 The next item of business is—I do not know if there is a conversation that the chamber needs to be aware of because it is quite noisy—the next item of business is a statement by Cabinet Secretary for Health and Sport, Homsa Yousaf, on NHS Scotland's pandemic pressures. The Cabinet Secretary will take questions at the end of his statement, so therefore there should be no interventions or interruptions. I call on Homsa Yousaf, Cabinet Secretary, on the number of people in hospital with Covid-19 has, of course, reached the highest level since the start of the pandemic. It is having a significant impact on our health and social care services, although especially on A&E right across the entire system. Our health board colleagues, those working on the front line, all tell us that the last two weeks have been the toughest in the pandemic so far, and the latest data shows some of the lowest performance against the four-hour A&E target that we have seen. That level of pressure impacts on patients and staff, and I want to start firstly by thanking our NHS and social care staff, whom we owe a huge debt of gratitude to and who are continuing to provide vital treatment and optimal patient care during some of the most challenging times, but also to patients and those who have in any way been either inconvenienced or indeed are suffering because of the current pressures. I have no hesitation in apologising for that suffering and for that inconvenience, and I appreciate the patience that every person is showing at this extremely challenging time. There are, of course, a number of contributing factors impacting on A&E services. They include a record number of people in hospital with Covid, infection prevention and control measures currently in place, workforce pressures that are exacerbated by record levels of community transmission, increased attendances to A&E services, high levels of delayed discharge and longer length of stay in hospital. Today, there are 2,322 Covid patients in our hospitals. That number has more than doubled since February. It has now passed the previous peak of last winter, when we had 2,053 patients in hospital with Covid in January 2021. Using the latest published Covid-19 modelling, we anticipate that this may well continue to increase over the next couple or few weeks. The increase in cases and hospitalisation is largely due to the dominance of the more transmissible Omicron BA2 variant, which accounts for around 90 per cent of all reported cases. The latest O&S survey data shows that 114 more than 7 per cent of people in Scotland in the community have tested positive for Covid in the week to 12 March. That is the highest estimate that Scotland has ever had since the beginning of the survey in autumn 2020. Thanks to the excellent progress that has been made on vaccinations, the recent rise in cases and hospitalisation has not, thankfully, translated into increased cases of severe illness requiring intensive care. However, this level of continued pressure is challenging in the context of a health service that has been dealing with sustained and relentless demand and pressure for nearly two years. Unlike when we have one of the pandemic, when services were stood down, we are, of course, remobilising our NHS. In addition, infection prevention and control guidance remains in place and is important for maintaining safety within our hospitals. However, that undoubtedly creates additional complexities and inefficiencies when it comes to moving people through the system. For example, patients cannot wait in the discharged lounge or sit out to wait for discharged drugs. That means that they must wait in bed space longer than required, which then requires to be deep-cleaned prior to any new admission. Also, patients cannot access normal transport, they must travel either on their own or with other patients with Covid. I am able to advise, though, that each of the four UK nations is looking towards developing an exit strategy from the existing UK winter IPC guidance and considering what a return to business as usual looks like going forward. Those next steps include a range of changes that, if implemented, would help to relieve some of the pressure that the system is currently experiencing. Ultimately, if we can control community transmission of Covid, we will help to alleviate the current pressures that we are under. On workforce, the level of NHS staff absences that are attributed to those who are testing positive for Covid has increased by almost 100 per cent. It has doubled over the last four weeks to almost 4,700 people. That increase in staff absences puts an incredible strain on the delivery of health services. Asymptomatic healthcare workers are asked to continue to test twice weekly. That includes all NHS staff in patient-facing primary care and dependent contractor staff, too. However, we are reviewing that regularly as part of the testing transition plan. In the latest week ending 22 March, an average of 6,000 NHS staff, around 3.4 per cent of the NHS workforce, were reported absent each day for a range of reasons related to Covid-19. We have worked hard throughout the pandemic to maintain record staffing levels across our NHS, and those NHS staffing levels are up by over 28,000 whole-time equivalents under this Government to a record high. We have invested in growing our workforce by just under 10 per cent in