 I remind members of the Covid-related measures that are in place, and that face covering should be worn when moving around the chamber and across the Holyrood campus. The next item of business is a statement by Humza Yousaf on winter planning for health and social care. The cabinet secretary will take questions at the end of his statement, and so there should be no interventions or interruptions. I call on cabinet secretary Humza Yousaf. I am grateful for the opportunity to update members on the action that we are driving forward to support and protect our health and social care services. This winter, our NHS is under more pressure than it has been at any point in the pandemic, and quite frankly, it is likely to get worse. That is why I have decided that our NHS will remain on an emergency footing until at least 31 March next year. Our social care services are also dealing with the same level of pressure and demand is extremely high. It is for this reason that I am announcing the most significant package of measures and investment since the advent of devolution to assist our NHS in social care services with winter pressures. The total package of measures that I will be announcing today amounts to more than 300 million additional investment in our NHS in social care services this year. In addition to the direct support that I will outline, I urge everyone to do whatever we can to protect each other and our services. Health and social care services are open, and I ask people to listen to clinical experts who can advise on the best service for them and to be kind and respectful to all the staff who continue to provide care for us under extremely challenging circumstances. Our winter planning preparations consist of four key principles and take a whole systems approach. First, it is about maximising capacity through investment in new staffing resources and facilities. Secondly, it is about caring for our staff through ensuring that they can continue to work safely and effectively with timely access to wellbeing support. Thirdly, it is about ensuring system flow through specific interventions to improve planned discharge from hospitals and increase access to care in a range of community settings. Finally, it is about improving outcomes through our investment in capacity of people and systems to deliver the right care in the right setting. This is not just about winter planning. It is about how we are building on the approach to recovery and renewal that is set out in our NHS recovery plan and our continued efforts to improve social care support. Let me now set out the range of measures that we will introduce to bolster the workforce, to build hospital and care capacity and, importantly, to support staff wellbeing. Supporting people to be cared for as close to home as possible is essential. I know that it is value that all of us across the chamber agree on. In that regard, multidisciplinary teams made up of staff from professional groups across health and social care are a crucial part of taking rapid action to keep people at home when it is safe to do so. To enable both the establishment of new multidisciplinary teams and strengthening existing teams, I can confirm today that I am making available an additional £20 million for the remainder of this financial year. That will be backed by an additional £15 million to recruit 1,000 additional health and care support staff working within those multidisciplinary teams and, indeed, in hospital settings. The 1,000 additional support staff will work to assist with patient flow and delay discharge and within community health teams. To support that recruitment, the Scottish Government has already provided £1 million to build additional capacity within recruitment teams across NHS Scotland. Although multidisciplinary teams will help people to return to and, hopefully, to stay in their homes, we recognise that we also need to make wider provision to improve access to care-at-home support in the first place. Therefore, I can confirm to Parliament that I will make available funding of £62 million this financial year to enhance capacity in care-at-home provision, which will help to address current unmet need and deal with the current surge in demand and complexity of individual needs. A further underlying reason for some of the challenges that we face providing social care support in the community is undoubtedly staff pay terms and conditions. Today, I can therefore announce additional funding of £48 million that will be made available to enable employers to provide an uplift to the hourly rate of pay for staff offering direct care with an adult social care. That means that hourly rate will rise to a minimum of £10.2 per hour. That demonstrates a significant step towards a continued commitment to deliver fair work in the sector, alongside our on-going work with coslin stakeholders and the fair work and social care implementation group on wider improvements. To assist us with freeing up capacity and, crucially, to help to ensure that everybody gets the right care and treatment at the right time and place, we need to make sure that people who no longer need to be in hospital can move to a community setting to complete their recovery. Therefore, I am announcing £40 million for this financial year to enable patients currently in hospital to move into care homes on a short-term basis. That will be an individualised approach with patients consenting to be discharged to complete their recovery in another setting. That will be, as I stress on an interim basis, within their immediate locality or another suitable location. Importantly and crucially, there will be no financial liability for the individual or their family towards the cost. In addition, we will also invest up to a further £28 million in primary care services this year, including in optometry and dentistry. That will underpin a range of measures, including accelerated multidisciplinary recruitment to support general practice, and targeted funding to tackle