 The next item of business is a statement by Humza Yousaf on NHS winter pressures. The cabinet secretary will take questions at the end of his statement and so there should be no interventions or interruptions. I call on Humza Yousaf up to 20 minutes, cabinet secretary. Thank you, Presiding Officer. I wish to update the Parliament on the extraordinary pressures facing our national health service this winter and the measures that the Scottish Government is taking to address them. Let me begin by stating a simple fact that this is the single most challenging winter that the NHS in Scotland has ever faced. Our NHS, its committed workforce, is facing a perfect storm of intense pressures, which are leading to extreme difficulty, disruption and delays right across the service. This especially challenging time for the NHS will continue, we suspect, for the coming weeks. As I have said previously, the full recovery of our NHS is not something that will take weeks or months, but it will take years. Let me once again take this opportunity to thank our incredible NHS and social care staff for continuing to provide exceptional care under what is the most difficult of circumstances. Our entire health and social care system is facing the continuing impacts of the pandemic, the biggest challenge that our NHS is facing in its 74-year existence. Covid remains a pressure on our health system, with most recent statistics showing that Covid cases are now at their highest levels since the summer. In the week ending 1 January, there were over 1,200 patients in hospital with Covid-19, a 15 per cent increase from the week ending on Christmas day, and double the number of patients from four weeks ago when there were over 600 Covid patients. Recent flu admissions were also around three times higher than emergency admissions due to Covid, and there have been rising cases of Strep A and other respiratory viruses. Challenges around delayed discharge of patients also continues to have an impact in driving up A and E waiting times, and overall pressures on the health system are significant. Last week, latest management information showed that hospital bed occupancy across Scotland was over 95 per cent. Some sense of the intense pressure being felt can also be seen in the almost 100,000 calls to NHS 24 over the two four-day breaks of the festive period, the highest festive period demand for over a decade. Traffic to the NHS Inform website and the symptom checkers in December was at its highest level ever, with 12.7 million page views. The impact on the ambulance service has also been significant. It dealt with over 16,000 emergency incidents last week, 11 per cent more than the average of the previous four weeks. While that highlights the significant levels of demand that we face, it also profiles the innovative ways that we are seeking to tackle this issue, providing effective triage and supporting hospitals and social care settings. The challenge is significant. These seasonal pressures come against the backdrop of the UK Government's mishandling of Brexit and the nation's finances, with such dire consequences for Scotland's social care sector in particular. While fully acknowledging the multiple difficulties that we are facing, this Government is determined to continue to take action to alleviate some of the pressure in our NHS and social care. I am convinced that we should pursue a whole-systems approach to tackling these issues and to support from all parts of the Government, the NHS and social care through the critical coming months. On Friday, last Friday, the First Minister shared a meeting of the Scottish Government's resilience room score to determine the next steps in addressing the unprecedented pressures across the NHS. As well as ministers, the meeting was attended by senior representatives from COSLA, the NHS, integrated joint boards and the Scottish Ambulance Service. It reviewed the number of measures that are being taken to alleviate pressures on the system. Those include the use of flow navigation centres as part of the redesign of urgent care, the hospital at home service and the ambulance service staff, providing treatment where appropriate to help to avoid hospital admission. Additional actions will now be rolled out across the health and social care system. I can today outline a further course of action to unlock additional capacity to alleviate the pressure of delayed discharge on the system. As I have mentioned, delayed discharges and their impacts on patients continue to be a significant issue. It has not only been exacerbated by increases in staff absences due to self-isolation requirements and sickness, but the number of care home places has been impacted by care home closures, too. There is no doubting that high inflation and high energy costs have significantly impacted a sector that was already facing multiple challenges. I know that teams across the country are working exceptionally hard to ensure that people are receiving the right care in the right setting. However, the fact is that, at present, there are more than 1,700 people currently in hospital who do not need to be there for clinical reasons and whose interests are not best served by being there, because care packages that would allow them to be discharged home or to a care home are simply not in place. As an additional and exceptional measure, COSLA and the Scottish Government have worked with partners across the care home sector to identify additional interim spaces within care homes to help to provide additional pathways for people to be discharged from hospital in a timely and safe fashion. To support health and social care partnerships, secure the extra provision. We are making funding of £8 million available, so beds can be purchased at an additional 25 per cent above the national care home contract rate. We will work closely with partners across the NHS health and social care partnerships and local authorities to ensure appropriate use of funds and evidence of the impact that that funding has. That is an extremist time limited measure that is required to help us with the current capacity issues that we face. The additional funding is intended to meet the increased costs of utilising those beds for a short period of time. With partners working collaboratively, we have managed to identify around 300 interim beds that are available. That is in addition to the 600 interim beds that are already helping patients in the system. That support is intended to be used as an additional tool that health and social care partnerships can deploy to support during the current situation and allowing additional flexibility to maximise capacity within our hospitals. We will work with partners to utilise every bed possible. Those interim beds may not be a family's first or second choice for their relative, but I hope that families agree that in the current circumstances this is about making the best possible choice for those in our care. That measure will only be in place for a limited period of time to directly support our hospitals to deal with pressures at the front door. However, it will enable some people to move from an acute setting to a more appropriate community one. Recognising the risk of prolonged stays in hospitals. In addition to responding to the pressures, a ministerial advisory group has been established now for a number of months. That group meets weekly. It brings together cabinet ministers such as the Deputy First Minister, myself, Shona Robison and other ministers—cosla, key stakeholders such as Scottish Care—to advise on pressures within the system and look at possible actions to mitigate them. This week, further guidance has been issued to boards, making it absolutely clear that they can and should take steps to protect critical and life-saving care if that is judged to be necessary. Boards can, of course, ask Government for advice as and when that is required. We believe that local health boards are best placed to judge what reasonable measures should be taken in each local health board area. Those measures could include, among others, opening or procuring additional capacity, moving staff to areas of pressure, increased engagement with a third sector or