the past two years to enhance our services capacity to deal with the new pressures that they have faced. We recognise the scale of improvements that are required and are working closely with partners to accelerate domestic and international recruitment to Scotland. A record £300 million of new investment to help services to deal with system pressures over winter introduced a range of direct workforce investments and new measures to support boards' capacity for both domestic and international recruitment. We are investing £11 million over the next five years in new national and international recruitment campaigns and we have established the new centre for workforce supply to provide labour market intelligence. We are also recruiting at least 200 registered nurses from overseas with funding of £4.5 million available to health boards to take that forward. We have asked boards to recruit 1,000 agenda for change staff to provide additional capacity across a variety of health and care services with funding of up to £15 million. We are working with boards to develop nationally co-ordinated recruitment campaigns to actively recruit nursing and medical staff in the United Kingdom. A band nurse 5 campaign launched on 18 February. Scotland has, as we know, the best-paid NHS staff in the UK and we have made available £12 million this year to support the wellbeing of our staff. However, demand is clearly putting pressure—an increased demand is clearly putting pressure—on our acute sites and right across our NHS and social care systems. In the latest week, attendances at A and E departments increased to 26,000, the highest in six months. The last time Covid in patients were above 2,000 that was in January 2021, attendances to A and E departments were at 16,000 for the week. That is an increase of nearly 40 per cent, putting even more pressure on stretched services. We are also hearing that people are presenting with higher acuity. They are coming to hospital sicker and, as a result, having to spend longer in hospital with the average length of stay up around one day, 16 per cent on historic levels, meaning a greater bed requirement. Those issues are not unique to Scotland and our A and E departments continue to be the best performing in the UK for over the past six years. The latest comparable data for January shows that Scotland's A and E performance was 11.4 per cent and 14.1 per cent better than England and Wales, respectively. Our colleagues in the community are also experiencing challenges. The current spread of Covid in the community is creating significant problems for our workforce. That is felt in social care, but our health and social care partnerships are working incredibly hard to support people both in the community and those who are coming out of hospital too. All partnerships are involved in our Discharge Without Delay programme to improve discharge planning arrangements and reduce the length of stay in hospital. For planned care, our NHS colleagues are working exceptionally hard to restart elective activity. Covid workforce and bed capacity pressures do, however, continue to create challenges. We are now receiving reports that some restarted electives are having to be postponed again to deal with the increasing pressure that our health boards are facing at this time. Extended waits for elective treatment increases the risk of deteriorating health and social care outcomes and the additional impact that has on unscheduled care. We are working closely with health boards and partners to support planning and delivery of the high-level commitments in the NHS recovery plan that was published last summer. We are also investing in our hospital at home programme. We have enhanced our hospital at home services across Scotland over the past few weeks, with further capacity expected to come on stream by the end of this month. That work is critical as we move into the recovery phase, and we are already beginning to see some of the fruits of that input. During the six-month period of September 2021 to February 2022, 4,500 patients received care from a hospital at home service, so 4,500 people who without those services would have had to go to hospital. That resulted in 26,700 occupied bed days for hospital at home services. Again, we have avoided 26,700 acute hospital-occupied bed days. The redesign of urgent care programme is, of course, incredibly important, too. We have supported it with £23 million this year. It is another example of positive work that we are undertaking through this work on strengthening alternative services so that those who think that they need to go to A&E, but their illness is not a critical emergency or life-threatening, they can be seen or treated at home or indeed in the community. We are, of course, increasing funding to NHS 24, too, so that people can get good advice, but quickly as well, because I know that some waiting times in NHS 24 have also been too long. I have been upfront and honest about the scale of the challenge in terms of our NHS recovery. It will take time. The recovery will not be a matter of weeks or months. It will take years. We are working closely with boards to look forward together to deliver a package of measures to support sustainable recovery. In the potential event of future Covid-19 waves, how can we insulate that recovery from those future waves? That is the work that we are