverse country. Mr Brown conflated and confused the two separate concepts of “membership” and “relationship”—hence our amendment today. The Government really needs to work out the difference and reflect on whether it is comfortable supporting its initial, ambiguously worded motion.

On the member’s point about groundhog day, when is his party going to tell us what Brexit means?

I thank the minister for that intervention. Our party is negotiating, and it is talking to her party about what Brexit means. I expect that to continue.

Does Scotland value its EU workforce? Of course it does. When the Government set up the debate, it did not think that anyone would disagree. Maree Todd was right to say that we should be able to assume certain things, and member after member queued up to appreciate the valuable contribution that EU nationals make to our health and social care sector. Their contribution is just as valuable as that of the UK nationals in the health and social care sector, just as valuable as the contribution of the non-UK, non-EU nationals in Scotland’s health and social care sector and—as Donald Cameron made clear at the outset—just as valuable as the contributions of those nationals to our wider economy in industry, agriculture and construction.

Just yesterday, I visited a fish processor in Peterhead and was told about the fear that its EU nationals felt because of the apparent uncertainty that exists—this despite the UK Government having committed to retain all EU employment protections post-Brexit and having stated its intention to protect the status of all EU nationals who are currently in the UK.

Perhaps the member’s constituents at the fish-processing factory are concerned because Liam Fox described them as bargaining cards. That might be the reason for their fear.

I am not convinced that Liam Fox ever used those exact words. Let me come on to what is going on—I thank Joan McAlpine for bringing the matter up.

Only last month, Ruth Davidson said:

“for those who have already chosen to build a life, open a business, make a contribution, I say this is your home, and you are welcome here.”

So, why the fear? Actually, it is not surprising because, almost on a weekly basis, we have sat on these seats and listened as SNP member after SNP member has decried the allegedly bigoted language of the Tory party and has tried to suggest—as Maree Todd did today—that we are xenophobic. Donald Cameron talked positively of opportunities only for Joan McAlpine to accuse the Tories of wanting to get rid of EU staff and of “pulling up the drawbridge” on foreign-born NHS staff. John Mason then confirmed the UK Government’s positive words but said that, behind them was the sense that those people are “not wanted”. As Miles Briggs said, the Scottish Government refuses to acknowledge the reassurances that are being given, and such rhetoric is very dangerous indeed.

Will the member take an intervention?

I will not, because I have a lot to get through.

The rhetoric is likely to rebound given that, as Jackson Carlaw pointed out, in 2014 Nicola Sturgeon threatened to strip EU nationals of their “right to remain” in an independent Scotland unless the EU accepted Scotland as a member state. SNP members should read the reports. Half of SNP supporters backed plans to make firms report foreign worker numbers, and roughly 400,000 of the more than 1 million people in Scotland who voted to leave the EU voted for the SNP in 2015, so Joan McAlpine should recognise that it is hardly a “Conservative Brexit gamble”. I say to the SNP that we have had enough of the scaremongering. The people of Scotland can see what is going on.

The Scottish Government is using Brexit as a convenient shield to disguise the facts. We have an NHS that is in crisis—as James Kelly said, it has missed seven out of eight of its targets and has rocketing waiting lists. There is a crisis of confidence in our educational establishments: school teachers are unhappy with intolerable pressure and low numbers; 150,000 college places have been slashed; and universities are concerned about the limited number of places that are available for Scots students.

The Government is also using Brexit as a shield to disguise its raid on the council tax, in which it is plundering hard-working families and spending not locally but elsewhere, and to disguise the fact that we have yet to have presented to the Parliament one bill that the Government wants to implement this session.

I hope that today marks a watershed, after which we will see the end of the SNP’s use of petty, ill-informed and generic language. I also hope that, in accepting our amendment, the Government can set a marker as to how we can move ahead constructively and for all the people of Scotland in a manner that does not airbrush 1 million leave voters from history. Let us get back to debating bills, programmes and ways to save the NHS, our education system and our local councils from the chaos that is being visited upon them by the SNP Government instead of spending two hours talking about inoffensive, safe and ultimately meaningless motions that have been presented by an Executive so tired, so out of ideas, so stuck in a rut and so obsessed with separatism that governing is the last thing on its mind. Let us see some governing from this Executive, for all our sakes.

16:51  

Thank you very much Presiding Officer, and let me start at the end, with Liam Kerr’s contribution. Mr Kerr quoted my speech about the closing speech of Oliver Mundell last week. In my closing speech in that debate, I praised Oliver Mundell. He made a fine speech, in which he raised some real issues. I have to say to Mr Kerr that he is no Oliver Mundell.

It is astonishing that the Tories are still resistant to debating and discussing the issues of Brexit. The Tories—Mr Kerr, in particular—want to sweep under the carpet the concerns of hundreds of thousands of people and the worsening prospects for the economy and for trade. In his speech, Mr Kerr asked why he is not being believed. Let me tell him. In his speech, he talked about the EU citizens in the independence referendum. I was active in the referendum and I heard what the no campaign—the Tories, in particular—said during it. They threatened European citizens: they told them that if they voted yes, they would have nowhere to stay and would be sent home. Those citizens were lied to. That is why no one—no one in those communities, no one in the Parliament and no one in Scotland—will believe the Tories ever again.