the backlog in routine dental care. Let me make two further important points on primary care, which I intend to highlight to all GPs in Scotland in a joint letter with the BMA later this week. Firstly, we must recognise that general practice has remained open throughout the pandemic and is at the forefront of our pandemic response. I reject any suggestion that general practice has been closed. I want to thank GPs and their staff for their efforts over the course of the pandemic. Secondly, even before the pandemic, phone and video consultations had a role to play in treating patients. They will continue to be part of the hybrid model that we offer patients for the foreseeable future. However, with recent changes to guidance and the measures that we are announcing today, I would expect to see an increase in GP face-to-face appointments. Our health and social care staff have been extraordinary in their response to the unprecedented demands that they face. Their wellbeing must remain a key priority. Earlier this year, the Scottish Government announced an £8 million package to support staff wellbeing, supplementing the local support that is already available. While that has had a positive impact on staff morale and physical and emotional wellbeing, we need to go further. I am providing today an additional package of support of £4 million this financial year to help staff with their practical needs such as hot drinks, food, access to rest facilities and, importantly, to pastoral care and access to psychological support. We have listened to staff and this new support sends a clear message to those working so hard to care for us that their wellbeing matters. International recruitment is a useful lever to alleviate pressures, bringing valuable skills and experience. We have already provided £1 million to boards to enable them to build the infrastructure to support international recruitment. Today, I am making £4.5 million available to boards to recruit at least 200 registered nurses from overseas by March 2022. We are also accelerating progress with a number of commitments made in the recovery plan, including developing structures to allow us to directly train international nurses and prepare them for the examinations that they must take to gain UK registration. Throughout the pandemic, we have seen a large number of retirees returning to support their colleagues. I am deeply grateful to them for their support. In addition to recruiting new workforce, we are also inviting those who have recently retired to return to service. Furthermore, using the skills and experience of healthcare students has also addressed some of the workforce challenges during the pandemic. A national offer will be made to healthcare students through their colleges and universities, signposting them to availability of fixed-term and bank work as healthcare support workers. In addition to those measures, we continue to work with staff and employers on further options to maximise capacity such as through targeted incentivisation payments, and have identified in-year funding of up to £15 million to support that. We will work with employers to ensure that any targeted measures that are introduced are right for them. They will buy additional capacity and support service resilience. The measures that I have set out today, backed by additional recurring funding of more than £300 million, demonstrate our commitment to ensuring that we have a well-staffed, well-supported and resilient health and social care system. We have already taken action over the course of the past few months to help to bolster our NHS and social care services. We expect this additional investment to make a significant impact over the course of the winter. That being said, it is important for me to be upfront and honest with the public and recognise that this winter is likely to be the most challenging we have ever faced. We have been engaged in extensive discussions with stakeholders about the winter pressures we are likely to face. I hope that many of the actions that I have outlined today will have a positive impact in the coming weeks. If we can continue to control Covid transmission and the signs that are positive and if we safely discharge people and keep them in community settings with the additional investment that I have just announced, we will create additional bed capacity within our hospitals, which will be vital in managing winter pressures. By investing in our workforce and increasing capacity, we will be able to better support a health and care system through what is said to be an unprecedented winter. To conclude, I previously said in the chamber that this Government will be there to support our NHS in its greatest hour of need. My statement and announcements today demonstrate that we are true to our word. Finally, I would like to end where I started and thank, once again, sincerely and heartfelt our exceptional staff, NHS and social care staff, who have made an incredible contribution to keeping us safe throughout this pandemic. I know that they will keep us safe during what will be an extremely challenging winter ahead. And I would ask those members who wish to seek to ask a question to please press the request to speak button now, and I call on Sue Webber. Thank you, Deputy Presiding Officer, and I thank the cabinet secretary for advanced sight of his statement. Like yourself, I would also like to echo your gratitude for the continuing and exceptional contribution of all our health and social care workers. The Scottish Conservatives have repeatedly called for a detailed winter plan for weeks due to the growing crisis in our NHS, and it appears that we are still waiting. In the last few days, we have seen statistics showing that A and E waiting times are now at the worst level since 2007. Reports from police that they are now filling in for ambulance crews by transporting patients to hospital and a U-turn on the closure of a drop-in vaccination clinics, and then a health board apologising for