potentially delivering a different model of care for a short period of time. In my role as health secretary, I retain the emergency powers and ability to direct that are set out in the NHS Scotland Act 1978. I am well aware that more severe measures such as blanket pause of elective procedures or key diagnostic tests are not without impact on the health service and, indeed, on patients. I believe that it is important at this time that we ensure that the NHS boards have the ability to respond flexibly to local circumstances and to deploy local solutions. Advice has also recently been issued to local leaders that provides clear guidance on the expectations around assessment and discharge practice and around care home oversight arrangements. We are also seeing record numbers of patients delayed under the adults with incapacity legislation. Those are patients who, although clinically ready for discharge, cannot be legally discharged with their court-appointed guardian being in place. Officials have been working with the Scottish Courts and Tribunal Service and the Law Society of Scotland to investigate where improvements can be made to ensure that people are able to be discharged in a timely manner. I have also met the Mental Welfare Commission and the ECHR this winter in regards to matters that are affecting adults with incapacity. Although some of the measures that I have just announced are to help in the short term with the immediate pressures that we are facing, we are also putting in place the long-term steps that are necessary and needed to address social care challenges that we face. We have invested significant additional funding to support social care. That includes, for the current financial year, £124 million to enhance care-at-home capacity, £200 million to increase the hourly rate of pay to £10.50, £20 million to support interim care arrangements and £40 million to enhance the multidisciplinary teams. A further £3.6 million of funding has been made available in the 2022-23 budget to support the further development of hospital at home across Scotland. It is clear that our accident and emergency services in Scotland are being impacted severely by the winter pressures. The situation is, of course, not unique to Scotland. Indeed, Scotland's accident and emergency services continue to outperform those in other parts of the UK, and they have done for the past seven years. However, that is, of course, called comfort for those who are waiting far too long for treatment. Scotland already has record numbers of NHS staff, and we are recruiting more staff as part of our winter plan. However, it is very clear that far too many people are waiting far too long for care, whether that is for an ambulance response or waiting too long for treatment when they attend our accident and emergency departments. We have taken action to improve any ways, including plans to recruit 1,000 new NHS staff and roll out of the £50 million urgent and unscheduled care collaborative to help to drive down those rates. Those measures include initiatives such as hospital at home, ensuring that people are directed to the most appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A&E. We have also increased the amount of virtual capacity hospital-level care provided at home to the size of a large teaching hospital. We will also bolster workforce capacity in NHS 24. NHS 24 is an incredibly effective service, and through the expert advice offered, the overwhelming majority of those who call NHS 24 do not need onward transfer to already busy A&E departments. This winter, NHS 24 is taking forward planned recruitment of around 200 new stars before the end of March. As part of this recruitment, the board has appointed over 40 whole-time equivalents, call operators, call handlers and clinical supervisors in the run-up to Christmas. While call wait times for NHS 24 were often longer than usual over the festive period, the vast majority of calls received were dealt with through their initial contact. Despite the pressure that I have outlined, we are seeing progress in some key areas across the system. For example, excluding NHS Lothian, the latest figures show that, despite continuing pressures, almost 90,500 operations were performed in November 2022. That was almost 21 per cent higher than November 2021 when more than 16,000 operations took place. That also marks the highest proportion of planned operations performed since the start of the pandemic, with more than 91 per cent of planned operations performed. That is progress in relation to our elective care. We are offering more support outside of hospital settings to assist people seeking help with common winter illnesses. NHS Inform has self-help guides to help to let everybody know when to stay at home and when to seek more care. GPs and pharmacies can also be contacted as a first port of call for non-critical non-emergency care. I would like to add a reminder for all of us that, if you have symptoms of a respiratory infection, try to stay home and avoid contact with other people. If you need to leave home, we strongly recommend that you wear a face covering. I understand that the NHS is built on the people that work in it who have had to work through incredibly challenging circumstances for years. The pressure of the pandemic—almost three years of a pandemic—has been relentless. I will always be available to talk to our committed workforce who provide incredible care for the people of Scotland day in and day out. I am grateful to Unison Unite and other trade union members who have accepted this Government's record pay-off for NHS staff. In fact, the majority of trade unions on-stack, the Agenda for Change Pay Negotiating Committee, have accepted our pay deal. Although I am naturally disappointed that we have not got agreement from every trade union, I am also grateful for the positive engagement with the GMB, the Royal College of Midwives and the Royal College of Nurses that has taken place. I will continue to pursue meaningful dialogue with all trade unions to try to invert industrial action. We sincerely hope that the additional pressure of industrial action can be avoided at this very, very challenging time for the health service. For my part, I remain absolutely committed to dialogue and to positively engaging with our trade unions. As I have outlined, unprecedented challenges continue to have a real impact on the NHS and on people right across this country. Although we face an extremely difficult period ahead, I remain confident that, with the combined effort of our incredible workforce and the determined will of this Government, those challenges will be met. Not only will the GMB be met, but it will be overcome. Let me end where I started by thanking our outstanding health and social care staff for their herculean efforts during these extremely challenging times. We will continue to honour them not just with warm words but through our deeds too. I thank you for the ability and the time to make this statement. Of course, I am happy to take questions from across the chamber. The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 40 minutes for questions after which we will move on to the next item of business. I would be grateful if members wished to ask a question where to press their request to speak buttons now. I call on Sandesh Gulhane. Under the cabinet secretary's watch, the Scottish NHS is on its knees. Any waiting times, cancer waiting times and delayed discharge are all at their worst-ever level, with no improvement in sight. Whilst record number of patients were waiting over 12,000 A&E, where was the health secretary? We heard nothing from Humza Yousaf over the festive period, only for this hastily cobbled together statement today before another divisive debate on independence, which is timetabled to last longer than this statement on healthcare. This is a national emergency. People are dying unnecessarily. Our heroic NHS staff are overwhelmed and are burning out. The crisis in our NHS should be a priority for this parliament, because it is a priority for the people of Scotland, and they will be appalled today. I simply cannot fathom why the cabinet secretary did not plan for, in his words, the