undertaking. We will continue to fund our national treatment centre's £400 million in that national treatment centre programme, which will again help us in our recovery, particularly around elective care. The funding for the NHS for 2022-23 is, of course, at record levels of £18 billion. Just to conclude, officers at health and social care services continue to face unprecedented pressures. There is simply no denying that. I hope that I have managed to set the context of why they are under such severe pressure. I will work day and night, as I have done since being appointed to this role, to make sure that we are supporting the men and women who are working so hard in our health and social care system. Once again, I end where I started by thanking them for their incredible efforts over the course of this pandemic. The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow 20 minutes or thereby, given the extra time that the cabinet secretary took for his statement, for questions after which we will move on to the next item of business. It would be helpful if those members who wish to ask a question were to press the request-to-speak buttons now. I call on Sandish Gohani. I thank all the heroic NHS staff who have worked throughout the pandemic and are still working hard now. The statement is essentially setting out a list of excuses and patting himself on the back, Cabinet Secretary. How can you possibly do this with the problems we are facing in the Scottish NHS? The cabinet secretary talks of spending more per head than in England, but with the Barnett formula, funding should be billions more. The cabinet secretary continues the self-congratulations by stating that we have more staff in our NHS. That would be fine if demand was the same as it was even five years ago. Demand is significantly rising. Actually, we have record vacancies in our NHS from nursing to physios. This is not all due to Covid. Your lack of credible workforce planning and a flimsy Covid recovery plan has led us to this. Cabinet secretary, what will you do to tangibly deliver help to us today, not in years, plus this was originally meant to be an A&E statement? What immediate tangible help will you be giving to A&E departments? I fear that you are making excuses here and there is nothing to tackle the problem. I am afraid that it is simply incorrect. It is not a list of excuses. What I am doing is setting out a context of why we are facing the pressures that we are facing. I would have thought that that would have been helpful, given that people are rightly asking why our performance is where it is and why our people are having to wait too long. If it was so flimsy, why on earth did his colleagues in London copy it? They imitated our plan. Our 10 per cent additional capacity that we will create is a central plank of their recovery plan. It is not a flimsy recovery plan, but what I am trying to say to members across the chamber is that we have to insulate our recovery as best we possibly can against future shocks and waves of the pandemic. I have already said in great detail—I do not intend to rehearse it because of brevity—all of the funding that we are providing our health boards from the £300 million winter plan to the £20 million additional for our Scottish Ambulance Service. If we had not made that investment, things would have been far worse than they are. I am very proud of the fact that we have the higher NHS workforce per head than in England, where his party are in charge, and our A&E outperforms in England where his party are in charge. We have the best paid staff in the UK. We have more GPs per head than they have in England where his party are in charge, and we have more dentists per head than where his party is in charge. I do not wonder that the people of Scotland continue to trust the SNP to run our health service as opposed to the Conservatives. That is not a list of excuses. What I have demonstrated today is the context of why we have these challenges and how this Government is stepping up to that challenge. I welcome the cabinet secretary's statement, but I look forward to a time when he is not just commenting on the context or how bad the problem is, but that he is actually taking action. The number of patients waiting in A&E is at an all-time high. In fact, it is higher than any time since records began in 2015. That is assuming, of course, that you can get to A&E, if you can get your call answered by NHS 24 and if you can get an ambulance to show up. Can I also thank the staff who are working tirelessly, but they are being let down by this Government? Everyone is waiting for this cabinet secretary to do something, but all he has are the answers that he gave in October 2021. Those initiatives have not worked. Delayed discharge has, in fact, increased taking up capacity in our hospitals, and that has a direct impact on A&E. As John Thomson of the Royal College of Emergency Medicine said, things cannot continue as they are. More patients will come to harm and staff are facing increasing distress. Perhaps the NHS would have been more resilient if the cabinet secretary's predecessors hadn't cut beds, had fixed the workforce crisis, and had sorted social care. However, those problems are not new and they predated the pandemic. The cabinet secretary is playing fast and loose with the lives of Scots. We need more than sticking plaster solutions