a mile-long queue outside a vaccination clinic, where older and vulnerable patients were having to stand outside in the terrible weather conditions that I have in here today as well, and some having travelled miles to get there. All this before we have even reached peak winter. While I really welcome the £300 million that is outlined today in the investment in our NHS and the comments around investing in our workforce and increasing capacity, most of which will understandably take some time, we continue to need to see urgent action now. So can I ask the cabinet secretary once again what has been done to drive down A and E waiting times right now, and can he promise that we won't see repeated scenes from the weekend of long queues outside vaccination clinics as we move further into winter? I thank Ms Webber for her question. Can I say to her that, when she talks about winter plan, I've just spent the last 10 minutes outlining how we'll spend £300 million of investment. If she's looking for a manicured varnish document, we can spend our time doing that, but ultimately what we're doing is announcing and getting on with the work and releasing the funds to be at local health boards, local government or local IGBs and so on and so forth to just get on with the action. That's what people want. They want us to step up with ideas, with funding, with investment and innovation. That's what we intend to do over the course of this winter. In terms of the more general comments that she makes, of course none of us want to see long queues outside of vaccination centres and that shouldn't be happening. In terms of vaccination centres, those are decisions for local health boards, of course, to make in terms of what facilities they have open and do not have open. As we vaccinate more and more people, and there are thankfully very few people that remain unvaccinated in terms of the eligible population, as that cohort gets smaller, I think it is important to let health boards find the balance between making sure that there is ample opportunity for those who want to get vaccinated at a time when they want and also making sure that we don't have, for example, a vaccination centre where 15, 20 nurses could be sitting there and only a trickle of people are coming through the door. That wouldn't be the best use of time for the nurses involved or the staff involved or indeed for the pressures that we're facing. We've got to find that right balance, but I accept Ms Weber's point that long queues are not something that any of us want to see. The final point that I'd make, Presiding Officers, is that nobody is sitting here having not acted, whether it was myself or indeed my predecessor, because winter planning starts. For months and months in the spring and the summer, we are working hard to invest in the pressures that we have been facing for a number of months. Whether that's the 1.9 billion that we've already invested in dealing with Covid pressures, whether it's the 12 million that I announced in July to help with non-Covid pressures, the 40 million that we've announced additional in the year for the Scottish Ambulance Service, not just the 20 million that I announced recently, 20 million before that, we will invest, but absolutely we can't. As soon as we have got some degree of clarity around the consequentials that we've received, I am therefore announcing having discussed internally with partners how we can make a significant contribution to the winter months. I can't promise her that things will not get more difficult and more challenging. She asked me to do that. I'm afraid that I can't do that because we are still in the midst of a global pandemic and the indirect and direct pressures of that pandemic that we are still facing. However, I promise that wherever there are good ideas from across the chamber, my door is certainly open to listening to those suggestions. Thank you, cabinet secretary. Perhaps we could have a slightly shorter answer. Thank you, Presiding Officer. I thank the cabinet secretary for advance sight of his statement, but it feels like sticking plaster for a much more profound problem. Before turning to social care, what additional bed capacity is being planned for our hospitals over the winter period and will elective surgery continue to be postponed? There were over 96,000 people on waiting lists for operations, but that figure has increased as cancelled operations have increased. On social care, the uplift for staff is insufficient. Working at the checkout at Aldi pays more. You will not retain or recruit staff if you continue to pay them low wages. When will the pay rise start and when will the cabinet secretary pay social care staff the £15 per hour that they so richly deserve? Finally, I welcome any additional funding for unmet need in social care, but can the cabinet secretary confirm that the money will be recurring in the next financial year? Can he also guarantee that the cutting of care services taking place in Glasgow, Lothian and across the country will be reversed so that the burden will not fall to the 759,000 adult carers in Scotland who, frankly, are exhausted? I found it astounding that the announcements that I have made today with the detail that I have announced today and the significance of the investment can be described as a stick-and-plaster. I do not accept that characterisation at all. A recovery plan, of course, goes into detail about how we will reform the service over the course of the parliamentary session. I agree with Jackie Baillie on that. I suspect that probably all of us tend to agree that, where there is reform needed, we are looking to do that as part of a longer-term project. What we are dealing with is an immediate challenge, which is often described, and I agree with that, as a real crisis. That is probably the most significant crisis that our NHS has ever faced in its 73-year existence. I have to deal with that immediate challenge in front of me by making an immediate investment in terms of the