worst-ever winter our NHS faces. Covid flew cold, accidents all increasing. This is predictable. For months we have been calling on Humza Yousaf to rethink his failing NHS recovery plan, and just last month we published a recovery plan of our own, but our warnings fell on deaf ears and the Scottish people are now paying the price for the complete lack of preparation. The BMA has said that the Scottish Government have run out of ideas. I was out there seeing patients over the festive periods in different parts of the country, and the problems are similar everywhere—primary care overwhelmed, secondary care, hospitals overwhelmed, patients scared of going to A&E. We need to see improvements and we need to see them urgently. In terms of the changes that were announced yesterday, I would like to know when we can expect to see real meaningful change in our NHS, improvements to A&E waiting times, delayed discharge numbers and cancer waiting times. Can the cabinet secretary confirm the timescales in which he expects to see significant improvements? Those are issues that are facing every single health service across the UK. Dr Sanders Gohani asked me where I was. I was busy in the festive period talking to our trade union colleagues. If his party, of course, did the same, they may not have nurses and ambulance drivers walking out on strike. In terms of his questions about planning, I noticed that the Conservatives published a winter plan. They published it in mid-December. That is not particularly helpful or useful, because the winter planning that we undertook, of course, took place after the past winter. I would say to Conservative members that if Dr Sanders Gohani was the oracle he claims to be and could have predicted every single one of the pressures that the NHS is facing, he might have wanted to tell his colleagues down south, because those are pressures that are being faced by every single health service, not just in the UK, but many across the world. What are we doing about it? There are a number of actions that we have taken, not just the actions that I have announced today, but I have already announced the recruitment of additional staff. In fact, we recruited staff last winter with recurring funding to help with pressures this winter. We have also increased our additional funding for the Scottish Ambulance Service. In 2021-22, the Ambulance Service recruited record numbers of ambulance staff. Our winter plan, backed by £600 million of funding, I have already given details of how that is already helping in relation to social care. We have taken action, but not with standing that I have always been upfront, always been honest and publicly stated, even with those mitigations in place, this would be the most difficult winter that our NHS has ever faced. I simply say that I expect, of course, with the action that we have brought forward, that we will see improvement in the very short term. Equally, let me be upfront and be honest that, as schools will return, as work returns, as people mingle at work, there may well be the possibility that we see a slight increase in some of those viral infections spreading. We expect that the first couple of weeks, a few weeks of January, to be extremely challenging. There will continue to be challenges, but with the action that I have announced both in terms of interim care beds, but also the NHS at 24 additional staffing, I hope that we will see in the short term some improvement to those pressures. Jackie Baillie The health secretary is keen to tell us that this winter the NHS is under unprecedented pressure and he cites Covid, flu and strep A. Let me join with him in thanking all NHS staff for everything that they are doing, but they will tell you that this crisis is not unprecedented. It was predicted by clinicians and, in fact, fewer patients are being seen in A and E now than before the pandemic. What is unprecedented is that the health secretary has been warned about this crisis by clinicians for well over a year and he has failed to listen and to act on solutions. What is unprecedented is that this Government failed to end delayed discharge, something that it promised to do in 2015 and, eight years on, it is at record high levels. Dr Ian Kennedy of the BMA is clear that the current crisis at the front door of A and E is because the back door of social care has not been fixed. What is unprecedented is that this Government has presided over inadequate workforce planning for the last 15 years so that we now have 6,400 nursing vacancies and, in some areas, 14 per cent of consultant posts lie empty. Let me ask the health secretary about the 1,000 additional staff. How many are in post and where are they deployed? Let me also ask him about the extra 300 beds, which will help, I am sure, but when the latest data reveals a record high of over 1,900 people stuck in hospitals, what impact will that have? Will he give a commitment to removing non-residential care charges and supporting whom and family carers, as that will directly contribute to helping to end delayed discharge? Finally, why is the First Minister not here giving the statement, as she did yesterday, and has instead sent along her spare? Cabinet Secretary. I do, of course, notice that Jackie Baillie is here, and I am not going to personally insult Jackie Baillie, because at a time of national emergency, the people rightly expect our political leaders to rise above their petty political differences and work together in this national interest. Jackie Baillie and her colleagues can shout from a certain position, but I think that it is important that I answer their questions on delayed discharge. Let me say, as I have said to Sandish Gohani, that I expect there to be improvement once, of course, when we begin to move people from acute sites into these interim beds. We expect that to be in the short term. Hopefully, as we begin to see the levels of flu and Covid abate and reduce, that will begin to see an improvement in our health service and in the performance indicators that she references. We have a very proud record. I am proud to stand on in relation to staffing of the NHS over the course of the last 15 years. We have staffing in the NHS at record levels, but Jackie Baillie is right to mention the high levels of vacancies that we are keen to fill. That is why I announced last year additional funding for nurses to recruit nurses from overseas. That was 200 nurses that we committed to last year. I can hear Jackie Baillie shouting from a certain position. I am literally answering your question as you are talking. We promised to recruit 200 nurses last winter that funding was recurring. We exceeded that. For this winter, we have said that up until April, we will recruit an additional 750 nurses. I believe that there have been 126 firm offers with 455 in the pipeline, which is what boards expect to fulfil. That is all the way up until April, and I will give a further update as we get towards the end of this financial year. I will continue to push boards to go further in terms of the recruitment where they possibly can. On her suggestion about non-residential charges, that is a promise, a programme for a Government commitment from us to do so in terms of the abolition of non-residential charges. I will continue to work within our portfolio to see when we can do that at the earliest possible opportunity. My question to the cabinet secretary is in relation to the amount of people that are suffering from flu and Covid, not just in our hospitals but in our communities. Can I ask the cabinet secretary what action the Government can take to increase the take-up of the Covid booster and the flu vaccine? Gillian Martin is absolutely right to focus on the issue of vaccination. We know that the vaccination for Covid, in particular, is a complete game changer. We know that the flu vaccine can also be effective. We have taken the decision in Scotland to co-administer both Covid and flu vaccines. The uptake has been very positive, but if I was to give any encouragement, it would be to all those who are eligible, who have not come forward. I would say, looking at the statistics, looking at the numbers and the data that we have in front of us, that