Meeting of the Parliament

Meeting date: Thursday, December 22, 2022

Official Report 1299KB pdf

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Maternity Services in Moray

The final item of business today is a members’ business debate on motion S6M-07192, in the name of Douglas Ross, on maternity services at Dr Gray’s hospital. The debate will be concluded without any question being put. I invite members who wish to speak in the debate to press their request-to-speak buttons now.

Motion debated,

That the Parliament notes with concern reports that Moray women and families are now in the fifth winter of living with what it considers downgraded maternity services; believes that this is unacceptable and notes the view that the full focus of the Scottish Government and NHS Grampian should be on delivering on model six, which is a return to a consultant-led maternity unit in Elgin; acknowledges the reported significant objections from campaigners and clinicians to model four, which is a community maternity unit linked mainly to Raigmore; understands that clinicians have stated that plans for model four are “predicated on a transparently and wildly inaccurate underestimate of the number of Moray patients who would deliver at Raigmore Hospital”, and that they are “fundamentally flawed”; believes that NHS Grampian will detail its plan for model six at a meeting of its board on 15 December 2022, and notes the view that the Parliament should have an early opportunity to debate this plan and hear the Scottish Government’s response to it.

17:16  

Thank you, Presiding Officer. Best wishes for the festive period to you and all the staff of the Parliament.

I will give a brief bit of background to the situation with Moray maternity services, because the issue has been debated many times in the Parliament. Members will be aware that, in 2018, a temporary downgrade for one year was announced and it continues now, as we come to the end of 2022. I asked for tonight’s debate and lodged the motion because, just last week, NHS Grampian finally produced its plan to deliver model 6, which is a return to a consultant-led maternity service. As this is the final debate of the year, it is important that members from across the political spectrum and the cabinet secretary can articulate their initial thoughts on model 6, raise questions about it and seek reassurance.

As a local representative, I appreciate the work of keep MUM and the maternity voices partnership, who have done and continue to do incredible work in raising the cases of Moray mums and families.

I also appreciate the fact that this is a cross-party issue. Richard Lochhead is a minister and so cannot fully contribute today, but he is here again. Rhoda Grant has been a great champion of the issue, as have my Highlands and Islands colleagues Jamie Halcro Johnston, Edward Mountain and Donald Cameron. I welcome that cross-party consensus.

I do not want to dwell on this point, but I note that, when I raised the issue as the member of Parliament for Moray in the House of Commons last week, and as I was articulating the concerns of Moray women and families, I was told, “Diddums” by Brendan O’Hara, the MP for Argyll and Bute. I hope and am sure that the cabinet secretary will want to disassociate himself from the words of his colleague.

Model 6 was proposed by NHS Grampian at its board meeting last week. From the outset, I welcome the fact that we now have a plan to deliver it. We all want a return to consultant-led maternity services at Dr Gray’s. My worry is about the timing. The report states that it could take up to a total of nine years from 2018 to reintroduce the service. I am also worried about the wording. Page 7 of the report states that

“consultant-led births could take place as early as the end of 2026 or early 2027”.

I worry that the word “could” is doing a lot of heavy lifting in that report. Let us remember that we were told that it would take one year from 2018. We are now in 2022, coming into 2023, and we are being told that it could happen at the end of 2026 or into 2027. We need the pace to be far quicker than that.

I agree with Douglas Ross that the cross-party spirit around this issue is important. I share his concern that it has taken far too long to get to where we are today, but we cannot change the past. We have to shape the future. Does the member agree that what we need now is a laser-like focus on recruitment from NHS Grampian and NHS Education for Scotland—with, I hope, support from the Scottish Government?

From the plan, I understand that perhaps not far short of 30 staff, including many specialists and medical staff, will be required to get full restoration of the service. Therefore, the sooner we can recruit, the sooner we can bring the date forward. That is absolutely the key to progress.

Douglas Ross, I can give you that time back.

I am grateful, Deputy Presiding Officer.

I agree wholeheartedly with what Richard Lochhead said. That laser focus must come from the health board, it must come from NHS Grampian, and it must—and, I hope, will—come from the Scottish Government and all the authorities involved. However, I have fears because, as Richard Lochhead knows as well as I do, we have had campaigns to recruit people to Moray before—in education—and they have been successful for a period and then the campaigns have dwindled away. When people come to Moray, they never want to leave, but the issue is getting them there in the first place.

