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The strategy document contains a commitment to regional action and a regional approach to recovery, with a focus on regional economic partnerships. Does the cabinet secretary recognise the different impacts of the pandemic and the recovery on various parts of Scotland—particularly island communities, which have been doubly disadvantaged by the ferries crisis? How will the regional approach be followed by proportionate support and funding?

On a point of order, Presiding Officer. I am sorry, but my app would not load either. I would have voted no.

The reality is precisely that it is a gamble, and one that might put vaccination efforts further back.

As was the case before the levels system, the Scottish Government is applying a blanket policy across Scotland regardless of local circumstances and prevalence of the virus. Despite its U-turns, it is implementing an impractical and ill-considered set of proposals that may have negative effects—

The proposals are in themselves dangerous to public health and a threat to business. I urge the Government to go further than it did yesterday and drop the plans.

Yesterday, the First Minister accepted what everybody already knew but she had steadfastly refused to accept. Having announced that the vaccination certification scheme policy would begin this week, the Scottish Government was completely unprepared for its implementation. Such an outcome was a long time in the making due to the culmination of a lack of meaningful engagement, the design of a policy without reference to those who would have to enforce it on the ground, and an arrogant dismissal of genuine concerns.

If it seems as though there is a lack of joined-up thinking in the Scottish Government’s approach, that is because there is. First, we had the hasty reversal of the Deputy First Minister’s position that vaccination passports were

“the wrong way to go”.

We had a policy announcement that was so confused that it led members in the chamber to resort to googling the definition of a nightclub on their mobile phones. Indications that certification would roll out with new age demographics—16 and 17-year-olds and potentially 12 to 15-year-olds—were reversed. We have now ended up with a situation in which guidance for businesses was only issued on Tuesday evening for a policy that they are supposed to put in place on Friday. Guidance for the general public and a marketing campaign to raise awareness are, it seems, still in the works.

If the SNP’s U-turns are not enough, we need only look to its partners, the Greens. Patrick Harvie once told us:

“the more I think about this notion of vaccine passports or vaccine certificates, the more concerned I am about it”.

It appears that thinking ends where ministerial office begins.

Over the past 18 months, the Scottish people have endured a number of restrictions to their lives. With remarkable generosity, they have faced contradictions and inconsistencies in this Government’s response. However, the scheme that ministers have outlined is categorically different from what has gone before. It should have been introduced only with detailed thought and sober reflection. Sadly, we have had none of that.

The First Minister has continually presented the alternative to vaccination certification as being the threat of businesses having to close again. We are currently in a period in which cases are dropping. Can businesses and other organisations have any confidence that, should that trend reverse, they will not be met with closure anyway?

That is not the only question that ministers have to answer, and I hope that the cabinet secretary will also address the following issues when he sums up. The Scottish Government is developing an approval process for medical exemption, which will apparently be published ahead of implementation on Friday. Has it developed that process? What guidance have businesses been given on that? Will the exemption be included on the NHS app?

Can the Scottish Government say with confidence that problems for individuals—for example, for those who received their first vaccination in one jurisdiction and their second in another—have been resolved? Can the Scottish Government point to any evidence that venues with people dancing and alcohol that close at midnight will have less effect on the spread of the airborne virus than those that are open for an additional hour? Finally, can ministers truthfully say, as their guidance states, that a large-scale events business will be able to

“refresh policies and organise training for staff”

before Friday based on guidance that was issued only on Tuesday afternoon?

There are many, many more problems with the proposals than those that I have set out. For one thing, the Scottish Government’s amendment mentions tackling vaccine hesitancy, despite the First Minister telling Parliament that

“Uptake rates across all groups in society are high—much higher than we anticipated at the start of the programme.”—[Official Report, 21 September 2021; c 23.]

I draw members’ attention to the words of Professor Sir Jonathan Montgomery, who told a committee of this Parliament that the same groups

“might respond with increasing distrust of the vaccine programme, and Government advice, because they feel that they have been coerced.”—[Official Report, COVID-19 Recovery Committee, 23 September 2021; c 7.]

The reality is precisely that it is a gamble—[Interruption.]

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

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

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

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

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

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

Another paramedic told me:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We have just over a week before the scheme is supposed to come into place. The Night Time Industries Association is launching legal action against the plans, which it says are not proportionate and are “likely to be unlawful.” UKHospitality Scotland has said that business confidence has been “shattered”. Yesterday, Liz Cameron of Scottish Chambers of Commerce said that businesses are expected

“to bear the burden of implementation costs, without any financial support whatsoever”,

of a scheme that

“is not workable in the timelines being proposed.”

Does the cabinet secretary think that all those bodies are wrong?

To ask the Scottish Government how it will monitor and review the Covid-19 vaccine certification scheme. (S6O-00169)

We know that the detail of the Scottish Government’s plans for vaccination passports has been severely lacking. Therefore, can the First Minister say whether everyone who is eligible for vaccination will be required to have a vaccination passport for certain events and if, as is now recommended by the UK’s chief medical officers, 12 to 15-year-olds will be offered a single vaccine dose, does that mean that a 14-year-old might need to have a vaccination passport just to go and watch their local football club play if the attendance is over 10,000 people?