the uptake levels for health and social care workers are not as high as I would like it to be. If you are a front-line health and social care worker and you have not had the Covid or flu vaccine, please do come forward. It will help to protect you and hopefully protect those that you give exceptional care to. I would like to put on record a thanks to the UK Government for the Covid vaccination programme. Cabinet Secretary, over the Christmas break, I was inundated with correspondence about the crisis in our Scottish NHS. The latest statistics seem to reflect a situation that is now spiralling out of control. Last week, just two in five patients were seen within four hours at the Royal Infirmary of Edinburgh, despite weekly attendance being lower than it was in the same week in 2020 before the pandemic. That should be 2019 before the pandemic. Let me put the current situation in the words of Dr David Caesar, a senior emergency medicine consultant at the Royal Infirmary. Dr Caesar said that dignity feels like a distant luxury and the fatigue among clinicians is bone deep with staff, dejected and in total, despair. In your answer, Cabinet Secretary, perhaps you could speak to Dr Caesar and not me. What is the one practical thing that you will do today that will help him and his colleagues tomorrow? I know that Dr David Caesar used to be one of our deputy chief medical officers here in the Government. I am grateful for the work that he has done. I read his piece in the times, but I read his public comments that he has made. What I would say to Sue Weber before I answer her question directly is that she is right. Attendances were lower, but what that asks is that any clinician on the front line will tell you that people are presenting with higher acuity. They are presenting sicker and therefore the length of stay is longer. That is currently the challenge that we are facing, as well as the exit block, the lack of capacity within already very busy hospital sites. What can we do to help the likes of Dr Dave Caesar and every other health and social care worker who is doing an exceptional job? What we can do is reduce that workload pressure. That is why the additional funding for those 300 interim beds that we have identified and will look to utilise as quickly as we possibly can will hopefully begin to reduce that workload pressure. What we can continue to do is to make sure that Dr David Caesar and NHS staff are properly rewarded. That is why we have put forward our record pay rise for agenda for change staff and we will make sure that we do what we can to retain our doctors and other staff as well to make sure that they are appropriately rewarded and remunerated. I welcome that the Scottish Government's resilience room has been convened or reconvened given the level of pressures that our NHS and care services are facing, and I am pleased that I have played a wee part in suggesting it. The First Minister's briefing yesterday, just like the briefings during Covid, was incredibly useful and helpful. Will the Scottish Government continue to keep this Parliament and the public regularly updated on the work that is being taken forward to help to address the pressures on our health and care services? I am happy to do media briefings in the First Minister, and I will reflect on whether to do another media briefing. I am, of course, happy at any point to come to this chamber to answer questions on this issue and keep Parliament updated. I think that there is something important that we should have the ability to speak directly to the public. That public health messaging is incredibly important, and she might have seen throughout the festive period that I was reiterating in some of the health messaging that the First Minister was, the likes of the national clinical director, Jason Leitch, doing so. I think that all of us have a role to play to communicate not just with our constituents but with the public more widely. In relation to the additional beds announced, unpaid carers have raised concerns about the potential of loved ones being parked their words in care homes, perhaps against their wishes as they wait for care assessments. There are serious concerns for people's wellbeing. So how will the cabinet secretary increase capacity to ensure that people are appropriately assessed and not abandoned in a setting that may be inappropriate and unwelcomed, particularly with reports this week that social workers in Scotland miss more than 30,000 work days due to mental health? Does he accept that all of this comes back to retaining and recruiting more social care staff by valuing them and ensuring that they are offered more than this Government's insulting rise of 40 pence? I thank Paul O'Kane for the important questions that he asked. I may disagree with some of the characterisation about it, and I will come to that in a second, but there are incredibly important questions. Those are difficult conversations to have, but I would say that, of course, clinicians who have conversations day in and day out do so compassionately, but also collaboratively with families. I was being up front in my statement that an interim placement may not be a family's first or second choice, but equally remaining within a hospital when you are clinically safe to be discharged in a hospital that may be at 95 or 99 or above 100 per cent capacity, that cannot be good for the individual involved, let alone for the hospital involved. Can we always work with families to ensure that the most suitable care placement is available for them? It may be the case that in some of those placements people are placed there and the assessment takes place within the interim care placement, and they are moved on to a permanent either care home place or, indeed, get the package of care that they require at home. However, being in hospital when you are clinically safe to be discharged is not the best choice for an individual, because we know that prolonged stays in hospital when you are clinically safe to discharge is not best for the patients involved. On social care staff, Paul O'Kane and I rehearsed this at committee this morning. Obviously, a £23.24 budget has an uplift of £10.90. That is the third pay rise in the time that I have been Cabinet Secretary for Health from 2020 to 2021. That represents, on a full-time wage, more than £2,000 of an increase over a year. What I would say to Paul O'Kane and I will correct this if I am wrong, of course, the £10.90 real living wage is also the same wage uplift that is being offered by Labour in Wales, where they are in charge of the health service, too. A recent report by the Nuffield Trust has warned that Britain's departure from the EU has worsened recruitment shortages, made accessing essential medicines more difficult and further exacerbated health inequalities. Does the minister share my concerns that the economic hit of a hard Tory Brexit is fuelling the severe challenges that the NHS in Scotland is currently facing? There is no doubt about it. You talked to any social care provider and they will tell you the damage that Brexit has caused. Social care has been hit by a number of real difficult challenges over the year. A hard Tory Brexit is certainly one of them, the pandemic being the other. However, the most recent concern that social care providers, whether they are a care home provider or care at home providers, they tell me is the high cost of inflation, which is a direct result, of course, of the UK Government's mismanagement of the economy. That has led to care home energy costs being exceptionally high. We know fuel costs being exceptionally high for care at home providers as well. I am in constant dialogue with the care sector here in Scotland, but I also have some regular conversations with other health ministers across the four nations. I will continue to implore the UK Government to do what it can in relation to migration, because we know that there is more that can be done to help our social care and NHS staff in relation to overseas recruitment, but also to see what more they can do in relation to mitigation against high energy and high inflation costs. There is much interest in this item and I would be grateful for concise