A concern that I have with the model 6 report is that there is nothing new in it. We are speaking about the need to attract significant numbers of staff, and I am not hearing much new from the health board about how it will achieve that, but I hope that that will change going forward.

The other area that I want to speak about is caesarean sections. The health secretary said—last year, I think—that he wanted to see a rapid reintroduction of elective caesarean sections, yet the report tells us that, under the model 6 plans, it will be more than two years until those elective C-sections will be introduced. Why, when the health secretary was very hopefully and enthusiastically saying that we could see a rapid reintroduction of elective caesarean sections over a year ago, are we now being told that it will be several more years before that happens?

The other area that I want to focus on is model 6, which is the ultimate destination. We want to get there very quickly, but it is underpinned by model 4 in NHS Grampian. Model 4 is seeing more Moray mums giving birth in Inverness, but I think that that is a red herring. As my motion says, I want to totally separate model 4 from model 6. Model 4 is “fundamentally flawed”, fraught with “patient safety concerns” and littered with

“factual errors and baseless assumptions”,

and it “should be rejected”. The health secretary will note that those are not my words but the words of clinicians at Raigmore hospital, which is where model 4 suggests that more Moray mums should go to give birth.

Therefore, why are we still, on the basis of that proposal from NHS Grampian, suggesting that model 6, which will come years down the line, must be underpinned by model 4? Senior clinicians are advising that model 4 should be abandoned, yet it still hangs over model 6. More shockingly, when, just a week ago, the NHS board discussed that proposal and all the factors of model 4 that underpin its plan for model 6, the clinicians’ concerns were mentioned not once. At the health board meeting, there was not a single reference to the concerns that are being raised by clinicians. That is shocking. It is unacceptable on the part of the board, and I do not know why it is not addressing those issues.

On Tuesday, I spoke to one of the clinicians at Raigmore hospital. He told me that, behind the scenes, no one is proposing anything that would make model 4 deliverable in the short or medium term. Local campaigners are telling us the exact same thing. Keep MUM has said there is “no evidence” to explain

“how model 4 leads to model 6.”

I will come to the issue of model 4 and model 6 in my contribution, but does the member agree that, even if there was no model 4, for the sustainability of services there should be cross-boundary working for maternity services for the north of Scotland?

Of course I agree with that. My constituents who live in Brodie are far closer to Raigmore hospital than my constituents who live in Cullen, who are closer to Aberdeen royal infirmary. However, at the moment, that is not working. As, I think, Edward Mountain and Jamie Halcro Johnston will discuss, there are capacity issues at Raigmore hospital. Clinicians are raising those problems, yet they are not being addressed by NHS Grampian.

I have taken up a bit of time and I do not want to skirt close to any issues with you, Deputy Presiding Officer, so I will focus on my last couple of remarks.

My motion is clear that I want us to focus on model 6. The clinicians are telling us to focus on model 6, and so are the campaigners. I have some requests for the cabinet secretary, if that is possible. First, we know that there is little faith in the milestones of model 4 and model 6 being delivered if there is no independent oversight, so what is he looking to do to ensure that campaigners can have comfort that we will achieve the milestones and that they will be recognised independently? NHS Grampian has continually let down Moray, and trust in the health board is at rock bottom.

Nothing that I have heard so far will improve that, to the extent that Keep MUM was not even involved in the development of model 6 and the paper that went to the board. It was asked to comment afterwards, but why was Keep MUM not involved in the paper?

Will the cabinet secretary put in a project management team to ensure that the milestones are met, and will he ensure that the project manager is from outwith NHS Grampian? On staffing and the point that Richard Lochhead raised, what conversations has the cabinet secretary had with NHS Education for Scotland to make sure that the 2018 issue of junior doctor shortages is not repeated in the future and that the additional recruitment that is required by the report is provided?

Why will it take until March next year to develop a strategy to market Moray? I said to Richard Lochhead that, for years, there have been cross-party efforts to recruit more people to Moray. What is coming up that is new, and why will it not start immediately? There is a request for additional funding from NHS Grampian. Will the cabinet secretary confirm that that request will be met, to allow NHS Grampian to go ahead with its planning as quickly as possible?