and more excuses. When will he come to the chamber with a plan that will actually make a difference? Listening to Jackie Baill, you would not have realised that we are in the midst of a global pandemic. You just would not have thought that there is a global pandemic. Not only are we in the midst of the global pandemic, but she is shouting excuses. We have the highest level of number of people in hospital with Covid. We have the highest level of community transmission because of Covid. We have high levels of workforce absence because people are testing positive for Covid. We cannot just magic away the pandemic as much as I would like to and I suspect as much as Jackie Baill would like to. We are taking action. She asked what action are we taking. I again go through the list of the funding that we have provided. On top of that, some immediate action is that additional funding for hospital at home. For example, I have just given her a detail of how we have just managed to save 26,700 acute hospital-occupied bed days. Delayed discharges, yes, she is absolutely right, have been going in the wrong direction. Of course, when we have so many outbreaks in so many care homes, it becomes more difficult to discharge people into the community. In some areas, we are making progress. I met Edinburgh Health and Social Care Partnership, and since the end of January to the present day, they have managed to see a reduction in standard delays. Some local authorities in health and social care partnerships are moving in the right direction. If we can keep Covid under control, that will be our best tool in order to aid our recovery. As we move from front bench questioners to seek to have more succinct questions and answers, I call David Torrance to be followed by Sue Webber. GP receptionists are trained to guide callers to the best care for the healthcare needs, especially as it is not always a GP that has the best place to help. However, many including those in my constituency have reported experience and increased abuse when they are doing their best to help. With the very start figures announced today, it is like that GP services will see an increase in those looking for an appointment. Will the cabinet secretary join me in urging callers to take guidance from GP receptionists as they play an important role in getting people to care in the right place? Will he join me in fighting those receptionists in my constituency and throughout Scotland for an incredible dedication and commitment that I have shown in the past two years and beyond? At this kind of behaviour, is it acceptable from the public? I agree wholeheartedly with David Torrance and I want to place on record my thanks to all GP staff, from the GPs of course, to the receptionists, to all the multidisciplinary team that work in a GP's practice abuse towards any of our NHS and social care staff is completely unacceptable. I do not buy into this narrative at all that GPs and their staff are not working hard to see patients. They are working extremely hard to see patients. That is probably why in the blog written by the chair of the BMA's GP committee, he congratulated the Scottish Government for the approach that it has taken and in the very stark contrast to the approach that the UK Government has taken. Thank you, Deputy Presiding Officer. Yesterday afternoon, the cross-party group on miscarriage heard that midwives are leaving the profession in droves. They cannot cope with the stress placed upon them by workforce pressures. Right across the sector, there are simply not enough of the right skilled staff on duty at any one time. Midwives are underfunded and overworked and quite simply burnt out. This statement offers nothing new for them, no additional support and no additional funding. At what point will the health secretary piece the self-congratulatory tone, get out of his echo chamber and bring forward a credible plan to relieve the long-standing pressures on the midwifery profession—pressures that long predate the pandemic? I disagree with Sue Webber's characterisation. There is nothing self-congratulatory. All the Government has done and I have done is set the context of why we are in the challenging position that we are in. I agree with Sue Webber that the wellbeing of our staff is absolutely central. Every single clinician that I speak to, every single member of our NHS and social care that I speak to, is frankly knackered. Therefore, the additional funding that I have brought forward and the Government has brought forward for staff wellbeing is to address that very variation. What I would say to Sue Webber is what I said to Jackie Baillie and to Sandish Gohani, that if we can control community transmission of Covid, that will significantly help us to alleviate pressure. Let me place on record my thanks for the excellent work that the midwives do right across the call. Vaccines are the best line of defence. Unfortunately, while we are seeing very high numbers in hospital, the vaccine is clearly having an impact on the number of lives lost to Covid. Is the cabinet secretary optimistic that the uptake of the spring booster amongst those eligible is set to be as widespread and positive as the previous booster? Yes, I am confident and I agree with Evelyn Tweed's articulation that vaccines have been a game changer, and I encourage anybody who has not had their first, second, third