questions and responses, as I call Alex Cole-Hamilton. Thank you very much indeed. It is now more than a year since I first asked the cabinet secretary to instruct an urgent Government inquiry into unavoidable deaths caused by the crisis in emergency care. We now understand the quantum of that with the Royal College of Emergency Medicine telling us over the Christmas period that as many as 40 people a week may be dying who did not need to die as a result of this crisis in emergency care. Can I ask him again will he now instruct that urgent Government inquiry into those avoidable deaths? I am not disputing our chem, the Royal College of Emergency Medicine's underlying premise. I do not think that any of us would that if patients are waiting excessively long periods for care, then they will come to harm. Each individual death would have to be individually examined to understand the true scale of that. I will not instruct a public inquiry into every single death that may have happened as a result of long waits. I will take some time to consider what Alex Cole-Hamilton has said so that we can truly understand the true picture of those who have come to harm due to excessively long waits. John Mason, to be followed by Craig Hoy. Can the cabinet secretary confirm that this year and the current year all financial resources are allocated so that to put any more resources into part of the NHS or the NHS as a whole there would have to be a balancing cut elsewhere? Yes, I do not know if I made this clear or not my statement but the £8 million that we are putting towards the £300 interim care basis coming from the health and social care portfolio, so every penny is allocated and there is no additional finance coming from central finance, so we would have to find that money from within the health and social care budget, which John Mason and other members know is extremely challenging given the financial circumstances that we are currently under. Craig Hoy, to be followed by Fulton MacGregor. Thank you, Presiding Officer. Delayed discharge predates the pandemic. Severe workforce pressures predate the pandemic and long A&E waits predate the pandemic. This minister has been warned of these problems for years and he has chosen to ignore those warnings, so now that the First Minister is doing his job, shouldn't he do the decent thing and resign? Again, I will not rise to the pathetic personal petty attacks but what I would say to Craig Hoy is that when our country is facing a national emergency, when they are facing one of the biggest challenges that the NHS has ever faced in its 74-year existence, the best Craig Hoy can come up with is a quip that he has practised in the mirror before coming down to this chamber. What I would say to him is that this Government is focused and I am focused on taking action, whether that is the recruitment of additional staff, whether that is the recruitment of additional ambulance staff, whether that is £600 million that we are putting forward to help with this winter and to cope with the winter pressures, that is the action that this Government and I will take. I will leave the flimsy apathetic party politicking from Craig Hoy. I will allow him to do that while this Government's relentless focus will be to support our NHS, the people that receive care and the wonderful workforce that give that exceptional care. I am sure that many others here in my inbox over the last few weeks have been filled with constituents concerned about long waiting times at A&E, primarily at Mount Lones for my area, with some reporting waits of up to 10 hours. I have also had many contacts from local NHS staff who I know have been working around the clock and I also want to offer my heartfelt thanks to them. I welcome the statement from the cabinet secretary today and I wonder therefore if I can ask him in light of the circumstances and pressures that are faced by at Mount Lones A&E how the additional support that he has outlined today can help NHS Lanarkshire specifically to avoid those pressures. I thank Fulton MacGregor for a very important question. Lanarkshire is one of the health boards that is facing that pressure most acutely and I have been to many sites as he has imagined in Lanarkshire myself and spoken to the new chief executive who has been in place since December about those pressures so we are interacting and I am personally interacting quite closely as you would imagine with NHS Lanarkshire. In my most recent visit to NHS Lanarkshire and I was in A&E department and I wish it was very clear to me that delayed discharge was causing some significant issues. I was talking to one patient who had been waiting far too long for treatment in A&E precisely because there was not a bed available so those 300 interim beds of course many of them or a portion of them I should say will be in both north and south Lanarkshire. I have to commend Lanarkshire they do have a very good collaborative pan Lanarkshire way of working when I speak to the chief officers of both north and south Lanarkshire the local authorities and both the chief executives of both north Lanarkshire and south Lanarkshire council and indeed the health board it's very clear to me there's a good collaborative working on the ground and I would encourage Lanarkshire to continue to do so. Officer make no mistake this is a humanitarian emergency it's costing lives and it's damaging the wellbeing of NHS and social care workers NHS Lanarkshire has just been mentioned that is a crisis within this crisis. The code black nightmare which began in 2021 continues today in 2023 so constituents in Lanarkshire want to know when that will end. I have two short questions for now one is again in Lanarkshire we need more doctors in out of hours and across primary care can the cabinet secretary update on that and as well as the immediate action we need we need a long-term solution so will he agree with the BMA and others to facilitate a national conversation on the future and survival of the NHS cabinet secretary. Can I say briefly to Monica Lennon of course working out of hours is one of the key does NHS Lanarkshire and new chief executive and I spoke about when we last met and she may have seen from NHS Lanarkshire that GPs practices in Lanarkshire will be open additional days on the weekends as well and that's something that I welcome I should say there are standing directions to every single health board to work with their GP practices in the health board area to see what more they can do around extending opening hours and I know that many GP practices and I'm very grateful to our GPs and the staff within the multidisciplinary teams within who are working those additional hours whether it's evenings or whether it's weekends to help to cope with some of the work to some of the demand that they're facing. In terms of the second question that Monica Lennon asks I gave an indication over the weekend doing some media interviews that I'm open to the idea of a national conversation a conversation with the public around the health service that must be grounded and I think Monica Lennon would agree with this that must be grounded and the founding principles of the NHS and I think most members of this parliament maybe not every member but most members in this parliament would certainly agree with that premise and I think an idea of a national conversation is a good one let's just make sure we're doing it in such a way and at such a time that it doesn't add pressure and work on to a system that is already facing significant pressure I'm not happy to keep Monica Lennon updated on those conversations. Jackie Dunbar to be followed by Julian Mackay. Thank you, Presiding Officer. Can I ask the cabinet secretary what actions are being taken to ensure health boards retain the ability to respond to local circumstances and alleviate some of the unique pressures they may be currently facing? Cabinet secretary. So I hopefully gave an indication of this in my statement that there has been some calls for for example the government to declare a kind of national major incident but I do think that it is right that local health boards retain that decision making at a local level and determine how to best