Will the cabinet secretary look at the urgent re-establishment and expansion of the University of the Highlands and Islands midwifery course? That issue came up among clinicians. The course would make a big difference to NHS Highland and also what we are trying to do at Dr Gray’s.

I have always said that the staff and team at Dr Gray’s do outstanding work. I have been blessed to have one child there, and I would like to see more and more Moray mums and Moray families be able to have their children there. Model 6 is the right approach, but we should have all the focus, attention and resources on delivering model 6 as quickly as possible, so that hundreds and hundreds of Moray families can see their children being born locally in the excellent facilities and under the excellent care of the staff at Dr Gray’s.

Thank you, Mr Ross. In the spirit of the week and the season, I am happy to gift a little extra time.

17:26  

When Douglas Ross said that he was hoping to see “more and more”, I thought that he was going to say more of his children born there, which would have been a little insight into the future.

I am really pleased to be able to speak on this motion for two reasons. First, as an elected representative for Banffshire and Buchan Coast, I believe that the mums-to-be across my constituency clearly deserve safe and accessible maternity services. That applies to those in the western end of my constituency, which includes part of Moray. That is why I have publicly welcomed the Scottish Government’s commitment to restoring consultant-led maternity services at Dr Gray’s in Elgin. What is more, I have met local campaign groups and the health board to get a better understanding of what it will take to achieve that goal.

Secondly, as a mum with six children, I am speaking from direct experience when it comes to the importance of maternity services. I know the sense of security that they provide, and although they do not take away all the anxieties about giving birth—as any mother will appreciate—the knowledge that there is medical expertise on hand is always a comfort. More than that, such expertise is essential in times of emergency.

I have experience of having to travel long distances from a rural location into the city of Aberdeen. People who are watching might know that, if someone’s waters break and there is meconium in there, it is quite a dangerous situation and they need medical assistance instantly. I have had that experience, so I am coming from a place of empathy in that regard.

If we all want decent maternity services at Dr Gray’s for the benefit of mums-to-be in Moray, how do we reach that goal? We do so by being realistic about the availability of staff, having properly considered planning and taking on board the views of local people. We also need to do it with timescales that make sense—we should not rush in because of political expediency.

If we go back to 2018, when the provision of maternity services changed, one of the big reasons that were given was workforce availability. That was before I become an MSP, but it certainly rings true given my experience since I was elected last year.

Time after time, across Banffshire and Buchan Coast, in health, social care and other sectors, such as education, as Douglas Ross mentioned, I hear stories about problems with recruitment. In general terms, the vacancies can be there but it is hard to attract qualified professionals to come and work in north Aberdeenshire and Moray. It is a problem across much of rural Scotland.

That is subject to on-going work by private companies and public bodies. I do not underestimate what they try to do within their sectors, not least within Grampian and Highland health boards with regard to maternity services. I am glad that that work is happening and I am certainly willing to collaborate with anyone who is looking to solve the problem. I am glad to hear that Mr Ross brought it up in Westminster and I ask him please to push on the subject of freedom of movement for qualified professionals; perhaps near neighbours in Europe, for example would be appreciated.

Moving on to the detail of the planning around maternity services in Elgin, I have sought assurances around the model 4 plans, which could deliver a networked community and maternity unit as part of the journey to model 6. I know that the Scottish Government has asked for further work to be done before it goes ahead and approves anything, and I have asked the Scottish Government to make the lived experience of women and families in Moray central to decision making on the issue.

I commend NHS Grampian on its development of the model 6 plans, under which it will deliver full consultant-led maternity services once again, it hopes by the end of 2026. I would, however, echo my colleague Richard Lochhead, who represents Moray, and say that NHS Grampian should approach that with a can-do attitude and a commitment to delivery—excuse the pun. From the top, the Cabinet Secretary for Health and Social Care has given his cast-iron commitment to those services and we all need to be a part of meeting that commitment, whether we are elected representatives from either side of the chamber or healthcare professionals.

Full maternity services will come back to Elgin and that will benefit women and families in the local area including the part in my constituency. However, they must return in a way that is person centred, sustainable and professionally planned. Only two days ago, I received an email from the campaign group Keep MUM, which has been absolutely incredible. It said:

“There must be a dynamic project management team in place with strict external oversight to make sure that milestones are met.”