questions that Ms Baillie asks. Yes, I would expect additional capacity to be created. I will not pluck a figure out of the air, but if I can and we can as a Government control community transmission of Covid, that will free up beds in the coming weeks and months. We are working with local government rapidly to try to safely discharge people from hospitals into community settings, be that care at home. That will create capacity in the system, which will be extremely welcome. On elective surgery, I know that health boards have made decisions about pausing elective surgery. They do so not lightly, but I know that having spoken to every single chief executive and chair of health boards on a regular basis that, as soon as they can resume them, they absolutely will when the circumstances are right at a local level. The social care uplift that I announced will begin from 1 December. If we can pull that forward, then I am happy to explore that and look at that. On Ms Baillie's request for going further on £15 per hour, Ms Baillie will have to come up with where we would source the funding, which on a recurring basis would be many hundreds of millions in the future years. That can be part of a budget discussion that we have with that. The funding that I announced for recruitment in my statement will be recurring. I appreciate that, for the two front ventures, there are questions where multi-faceted and required responses to each point. We are to finish this statement at 16.20. I have a number of speakers. Please be succinct in your questions and the answers. I call Stuart McMillan to be followed by Craig Hoy. Cabinet Secretary, social care staff across the country do not always have access to parking permits in the fallen fill of local restrictions, but as we head into the winter, parking two or three streets away from patient silence will not be advantageous. I would be keen to know what discussions have taken place between the Scottish Government and also COSLA to help to find a solution to assist social care workers to go about their vital work without penalty, particularly in the months ahead. In the interests of brevity, Stuart McMillan raises a very important point. I am having on-going discussions with COSLA. I have had discussions, as you can imagine, quite intensely over the past few weeks. I am happy to provide a degree of flexibility to the funding that we provide in order to help to tackle some of those ancillary challenges that face our staff, which make recruitment and retention and make it difficult to do their job. I will continue to have those discussions with COSLA. In 2015, the SNP Government said that it would eradicate delayed discharge. Today, we discovered that in August, there were 46,171 days spent in hospital by people whose discharge was delayed. Other than ministerial incompetence, why is this Government failing so badly to reduce delayed discharge? Cabinet Secretary, it cannot simply just be down to Covid. You cannot ignore the impact of Covid. My predecessor, Jeane Freeman, had managed to drive down some of that delayed discharge, but it is a challenge that we face with an aging demographic, with challenges in our own social care. It is why it would be helpful if the member got behind our national care service, which will look to provide consistency across care. What I can say is that, with the measures that I have announced today, we hope to see significant reduction in delayed discharge over the course of the winter, which will free up bed capacity, which will help us with the winter pressures. The use of step-down care home beds have been used in previous winters to improve the flow through hospitals and get people the care that they need in the right place. Can the cabinet secretary outline how today's announcement will help people whose discharge has been delayed into a more appropriate care setting? Hopefully, the point that I was trying to make in my statement came across that we have to take a whole systems approach here, so we can invest in social care and that can help no doubt acute services and indeed primary services as well. Step-down care has been used before, as Emma Harper quite rightly says, the investment that we will make will help to bolster the staff, the uplift in terms of pay. We will also help to retain staff as well and, therefore, hopefully, allow us, with the multidisciplinary team investment that I have announced, to get people rapidly but safely into a setting in their community, which, hopefully, as I have said to other members, will help us to free up bed capacity, which is much needed in our acute settings. At present, councils across Scotland, such as in the Lothians and Glasgow, are scaling back care packages and asking families to take on more support themselves. The cabinet secretary has committed to increasing capacity in multidisciplinary teams, but we know that the Government has already missed its deadline of April this year to embed multidisciplinary teams in GP practices and, year on year, cuts local government have made things perilous. With the onset of winter, does the cabinet secretary accept that councils and partners must be provided funding straight away to recruit more carers? That is just what I have announced. I am sure that there is a welcome in there somewhere, but that is what we have announced. We have announced additional £300 million of funding that I am sure COSLA and partners will welcome, and it will be released immediately—absolutely—that is the purpose of my statement. I would hope that it will make a difference in the ways that Paul O'Kane articulates. Do you want to hear his slot to be followed by Brian Whittle? It is the Michael's hospital for elderly nursing care and respite in the mythical. My constituency is subject already to temporary closure since the summer due to wider health staff shortages in Lothian due to illness and self-isolation. West Lothian still has one of the highest Covid rates of infection, but can the cabinet secretary assure me