flex their services in order to cope with that demand that they're facing so I'll continue to give that flexibility to local health boards but the government at a national level whether that's myself, whether it's the chief executive of the NHS, Caroline Lamb, the chief operating officer John Burns, we will always remain close to our NHS boards to offer advice and support where appropriate. Julian Mackay to be followed by Co-Cab Stewart. Thank you, Presiding Officer. The cabinet secretary will be aware of my keen interest in staff welfare. Time away from wards is the biggest barrier cited for staff to access breaks. For them to be able to do this we need more staff and Brexit has undoubtedly been a factor. I welcome everything the cabinet secretary has said so far about recruitment but further to the answer to Rona Mackay's question, what conversations has the cabinet secretary had with the Home Office and UK Government ministers about fast-track visas for those coming to work in the Scottish NHS and if these conversations have not yet taken place will he ask for a meeting as a matter of urgency on this? Cabinet secretary, I have raised it previously with UK Government and in fairness that wasn't just raised by myself, it was raised by the Welsh Health Secretary at the time as well and she's very supportive I know of continuing those discussions with the UK Government to try to get them to see sense when it comes to the very prohibitive and restrictive immigration rules that we currently have. I genuinely don't understand it because I know there are many NHS trusts in England who are facing the same challenges from a social care perspective as well as an NHS perspective too. So I think that Julian Mackay makes a good suggestion in my next four nations meeting. I will ask that the issue of immigration and immigration rules in particular are back on the agenda. Thank you, Presiding Officer. Given the additional pressure that Covid and seasonal flu are responsible for in both primary and acute care sectors, can the cabinet secretary confirm whether medical opinion indicates that it would be a valuable step to extend eligibility for the vaccination booster programme from all adults aged 50 years and over to include adults under 50 years old? That's a very good question from co-caps juror. What I would say to co-caps juror is that the eligibility for any Covid booster programme, any future Covid vaccination programme, is always led by or informed by advice from JCVI. We haven't departed from that JCVI advice in any significant way previously, so we'll continue those discussions with the JCVI, but I think it is important that we take that informed expert advice from the Joint Council for Vaccinations and Immunisation and then come to a decision based on the circumstances at the time. Sharon Dowie to be followed by Bob Doris. Cabinet secretary, one in 10 patients arriving at hospitals by ambulance in the final week of December waited over three hours to be offloaded into A&E departments. I also had one constituent who called 999 and waited for 12.5 hours for an ambulance crew to arrive. What steps is the cabinet secretary taking to ensure that ambulances can get back onto the road as soon as possible, and what steps is he taking to ensure that call handlers have the training they need and are able to prioritise calls as they come in? That's a very important question from Sharon Dowie, and she's right that the ambulance turnaround times have been far too long and far too many acute sites, particularly I think that Sharon Dowie has an interest in air hospital and cross-house hospitals and in those two sites in particular a hospital turnaround times have been far too long, so we're working closely with the board in Ayrshire and Arnys, she would expect us to do in order to try to improve the situation, but she knows, I think that she's very well aware that the entire system is connected and that's why I said in my statement that we're taking a whole systems approach. So if we can create some capacity by safely discharging 300 people within the current system who are clinically safe to discharge, get them out of busy acute sites, that of course helps with the flow in our hospitals and that will allow ambulances to be able to convey to the acute site much quicker and get back out into the road and that shortens the response times because I agree with her the type of response times that she's just referencing, not the standard of care that we'd expect, so the measures that I've announced today directly will help to impact those turnaround times. We're also working with the sites and with health boards such as Ayrshire and Arnys where those turnaround times are far too high to see if there's other conveyancing areas that can be created, accepting that there's limited capacity within acute sites, but is there any additional space that can be found to convey and then allowing hospitals to quickly turn around and get back out into the road? Presiding Officer, I was contacted by a constituent regarding a recent call to NHS 24 which went unanswered and they were cut off after a two-hour wait. I'm sure that the cabinet secretary agrees that this should not happen. In such circumstances, patients are likely to attend A&E, for instance, although they might not always be required to put additional pressures on service. Can I therefore ask, as a route of increased demand to NHS 24, what provisions are being put in place for future surge capacity to adequately handle calls to ensure people commit goose of the service instead of accessing other parts of the NHS, including hospitals? I was at NHS 24, I went to speak to staff and meet with staff on Christmas Eve, so I was there when pressure was at one of its highest possible times and moments. In fact, I went at 10 in the morning if memory serves me correct and there was already 900 people waiting in terms of the call to be answered. I hope that Bob Doris understands and appreciates that he does the exceptional pressure over the festive period. In fact, I made reference to the almost 100,000 calls that NHS 24 received over the two, four days, weekends or holiday periods. That is just a demonstration of a high level of demand. NHS 24 did expect high levels of demand to increase their staff. I referenced some of the increase of staffing between October and December, but even with that in place, there were still challenges for some people getting through. It is why I have made reference to the additional staff, 200 over the course of the winter, that NHS 24 will recruit and that will help with call-answering times. What I would also say to Bob Doris and to anybody listening is that there is the NHS 24 app. It is a minimal viable product. It has got its own self-help guides on it. It has information about your local GP practice, your local pharmacy and so on. We will keep building on that app so that it is a full digital offer in the weeks, months and years to come. I would also point people towards NHS inform as well. Thank you, Presiding Officer. Constituents in Lothian region have struggled to get through to a call-handler on NHS 24, causing distress and anxiety to those who are ill and do not know where to turn. As a result, constituents may be more likely to unnecessarily attend A&D to get medical attention, thereby increasing pressure on NHS service, which are already at breaking points this winter. Can the cabinet secretary advise what support will be given to Constituent desperately trying to get help from NHS 24 before the recruitment of new starts is completed by March? Over 100 train staff are being let go from the Covid national contact centre. Could this worker be resigned to assist? Thank you, Presiding Officer, for his suggestion. Obviously, as we have began to reduce the numbers working in the national contact centre, we have looked to deploy as many as we possibly can back into the health service and some into social care as well. What I would say to Presiding Officer is that the 200 additional staff in NHS 24 that I have referenced, the recruitment began in October to help with the festive period as well. We will continue to recruit that help with the constituents that he has who are