I see nothing to disagree with there.

17:32  

I say at the outset that Douglas Ross’s words are wise words that come from the heart, not only that of his constituents but his own, because he has been through this situation and seen at first hand what effect it has. I feel some pity for the cabinet secretary, because it is not his problem. He has been left holding the baby, because it was his predecessor’s problem and her predecessor’s problem—that is where it all started. I know that the cabinet secretary has a lot to deal with. I also make the point that we are all after model 6 for Moray and that it has to be done as quickly as possible.

I am going to come at the issue from the other way round, from the Highland perspective, and talk about why I believe that model 4 is such a threat to the Highland service. First, we have to remember that Raigmore hospital recently had to take on all the duties of gynaecology and midwifery from Caithness, which put on a huge strain on it. About an extra 250 mothers a year come down from Caithness to Raigmore now. I think that there were only eight births in Caithness last year—not many; most of them are coming down to Raigmore, which is having to cope with that without a single extra bed.

I know that the cabinet secretary has been and looked at the facilities at Raigmore, but they are 25 or 30 years old and pretty rudimentary, if I could be so bold as to say that. In fact, if your baby is put into the special care unit there, you cannot even be taken down there on bed, if you have just delivered, because the corridors are too narrow. Also, nurses cannot work in the special care baby unit except to deliver the care, because there is no station for making notes and no ability for them to work around that.

Model 4 is being discussed, and I have looked at the plans. The £5 million that was promised by the cabinet secretary for model 4 to deliver the extra facilities will not deliver one extra bed—not one extra bed!—but Raigmore is being told that it may have to take on an extra 500 patients from Moray until model 6 is sorted out. That is a real issue, because while those 500 patients are coming to Raigmore and the facilities are being upgraded, whole services at Raigmore will have to relocate through the rest of the hospital, and there are not the facilities for that. I should not have to remind the cabinet secretary that 3,200 people are waiting for orthopaedic operations alone at Raigmore. Relocating the maternity unit to another ward in Raigmore means that operations will have to suffer, and that is just not good enough.

It also means that you will fracture the delivery of the service, because you will not be able to concentrate all the midwifery and other services that are provided in the unit in one ward. Raigmore does not have the facilities—for example, it has no way of extracting the anaesthetic gases that are used during delivery, which means not only that delivering mothers will not feel the full benefit of the gases but that the staff who are working around them will have to deal with it, and that is very dangerous for them in extended periods of treatment.

I see that the clock is ticking down, but I want to say this: cabinet secretary, you went up there. You met the clinicians, and they told you that model 4 is not safe. If somebody tells you that, you have to be really careful, because what I perceive is going to happen, cabinet secretary, is that if you push on with model 4—

Through the chair, please, Mr Mountain.

I am just finishing up, Presiding Officer.

If you push on with model 4, mums who are coming down from Caithness will not be able to get in, because the beds will all be full, and their ambulances will just be diverted to the next hospital. If you have spent two hours strapped on a gurney to get to Raigmore, the thought of spending another two and a half hours to get to Perth or to Aberdeen is just not acceptable.

As a representative of the Highlands, I am talking specifically about Highland mums, and Caithness mums in particular. You have been told that what you are proposing on model 4 is not safe and it is not acceptable. Although I would always encourage cross-border working, to do so when you are being told that it is not safe is not something that I could ever countenance or support you in doing.

17:37  

I congratulate Douglas Ross on securing the debate, and I congratulate Keep MUM and the other campaigners who ensure that the issue is not forgotten. Like Edward Mountain, I want to highlight the similar plight in Caithness for the community there. I hope that they will not be ignored when fighting for similar services.

No one looking at the photos and film footage in the past week could be anything other than horrified at the prospect of driving in those conditions, yet that is the reality for pregnant women in Moray and Caithness. Imagine having to drive those roads with someone who is in labour, trying desperately to get to a suitably equipped hospital. Where there are enough births to warrant suitably trained staff, there should be support for complex labour and births.

Those of my generation remember the tragic case when a midwife, paramedic and baby died when being transferred from Skye to Inverness on icy roads. It can still happen, and we cannot let it happen again, especially when we have the ability to provide services much closer to people.