that when this is reviewed by West Lothian health and social care partnership, he will encourage them to put the importance of community-based elderly nursing care and respite in the north of West Lothian in the county as a priority for services with the resources that he has announced today? I will do that. Ultimately, that will be a decision for local stakeholders such as the HSCP to make, but I will stress that point in my regular engagement with local partners. Brian Whittle, to be followed by Alex Cole-Hamilton. I know the cabinet secretary's comments on international recruitment, which are welcome. However, the number of Scottish students applying for places in Winwifery, nursing, physiotherapy, other AHPs and OHPs consistently far in struts in the number of places available. Can I ask the cabinet secretary if he accepts that this fact, along with the Scottish Government's cap on Scottish students' application for medical school, highlights a long-standing staffing issue that is exacerbated by Covid? Will he commit to opening up more opportunities for Scottish medical students? We are, thankfully, in our undergraduate programme, seeing more and more students fill those places. We are also seeing, when it comes to training, that the fill percentage rate has increased this year, which is positive as well. There are some areas, and Brian Whittle highlights some of those areas, where we still find challenge when it comes to filling those posts. We are doing everything that we possibly can in that respect, and we will continue to work with partners in that regard. The Royal College of Nursing told me in June that the NHS workforce had upwards of 4,000 vacancies in nursing and midwifery. That crisis does not come from nowhere and follows years of SNP mismanagement of the workforce. Will the cabinet secretary commit to an updated workforce management plan and annual workforce management plans thereafter? The workforce crisis of this scale is not repeated, given that it has announced today that just 200 registered nurses from overseas will be recruited by March 2022. It is important to put on record for some context and perhaps some balance that we have the highest record number of staffing in our NHS and the best paid staff anywhere in the UK. That is an important part and point to make. On nursing vacancies, I have spoken to the RCN most recently just a few days ago about a range of issues that affect our nursing colleagues. I will commit to a workforce plan, and we have already said that we intend to make that available and do the work on that before the end of the year. The Scottish Greens' co-operation deal with the Scottish Government included fair work progress for the social care workforce as a priority. I am pleased to see swift action to ensure that it gets more than the living wage, as well as vital funds to support the wellbeing of our front-line NHS workers. Can the cabinet secretary confirm that the uplift in social care pay is just the first step in bringing parity between health and social care workers and that we will further look to improve both pay and working conditions as we work to establish the national care service? I am not sure why Labour members were heckling Gillian Mackay during that, because she is welcoming, and I suspect that she would welcome a pay-up lift for some of those who are not paid as highly as we would want them to be. I have done an incredible job over the course of the pandemic, so I am not sure why there were heckles for that welcome move. Gillian Mackay is absolutely right. It is an additional step. It is the first step. We already invested money previously to ensure that social care staff were paid £9.50 an hour. That is another step in that direction towards increasing pay. We have a commitment by the end of the parliamentary term to ensure that they are paid £12.50 an hour. Pay is one element of it. I have had good discussions with people like Andy Kerr, who is leading much of our work in relation to fair work, on how we can improve terms and conditions. With an increase in Covid-19 admissions, staff, sickness and rising accent emergency attendances, NHS Ayrshire and Arnan is under tremendous pressure. From the very welcome £300 million that the Secretary has announced, what additional support will be provided across NHS Ayrshire and Arnan in its aligned health and social care partnerships to reduce further escalation as winter begins? It is a challenging winter. Frankly, we have not even hit the flu season yet. Therefore, there could be even more significant challenges ahead. We are also, as you can imagine, planning for COP26. Although that will focus in and around Glasgow, many other local authorities will also have to manage some of the challenges around COP26, too. The point that I am trying to make is that there are additional pressures coming in line in relation to NHS Ayrshire and Arnan. I would expect that the funding that I have announced will mean that there will be an additional workforce across NHS Ayrshire and Arnan in the sites across NHS Ayrshire and Arnan, not just acute sites, but that social care will be bolstered across NHS Ayrshire and Arnan, as well. Can the cabinet secretary say any more about the international recruitment that she announced and how that will happen? Other than we expect that to happen immediately, but what I would say to John Mason is that we have made previous investment that I have announced prior to this statement in order to help to create more capacity within HR departments across health boards and also making sure that the provisions are in place for recruitment and registration of those international nurses as soon as they arrive. We have done a lot of the work in preparation, and now I have announced additional investment to help to get those international recruits. We are also working with the Oval Trust in England, which has expertise in international recruitment. A lot of the preparatory work has been done, and now the investment has followed.