struggling to get through to NHS 24. I have seen the latest data and we are seeing reduction in the amount of time that people are waiting for the call to be answered. That is, hopefully, a positive sign for things to come. I would also say to people that, as well as NHS 24, we have the app that I have mentioned, we have NHS Inform, which has a symptom checker, which has been checked millions of times actually over the course of the festive, over the course of the past few months. We also have pharmacy first and your GP, so there are many avenues that you can go to before going to A&E, and I would encourage everybody to make sure that they get the right care in the right place in the right time. Both Bob Doris and Fausal Chowdry have just raised the really important issue of the time that it takes people to get through on NHS 24. Sometimes I have had examples of people waiting two hours or more to try to get the phone answered, which leads to traditional problems. Of course, people still have other problems trying to access GP services, for exactly the same reason, making call after call day after day trying to get an appointment and not able to do that, and that just builds up problems for the future. So what specific action will the Government take to increase the availability of GP appointments to try to avoid warranted unnecessary presentations at A&E? That is a really important question from Murdo Fraser, and it is a really important issue that he raises. First of all, it is worsening, and I think that Murdo Fraser would agree with us that our GPs and our GP staff are doing an incredible job in really difficult circumstances, and the workload pressure that is upon them is unprecedented as well. At the same time, I recognise the situation that he articulates. Many members across this chamber from all the political parties represented have written to me to tell me over the weeks, over the months that they have constituents who have struggled to get GP appointments. That is why I announced a couple of measures, or few measures, one funding for telephony services, where GP practices can improve their telephony services to help with access issues. We have provided some funding. I have written to every GP practice to say that my expectation is that every GP practice should offer pre-bookable appointments, because we have the situation in still far too many GP practices where we have to phone up at 8 in the morning. You might not get through. You will be 25th in the queue, and people hang up and end up at A&E, as Murdo Fraser has said, so pre-bookable appointments could help with that. The last thing that I would say in this particular issue is that I have instructed a GP access group to be set up, which will have GPs on it but also a patient representative to unblock any of those GP access issues that currently exist. I mean, regular dialogue with the BMA, he'll know Dr Andrew Buse, I suspect, fairly well, and a constant regular dialogue with the BMA about what more we can do to work collaboratively together to improve access to the GP practices, but let me make it clear. Let me end that question where I started, that I understand just how hard our GPs and GP practice staff are working under unprecedented pressure. Paul McClennan, to be followed by Brian Whittle. Sorry, Mr McClennan, I'm taking a point of order from Mr Kerr. Mindful, Presiding Officer, that you had allocated 40 minutes, we're now at 39 minutes, and a number of colleagues, I'm sure, still want to ask questions, including people on these benches. Would you be minded, with the precedent of the Dr Gray's statement of last year, understanding order 8.14.3, to extend the time until all colleagues who have issues to raise with the Cabinet Secretary have the opportunity to do so? I thank Mr Kerr for his point of order. While I'm not minded to accept such a motion, I am determined that those who have pressed will have their questions taken. I go to Mr Paul McClennan. Can the Cabinet Secretary provide an update on the measures previously put in place to recruit additional staff when I'm out with Scotland and what progress has been made towards this? Let's just say before I answer that question, I'm happy to stay in the chamber for as long as necessary to answer those important questions. In terms of recruitment out with Scotland, I've already referenced, I think, in some of my answers, the efforts towards international recruitment. We made those efforts in terms of international overseas nurses last winter with their current funding to help with this winter. We exceeded our target of 200 nurses, and we've given further funding, as the member probably knows, that I announced in October around £8 million to support the recruitment of up to 750 nurses, midwives and EHPs. As a reference and an answer to Jackie Baillie, around 126 firm offers have been accepted, and we expect many more in the pipeline towards April. We're also continuing to ensure that we proactively encourage Scotland as a destination for particularly GPs from across the rest of the UK. I think that Scotland's a very attractive place to work, particularly a remote rural and island community, so we have a proactive campaign under way to see if we can attract GPs from the rest of the UK to work here too. I've just got a text from my GP surgery saying that they will only be providing emergency appointments, and that is a similar text that I've been receiving since the June 13th, since I've been trying to access more in GP surgery, so we are in a real crisis. However, what I wanted to ask the cabinet secretary was, and I've said many times in this place, that the trajectory that the Scottish Government is taking the healthcare in Scotland is unsustainable, and that the Scottish Government is just managing the decline of our health service, and Covid has just accelerated that decline. Isn't it about time that the long-term sustainability of the Scottish national health service was mapped out? We looked at the preventable health agenda, where we tackle Scotland's poor health record, where we are still the unhealthiest nation in Europe, and shouldn't we be looking to prevent the need to seek healthcare in the first place, or at the very least treat patients at an earlier stage before they become acute and require more intensive care? Cabinet secretary, surely that is a significant way to reduce the pressure on our health service. I agree with everything that Brian Whittle has said in relation to the importance of the preventative agenda. I spoke at length about this in committee when I appeared this morning, so a 23-24 budget continues that focus, that investment and funding towards the preventative agenda. I think that he's right that we will avoid that temptation, of course, but there can be a temptation when you're dealing with an unprecedented emergency situation in front of you to lose focus of the preventative. We won't do that. We'll continue to focus on smoking cessation, on our work around alcohol and drugs treatment in relation to obesity and healthy and active lifestyle—something that I know is very important to Brian Whittle. I can give him a very firm commitment that will continue our focus on the preventative while also dealing with the unprecedented pressures that we are currently facing. The cabinet secretary will be aware that AHPs have unique skills that help with discharge from hospital. They are essential to making this happen and return people home safely. That undoubtedly helps with pressures on acute beds. AHP services are currently under pressure with vacancies across the country. What discussions has the Government had to ensure that that increase in bed capacity also gives patients access to this essential group of staff? I can agree more with Karen Walker about the importance of AHPs. A multidisciplinary approach that has needed to be taken to provide people with holistic healthcare is why we have recruited more than 3,220 members of those multidisciplinary teams. Many of them are working in general practice right up and down the country. Of course, we are investing in AHPs in our hospitals and frailty teams, for example, to help to reduce the length of time, particularly elderly people