Members of the Moray community do not have faith that NHS Grampian will implement model 6, which would reinstate maternity services at Dr Gray’s hospital in Elgin. They do not believe that NHS Highland has the resources or the staff to implement the interim model 4, under which women can elect to go to Raigmore hospital in Inverness rather than Aberdeen. As Douglas Ross pointed out, those concerns regarding model 4 are shared by clinical staff in Raigmore. I take their intervention very seriously.

Keep MUM has asked for independent oversight of the project to reinstate services at Dr Gray’s, by somebody outside the NHS Grampian board. Keep MUM would prefer someone from the community who understands the issue, and I believe that that would be helpful in rebuilding trust. Oversight from someone with the authority of the Scottish Government who can act on behalf of the cabinet secretary might also be required. Such oversight would give comfort to the community, campaigners and politicians such as ourselves that the reinstatement of services was being pursued with sufficient urgency. I ask the cabinet secretary whether he will consider that request and address it today, or undertake to come back at a later date with his thoughts on how it could happen.

Members of the community believe that the basic information on which the models are based is not robust. They believe that many more births will be moved to Aberdeen and Inverness than is suggested.

One of the reasons for originally withdrawing maternity services from Dr Gray’s was staffing, and we have heard about the lack of junior doctors. That is an issue in all rural hospitals and communities and, because of it, we miss out on fully trained staff. We all know that, where people train, they put down roots and stay. If junior doctors are not placed in rural health locations, we lose them forever. That concern applies with regard to all health professionals in rural areas, and it will continue until we ensure that rural areas have an adequate supply of trainees and junior staff.

I have raised the issue with NHS Education for Scotland. I ask that, in summing up, the cabinet secretary says what steps the Scottish Government is taking to ensure that it is addressed.

The NHS Grampian board report is full of caveats, and I share concerns that it might never reinstate full maternity services without a concerted effort. I am also concerned to learn that NHS Grampian does not normally invite elected representatives from Moray to its regular MSP briefings, nor does it brief regional MSPs on progress on these issues, which is absolutely unacceptable. That the board does not believe that it is required to brief elected representatives, especially at a time such as this, gives a sad indication of the importance that it places on the Moray community. I hope that that will change, because it does not give me confidence in NHS Grampian.

17:42  

I pass on my good wishes for the festive season, and I recognise the Presiding Officer’s generosity at this festive time in regard to my contribution.

I whole-heartedly sympathise with my colleague Douglas Ross when it comes to the problems that he faces around the serious lack of maternity services at Dr Gray’s hospital in Elgin. Although my speech is not specifically about Dr Gray’s, I believe that—with your indulgence, Presiding Officer—it will highlight that that is the case not just in Moray but in other rural areas where trust in health boards is at rock bottom.

I am sure that it will be of little comfort to Douglas Ross to know that he is not alone in witnessing a serious erosion of health services. In Galloway and West Dumfries, we are experiencing a similar crisis that needs to be rectified as a matter of urgency. There has been much talk in the debate about option 4 and option 6 but, in Galloway, we have no option. Mothers-to-be in Wigtownshire are facing the daunting prospect of a 70-mile trip to Dumfries and Galloway royal infirmary—a journey that can often take two hours—in order to give birth. I speak from experience. My wife had to stay in DGRI for a period prior to giving birth because a condition that she had meant that there was too much risk in her possibly taking an hour or more to get to hospital when labour started.

There is a midwife-led community maternity unit in Stranraer that, incredibly, was once the eighth busiest in Scotland but, bizarrely, it is currently closed. What makes the situation all the more galling is the fact that there are four midwives who live in the immediate area but who have to travel to Dumfries instead of being employed locally in the unit.

An independently reviewed formula is used to identify funding for health boards, but we have to ask whether it is fit for purpose when it comes to areas such as Moray and Galloway. It is clearly unacceptable that there are glaring health inequalities, with pregnant women in my constituency having to make that two-hour journey by car or ambulance. There have been numerous instances of women giving birth in lay-bys along the A75, including as recently as last month.