If that were not a big enough problem, at the end of his speech, Mr Kerr described the debate—a debate about the work of hard-working NHS staff and individuals who have contributed to our society, who wish to stay here; I will come on to some of the tributes that have been paid to them shortly—as “meaningless”. No one will trust a Tory who says that it is “meaningless” to talk about the work of NHS staff. That will be remembered in Parliament for a long, long time. Oliver Mundell would not have made that mistake.

I turn to the other contributions to the debate. I was particularly impressed by those of three members. The first was the speech of my old colleague and friend, Richard Lochhead, who talked about the impact of the NHS and NHS workers on his own family. That was not “meaningless”. Maree Todd spoke about the impact on friends and colleagues of hers in the NHS when they were treated as foreigners. They did not regard that as “meaningless”.

Emma Harper talked about the good practice in the operating theatre that she worked in, where they used a method that was promoted by Dr Atul Gawande, who is very much worth reading. She also talked about the way in which people worked together, no matter where they came from. That is not a “meaningless” contribution to the health of citizens in this country.

Anas Sarwar will find it surprising that I want to mention his contribution to the debate, too. However, for the most part, he put aside the political divides that exist to make it clear that on this issue we all need to do

“all that we can to minimise the consequences”

of the current Brexit debate on all who work in the NHS and all who use it. He was absolutely right to make that point, which was echoed by James Kelly and others.

Richard Lochhead pointed out something that Colin Smyth referred to, which was the mysterious missing £350 million a week, of which at least a proportion was to come to Scotland to be used in the NHS. Not a single penny of that money is going to be seen because that was, unfortunately, another lie. It was a lie that no doubt persuaded some people to vote to leave. It is not money that we will ever se—it is money that will not come to Scotland but which could have been useful in Scotland. Unfortunately, the claim about it was not true.

Among the contributions to the debate were two distinguished Tory speeches. I am going to embarrass both the contributors, who were Oliver Mundells in that sense. Jackson Carlaw was very clear that he wants a message to be sent out to NHS staff that they are valued and that he wants them to stay. Indeed, he made the very good point that the demographics in Scotland require that those staff be employed here. Donald Cameron gave the same message, although it was perhaps circumscribed a little by his role on the Tory front bench. However, he said that he wants to ensure that those staff stay.

I say to both those members—who I know were both strong remainers—that all they have to do in the circumstances is say to the Prime Minister, who is another Tory party remainer, that those NHS workers are needed. They need to say it often—surely the Prime Minister will listen to that message from those two distinguished contributors. If she does, perhaps we can get an end to the endless speculation that Liam Kerr apparently believes is “meaningless” but which is actually about the entire future of those NHS staff and, indeed, their families.

I now come to the least cogent Tory contribution to the debate—I am sorry that I wrote that down before I heard Liam Kerr’s contribution—which I am afraid came from Miles Briggs, who is experienced in politics; he worked in Parliament for some time. Unfortunately, he was factually incorrect on two key issues, the first of which was the education cap. There is no cap on Scottish university places—that is quite clear. In health, as elsewhere, there is workforce planning.

Universities Scotland has said that it is getting harder and harder for Scottish applicants to win a place at universities here, thanks to the strict controls that have been imposed. Is that a cap, or not? What is Universities Scotland referring to?

The number of places was increased this year. I am quite happy to quote the figures, which suggest that 8.6 per cent of the total of 40,000 places in these islands should be in Scottish medical schools, which would be 3,446. However, there are actually 4,857 places. We are therefore training a third more than we have to, and the reason for that is workforce planning. Alex Neil, who has been—[Interruption.] The Tories, of course, do not like—

Will the minister take an intervention?

No, I am sorry. I have to make this point.

The Tories do not like the idea of workforce planning, but the reality is that every year the deans of the medical schools sit down with the cabinet secretaries for health and education and plan what will go ahead. However, according to Mr Briggs, they should just abandon that planning. Does Mr Briggs know better than the deans of the medical schools; does he know how many places are required? No, he does not know how many are required. That information is held by universities and the Government. The result is that we train more than our population share.

I will correct Mr Briggs on another point. He described me as a Grinch. I find that very sad. However, the more I thought about it, the more I decided to go into the role this afternoon. The definition of a Grinch is someone who

“spoils or dampens the pleasures of others.”

I am delighted to spoil or dampen the pleasures of those who reject the importance of migration to Scotland. I am delighted to spoil or dampen the pleasures of those who refuse to listen to the Scottish electorate, who said that they want to stay in Europe, and I am absolutely delighted to spoil or dampen the pleasure of the born-again Brexiteers in the Tory party.

Finally, I relish the chance of spoiling or dampening the pleasure of any member of this Parliament who thinks that the contribution to the health service of those from other parts of the EU is “meaningless”. I rejoice in that role.