who have a fall come into hospital. We will continue to work with all the relevant bodies in relation to AHPs, but I want to place on record my thanks for the incredible work that they do and the holistic care that they provide up and down the country. Why did the Scottish health boards have to wait for days for this slothful SNP Government to send a letter to allow them to move staff around to deal with the crisis when, on Friday, Humza Yousaf knew that the BGH, the Board of General Hospital, were cancelling routine operations for my constituents? I would like to know from the health secretary why the delay. Rachael Hamilton's question betrays her ignorance of the health service and how the health service works. There has never been a blockage on local health boards being able to take local decisions. In fact, she has just given an example of how a local health board took a decision to meet local demand. That has happened up and down the country far before I was health secretary. It has happened for many, many years and is the foundation principle of our national health service that local health boards have the ability to locally flex the care that they provide. What I simply did in my letter was to make sure that there was further guidance, particularly in those emergency-type situations, should health boards require it. As Rachael Hamilton referenced in her question, this is already being done and I am very grateful to local health boards for taking really difficult decisions in a time of great emergency. The villages and communities of Port William and Whitton and Wigtonshire have been without adequate GP coverage for many months, but the closest A and E and hours drive away, and with four-hour waits on NHS 24, there is massive pressure on the community pharmacy who are going above and beyond to look after the health concerns of locals. The pharmacist in Whitton is looking at an average of 83 pharmacy first a week, of those 28 pharmacy first plus. That is over and above the normal day job. Over the last few weeks, it has been dramatically worse. That is far more than an average pharmacy would see over a month. That is undeniably a crisis that is putting people's lives at risk. Will the cabinet secretary consider intervening and deploying as a matter of urgency GPs to those two rural communities that are undeniably areas with the greatest pressure, greatest needs and greatest risk? Cabinet secretary, I have regular conversations with our health boards, including Dumfries and Galloway and also NHS Borders, where we tend to see some pretty significant and grampian actually significant pressures in relation to general practice and also in relation to community pharmacy. I will continue those conversations. What I will do on the back of Finlay Carson's question, I will ask both the chief medical officer and the chief pharmaceutical officer to see what more can be done, particularly on general practice cover in the areas that Finlay Carson references. I am interested in patient rights with regard to the interim beds. Can patients refuse to go to those interim beds in the care homes because they want to go home but there is not a care package for them to be able to go home? Will there be part for weeks within those beds? Is the cabinet secretary confident that he can move them on quickly? Will he guarantee that those people will not be required to pay the fees for the care homes if they are self-funders? Can I say that these are very important questions that Willie Rennie asks? The choice guidelines are still in place. We have not suspended the choice guidelines. The choice guidelines are still there. They exist. Clinicians are very mindful of them. They have those conversations that I mentioned in a previous answer day in and day out, so we are not going to be forcing people out. I simply said in my comments, and I hope that Willie Rennie takes them in the spirit that they were intended, that an interim place might not be the first choice. It might not be even the second choice, but ultimately, being in a hospital that is over-occupied and facing the pressure that it is under, when you are clinically safe to be discharged—and that is crucial, those people are clinically safe to be discharged—is not best for the patient. It is not best that they are there. Can they be in an interim place in an environment? To answer the question directly, the choice guidelines are still in place and have not been suspended. I do not like the phrase that anybody is going to be parked. Care homes, whether it is an interim care home place or a permanent care home place, people working in social care—I think that Willie Rennie agrees—provide exceptional care, so their care needs will be tended to as best as we possibly can. We are looking for measures to be a very short-term interim measure, weeks, not months. We do not want people in those interim placements for months and months. We want them to be there for weeks. I have got every confidence that chief officers who are excellent at their job, whether it is in Fife or whether it is in any other parts of the country, to do a phenomenal job of getting people the permanent care package that they require. On the very last question, there will be no cost to the individuals that are involved in relation to the interim care placements. The cabinet secretary will be well aware of why I might be concerned about the situation in Forth Valley Royal hospital in the context of the measures that have been taken to reinforce the management and work practice at Forth Valley health board. With that in mind, not having had a view of the statement in advance or having had a chance to read it, I have listened carefully to see whether there was something that was going to happen right here and now that was going to meet the need that has been identified by the chair of the BMA Scotland, who said, and I will quote if I might, that the NHS is hemorrhaging crucial staff, staff who we urgently need now more than ever before and the Government must step up to stop it. They can talk all as much as they want about recruitment of staff, of investment in systems or plans for improvement, but every single one will fall flat on its face unless there is laser-like focus on keeping the staff we have. That is what he said, so would the cabinet secretary please underline the one thing that is going to happen now that will reinforce the retention of the very valuable NHS workers? Cabinet Secretary? I can give him more than one in just a second what I will say about Forth Valley Royal hospital. I am more than happy to have conversations with members who are interested. He will know that that improvement plan is in place and I have committed to come back to this chamber to give an update on how that improvement plan is being enacted, so I commit to absolutely doing that. One of the actions that doctors have asked us about is the reintroduction of a rec scheme or recycling of employers contribution scheme, so we have done that or given that ability to health boards and that has gone live in many health boards up and down the country at the end of last year, so that will help directly with retention. That was an ask from the BMA directly to me. The other ask, of course, is on other pension issues and there has been some movement from the UK Government, but the BMA say not enough, so we will continue to lobby the UK Government in that respect. We will also pay our workforce, and that is really important. We will make sure that when we pay them, we pay them adequately and fairly. We will continue to engage with them and we have done that in the Scottish Government. We have put a record pay deal on offer for agenda for change staff and we will continue to work with the medical workforce as well to listen to them, particularly junior doctors who are feeling particularly aggrieved and understandably so, given the pressure that they are under and given the pay differentials that exist between junior doctors and senior medical staff. We will continue to engage on pay. That will also help with retention as well. That concludes the ministerial statement on NHS winter pressures. There will be a brief pause before we move on to the next statement.