In November, the Minister for Public Health, Women’s Health and Sport, Maree Todd, visited the unit in Stranraer to see for herself the facilities that were on offer but, sadly, the unit remains closed. The minister was involved in discussions about a woman who had tragically suffered a miscarriage but still had to make the long journey from Stranraer to Dumfries. That lady bravely told of her heart-rending experience, which was exacerbated by the fact that she could not go to her local maternity unit in Stranraer. In this day and age, it should not be allowed that women have to face such untold stress and anxiety while about to give birth. Giving birth should be a joyful and memorable experience, but that has been denied to so many women in Wigtownshire.

It is positive that the cabinet secretary has reiterated that not just maternity services but all health services should be provided as close to home as possible, but I sincerely hope that the Government sticks to that commitment and puts sufficient pressure on NHS Dumfries and Galloway to deliver on the provision of maternity services in Stranraer.

Of course, it is not just maternity services that have been affected. Other health services that were previously delivered in the likes of our cottage hospitals have been largely paused since the outbreak of the pandemic. NHS Dumfries and Galloway has refused to instigate a full return of the health services that were previously provided in Castle Douglas, Kirkcudbright, Newton Stewart and Moffat, which is not in my constituency. The strength of local feeling on the importance of delivering a range of health services, such as palliative care and step-down care, in our cottage hospitals has been enormous, so it is abundantly clear that people need to be cared for as close to home as possible, rather than having to undertake unreasonably long journeys.

It is important that the Scottish Government and health boards listen to the people who matter—the public—everywhere, in rural and urban areas. They deserve to have, and demand, maternity and other health services on their doorstep, where they live.

Thank you, Mr Carson. You might have tested to destruction the definition of relevance, but at least you did not dress it up as a point of order. Thank goodness for small mercies.

I call Carol Mochan, who will be the final speaker in the open debate.

17:46  

Members will be pleased that some of the points that I had intended to make have already been made, so I will be quite brief. I thank Douglas Ross for bringing the debate to the chamber. One of the first speeches that I made in Parliament, in June 2021, was on a motion lodged by Douglas Ross that called for action to deliver locally based maternity services for women in Moray. I think that we can all agree that it is a concern that we are here again, some 18 months later, debating the same topic.

I was going to discuss the issues that exist in my South Scotland region, which Finlay Carson talked about. The fact that women are having to travel from Stranraer right across to Dumfries is wholly unacceptable. Anyone who has been on that road would accept that point. I hope that the cabinet secretary has something to say about it.

As members will know, I have raised the issue of a women’s health champion many times in the chamber. Unfortunately, that issue is yet another example of the Scottish Government falling short on women’s health. It is clear that a women’s health champion is needed to spearhead many women’s health-related campaigns and issues. The situation with regard to maternity services is a clear indication that we need to get such a champion in place. I have been asking since June when an appointment can be made, and I ask the cabinet secretary to ensure that it is one of the first appointments made in 2023.

We need to have someone who can push on issues such as maternity services, scrutinise what is being done, go back to the Government and report to us so that we have the information that we need. That would benefit the women in Moray, whom we are discussing in this debate, and those in my region, and I am sure that there are examples of other areas in which women would benefit from the appointment of a women’s health champion. Therefore, it is really important that we get that done.

I pay tribute to the campaigners who have consistently stood up for the services that they want. It is our responsibility to keep bringing the issue back to the chamber and to push the Government harder and harder on it. I will not stop asking for a women’s health champion to be put in place, because I fully believe that having such a champion will help us to address some of the issues.

I invite Humza Yousaf to respond to the debate.

17:49  

Thank you, Presiding Officer. I begin, as you and many others have done, by wishing everybody all the very best for the festive season—a very merry Christmas indeed—and all the best for 2023. I have a secret list of who I think will be getting a lump of coal for Christmas, but it would be uncharitable of me to even suggest who might be on such a list.

As is customary, I begin by thanking Douglas Ross for securing this important members’ business debate. I am pleased that, notwithstanding the exceptionally long couple of nights that we had as we engaged with the Gender Recognition Reform (Scotland) Bill, we were still able to make time in the Business Bulletin for this debate, which is important not just to members in the chamber but to many people across Moray and, as Finlay Carson has demonstrated, across Scotland.