or booster doses, if they have not had any of the doses that they are eligible for, to please come forward. Vaccines are our number one tool in the fight against the virus. This week, NHS Greater Glasgow and Clyde once again issued a warning not to attend any unless your situation is life-threatening. The warning has been used repeatedly by the board since August. Instead, people have been advised to use NHS 24, but we know that from September to January, 240,000 calls went unanswered. That leaves people in a very precarious position and not knowing where to turn, often in very serious situations. I note in the statement the re-announcement of the opening of the Dundee contact centre, but can the cabinet secretary clarify how many additional staff are required to meet the demands on NHS 24 and how many have been recruited in order to ensure that people are not being put at risk when they are being told not to attend any and they are not having their call answered at NHS 24? I am certain that Paul Cain absolutely accepts this. Nobody takes those decisions that NHS Greater Glasgow and Clyde and any other health board has done so lightly. They do not put out messaging like that at a whim. It is a really difficult decision to do so, but it is because of the pressure that they are ultimately under. I visited the NHS 24 site in Dundee, and the recruitment is on-going. That recruitment is to help us to meet that demand. NHS 24 is focused on ensuring that patients receive the correct advice immediately without requiring to be placed in a queue and having consistently exceeded the 90 per cent target for care delivered at the first point of contact. In fact, the statistics for the 20th of March show that the number was up to 95.4 per cent. We are making progress and the recruitment that we are undertaking at the moment will again help to alleviate some of that pressure. Everybody understands the acute pressure on the NHS at the moment, and clearly this pressure is going to have real consequences, not least on the capacity of an ambulance service to quickly get to those in need. I welcome the cabinet secretary's engagement on a case that I raised with him recently. Can the cabinet secretary therefore provide an update on how the Scottish Government is going to improve waiting times for ambulances? I thank Yvonne Brown for raising a case with me recently. Let me reiterate what I said at the beginning of my statement that anybody that has to wait too long for an ambulance is suffering as a result of that, then I make no hesitation in apologising to them for that inconvenience and for any suffering that they have experienced. Yvonne Brown is of course right that the NHS and social care system that we have is interconnected. Therefore, the pressures that we are facing on A&E, of course, are having an effect on our ambulance service. Despite the challenges, including managing staff abstraction due to Covid and serving in some of the most rural areas in the UK, in 2020-21, our ambulance crews responded to over 70 per cent of the highest priority calls in under 10 minutes and 99 per cent in under 30 minutes. Ambulance crews are saving more critically unwell patients than ever before, and figures show that the 30-day survival rate for the sickest patients are at the highest rate, with a survival rate of 53.8 per cent. However, I know that the improvements that have been made and the significant efforts of our ambulance service may well be cold comfort for those who have to wait a long time, and that is why I took action in the summer of last year to ensure that there was more additional funding for our Scottish ambulance service. Liam McArthur to be followed by John Mason. Obviously, like others, I pay tribute to all those who are working in our health and care services. In January, I asked the Government when self-referrals for the over 70s to the breast cancer screening programme would resume. There was no mention of the resumption of self-referrals in the statement despite a commitment in January to consider accelerating the timetable. Can the cabinet secretary provide a clear timetable for when the service for the over 70s will resume and ensure that those who need or wish to be screened, including those in Orkney, who are reliant on a mobile screening unit visiting once every four years, can be seen without fear of lengthy delays? I can say to Liam McArthur that I have been actively engaging with our screening colleagues on this very question. I have gone back to them to say, well, can we accelerate the over-referral route for those who are 71 and older? I did say to them at the time in January that it is difficult to hear that, if we were to do that now, it would probably extend the gap between cycles for those who are between 50 and 70. Now, it may be that the amount of time that that gap has extended may well not be the benefit risk of doing so, and it may be beneficial for those who are over 71 in terms of self-referral. We are looking at this issue. I would hope to have an update, if not in a matter of weeks, in the very short future. I will ensure that Liam McArthur has kept updated in those discussions. The cabinet secretary mentioned the importance of controlling community transmission of Covid. In one sense, community means the world. It does not just mean Scotland, so can he say anything about what Scotland can do, either directly or through the UK Government, to help other countries through Covid? That is a fundamentally important point. Time and time again throughout this pandemic, we have said that nobody is safe until everybody is safe, and that is absolutely true. Although we are not officially a member of COVAX, we have been in touch with the UK Government regularly on how we help the vaccination effort across the world. We have asked how we particularly focus some of our efforts in Malawi and in Zambia, where we have, of course, that really important people-to-people relationship. I want John Mason to know that the Scottish Government is very keen to play its part as a global leader and a member of the global community in relation to vaccinations across the world. In the week ending 13 March, 51.9 per cent of people attending A&E in Forth Valley were seen within four hours. That is the lowest figure of any health board in Scotland. I know that staff at Forth Valley have been working incredibly hard to improve waiting times and that January saw remarkable improvement. It is concerning to see the figure drop again. Forth Valley has one A&E and demand is simply outstripping capacity. What more support can the Scottish Government provide to Forth Valley and other health boards who are experiencing similar pressures? She is right to say that there have been concerns around Forth Valley. I have spoken obviously, as you can imagine, to the chief executive and chair of Forth Valley. What I would say is that Forth Valley, when I look at other metrics, actually manages to perform well in terms of, for example, protecting some element of elective capacity, Forth Valley has managed to do that, where other health boards perhaps have not been able to do that. I have said to every other member that has spoken that the best thing we can do on top of the additional investment that I have announced is to ensure that we get Covid transmission under control. We have seen in the period last year between the Delta wave and the Omicron wave between October and November that when we had that Covid transmission under control, we saw that, for example, there was a significant increase between October and November in scheduled operations. The ability of the NHS to recover and recover quickly is there, but we have to control Covid. I thank the minister for his statement, which, like his previous announcements, has lots of words but very few actions. The cabinet secretary claims that the problems that we see in Scotland's health service today are largely down to pressures caused by the unprecedented number of patients in hospital with Covid. However, can he say how many of the 2,322 Covid positive patients are in hospital because of Covid and not only with Covid? Does he have data on the number of people who are admitted without Covid but go on to acquire it once in hospital? If he does not know basic things like this, how on earth will the Government set about implementing its flimsy NHS recovery plan or set a new clinical roadmap to get the NHS back to business as usual? Again, he calls it a flimsy recovery plan, as his colleagues and Westminster copied it. They copied our 10 per cent target because they must have thought that it was a very good plan indeed, so I am not sure why he chooses to call it a flimsy. If we had also listened to the Tories who demanded that we lifted protective measures a long time ago, goodness knows how much more difficult the pressure on Covid would have been. In terms of his question, I have asked Greater Glasgow and Clyde to do another audit similar to what they did during the original Omicron wave to determine whether we can get greater detail around those who are in hospital with or because of Covid. However, what I would say is that data undoubtedly is important, regardless of whether you are in hospital with or because of Covid. The IPC controls around you continue and remain, and that is what is putting significant pressure on our NHS. Emma Harper is joining us remotely. Thank you, Presiding Officer. Due to the success of the vaccination programme, we can move away from legal restrictions and rely on other behaviours. We know the value of appropriate face coverings in preventing the spread of Covid-19 with the possibility of this restriction being lifted soon. I can ask the cabinet secretary what assessment has been made of the need for people, especially those in clinical vulnerable areas, to wear higher-protecting FFP2 type or equivalent masks for in clinical settings or crowded public places? To be brief, the cabinet will have a discussion and come to a decision on the future of potentially lifting the legal requirement of wearing face coverings. That decision has not been made and, of course, will be debated in cabinet, as you would imagine, on Tuesday, with the best clinical and most up-to-date clinical advice that we receive. On her substantive point about FFP2 masks, I can confirm that we are again looking at this really closely with our clinicians around whether there is more protection that can be afforded to those at the highest risk through the use of FFP2 masks. The wearing of face coverings and what grade of face covering is something that is kept under regular review. That concludes the statement on NHS Scotland pandemic pressures, and there will be a very short pause before we move on to the next item of business.