I am pleased to acknowledge, too, that an exceptional cross-party campaign exists on this matter. I have met a number of elected members—Douglas Ross, Richard Lochhead, Rhoda Grant and many others across the political spectrum—in relation to that excellent campaign.

I restate the Government’s cast-iron commitment—as Karen Adam asked me to do—to returning consultant-led maternity services to Dr Gray’s hospital. I will not go through the background, because people are aware of it now that they have heard it from other members; instead, I will try to address some of the points that have been raised.

Many colleagues have made the point—Edward Mountain made it most forcefully in his contribution—that it is so important that we listen to clinicians, whether in Raigmore or at Dr Gray’s. That clinical expertise is exceptionally important. I do not want anybody to leave the chamber thinking that I do not listen to and put a lot of stock in the opinion and expertise of clinicians. The concerns that clinicians had raised were playing heavily on my mind when I last talked about Dr Gray’s in the chamber, which is why I was not in a position to approve the model 4 plans then.

Douglas Ross and other members have posed a question to me a question about model 4, and they have raised concerns along with keep MUM, the maternity voices partnership and others. I think that model 4 has probably become a distraction. We are trying to describe an improvement journey, with all the elements that are required for an integrated model. When I asked Douglas Ross whether he believed in cross-boundary working, his answer was, “Absolutely”, which is right. If we are going to have a sustainable model, with all the recruitment challenges that we have in not just the north-east of Scotland but many areas of remote, rural and island Scotland, cross-boundary working will be exceptionally important.

However, it is fair to say that there are clinical, community and elected representative concerns around model 4, and that model 6, which is the plan that we have in front of us, will not go fast enough for many people. Many months ago, people were saying in the chamber that model 6 might take seven or 10 years, which is what they had heard from others, but I should say that it is far more ambitious than that.

Having taken all those things into account, I have decided that we will not continue with model 4 as previously outlined. However, as I have already said, I expect NHS Highland and NHS Grampian to continue to work together to ensure sustainable maternity services for women in the north of Scotland.

That is a very welcome announcement, which I asked for in the motion and campaigners have been asking for.

The cabinet secretary has said that he will not continue with model 4 in its current form, but we cannot just have a change of name. I am just trying to tease this out. The concerns will remain if the model is called something different or just slightly tweaked. What does the cabinet secretary mean when he says that he will not continue with model 4 in its current form?

On his point about my agreeing with the cross-border opportunities, we know that, with model 6, some mums in some circumstances will still need to go to Aberdeen—we all accept that. However, they should be the exception rather than the rule. I want to see as many as possible of the thousand births that happen in Moray each year on average happen in Dr Gray’s.

I suspect that I will not be able to do the matter the justice that it deserves in the time that we have. I am happy, as always, to pick it up with Douglas Ross and other members, and maybe to do a briefing for cross-party members in order to address some of the issues.

What I mean is that our laser-like focus should be on model 6—the end destination, which is the full return and restoration of consultant-led maternity services to Dr Gray’s. We will not proceed with model 4, as per Ralph Roberts’s report. However, it is really vital, where there are recruitment challenges, that there is cross-boundary work to ensure that services at Dr Gray’s are sustainable.

Douglas Ross knows that NHS Grampian’s model 6 plan, as endorsed by NHS Highland, makes the point that we are going to make significant investment in Raigmore, for all the reasons that have been articulated by Edward Mountain. Raigmore is in need of not only refurbishment but an investment in the workforce.

If there is a time, as per the current plan, when Raigmore has in place the clinical capacity and infrastructure to take more women from Elgin or Moray more widely, while Dr Gray’s is still being fully restored—because there is a time gap between 2025 and the end of 2026-27—we should ask whether Douglas Ross’s constituents should have the choice of going to Raigmore, which is a shorter journey than going to Aberdeen. That conversation is absolutely worth having.

Members should make no mistake about it: given the ambitious timescale for the return of maternity services to Dr Gray’s, my feeling—which I have shared with the health board—is that the focus must be on model 6.

I welcome the cabinet secretary’s announcement, which is something that I called for when I conveyed the views of keep MUM at a meeting a few weeks ago.

With regard to the integrated model, there is no one in Moray who would dispute or argue against the idea of staff being recruited on a cross-border basis. Everyone is focused on the outcome of having a fully restored service at Dr Gray’s. The integrated model is perfectly acceptable as a means of staff recruitment, and having consultants working between Raigmore and Dr Gray’s would be welcome if that plugs the gap and restores service.

There is some anxiety in Moray about affordability, because of the timescale and the need to recruit consultants. The NHS Grampian plan for full restoration of the service suggests that just under £22 million of investment is required in the next five years, with £7 million per year thereafter. Can the cabinet secretary make any comment about the local anxiety that affordability issues will slow down the timescale if those figures turn out to be a reality?

I can give assurances about that. Before I do so, I say that Richard Lochhead has perfectly articulated the integrated model that we are talking about.

Let me be clear: we will not proceed with model 4; the focus is now on model 6. Instead of even calling it model 4 or model 6, let us say that we are talking about the restoration of consultant-led maternity services at Dr Gray’s. That is where we are going. Richard Lochhead has articulated exceptionally well how important the integrated model will be if it helps with the sustainability of the service, which I absolutely think it will.

The short answer to Richard Lochhead’s question is yes. The Government and I have committed to the full restoration of consultant-led maternity services at Dr Gray’s. That means, of course, that we must step up to ensure that that is fully funded, and we will do that. There will always be an element of discussion with the health board.

I give an absolute assurance that none of that means that we will not continue our investment in Raigmore. Edward Mountain and Fergus Ewing raised the issue of investment in Raigmore, as many other members have done.

I suspect that I am vastly out of time. Is there any additional time?

I am being generous, cabinet secretary.

Good. I will try not to keep people back.

You may continue for the time being.

How much time do I have?

I can give you another couple of minutes.

That would be great, Presiding Officer. It is much appreciated.

I want to touch on a number of issues that have been raised directly with me. It may be better for me to write to some members, because of the time constraints.

The question about external assurance was raised by a number of members. There may be some perceived distrust of the health board. I have two things to say on that. First, an external assurance panel is in place. Members have met Linda de Caestecker, who is heading that panel. She is not the only person who is part of that panel; as the name suggests, a number of people are involved in it.

Secondly, I am not minded to put an external project manager into Grampian. NHS Grampian has to have ownership of this. I sincerely believe from the discussions that I have had with it that it has an absolute commitment. I think that its plan, which has a far shorter timescale than some members had expected—they had raised 10 years and seven years with me previously—shows that it is committed to this.

On the issue around C-sections, I am always clear that it is good to take clinical advice, so why did we come up with a different timescale previously? It is because that was the timescale that was in the Ralph Roberts report, which was presented to me. That report was rightly interrogated by clinicians and they have come up with the timescale of early 2025 for elective C-sections to be reinstated to Dr Gray’s.

A number of colleagues raised NES, in relation to both NHS Grampian and NHS Highland. Touching on what Finlay Carson said, I note the broader issue that it is really important to get more trainees to train in rural Scotland, and NES is fully involved in that very mission. In fact, it has been left in no doubt about my expectation of its involvement in relation to Dr Gray’s. Given that I have only a little time left, I will write to members about that.

Karen Adam made an excellent point about freedom of movement and immigration. Having raised the issue with the UK Government, I can say that, certainly from a health perspective, my fellow health secretary understands the need for the Home Office and those who are responsible for immigration to work to help us to plug some of the gaps in the workforce. That would not be a panacea, but it could certainly help.

I will conclude by addressing Carol Mochan’s point about a women’s health champion. I or Maree Todd will update Parliament on that early in the new year. Carol Mochan is absolutely right and she has every right to push the Government really hard on that appointment. We made a commitment in that respect, but it is so important that we get the right person, because I hope that they will stay in post for many years to come and push the Government in relation to the women’s health plan. I am absolutely committed to that.

Thank you for your generosity, Presiding Officer. I end by saying that the Government is absolutely committed to fully restoring and returning consultant-led maternity services to Dr Gray’s. We will not proceed with model 4. We will proceed to that destination, and I look forward to keeping members updated. I finish where I started, by wishing you all the very best for the festive season.

Thank you, cabinet secretary. I congratulate everybody on persevering and making it through to the end of what has been a long week and a busy term. I add my good wishes for the Christmas season and the new year.

Meeting closed at 18:02.