 Y Llywyddyn Y Llywyddyn Y Llywyddyn The first item of business is portfolio questions, and the first portfolio today is rural affairs and islands. If a member wishes to request a supplementary question, they should press their request to speak button, or indicate so in the chat function by entering letter R, during the relevant question. In order to get in as many members as possible, I would appreciate succinct questions and answers to match. Question 1, Elena Whitham. To ask the Scottish Government what assessment it has carried out on the impact on farmers in Scotland of the UK Government's energy price cap. First of all, I don't want to say that, of course, we welcome any intervention that can help in this crisis, but the UK Government's energy bill relief scheme is too little too late. I'm aware from my on-going engagement with farmers that they are facing a range of increasing costs, whether that's animal feed, fertiliser as well as fuel, and indeed the general increase in cost-facing businesses right across the board are all having an impact. In this scheme, I know comes too late for many agriculture businesses who are already struggling to pay bills, and the scheme is also only in place for six months. I've written to the new secretary of state at DEFRA to request a meeting, and we'll continue to press the UK Government to do more to ease the pressures that are currently being faced by farmers and the wider food supply chain. I thank the cabinet secretary for that answer. NFU Scotland is working with its members to gauge how the energy price cap will benefit hard-pressed food and farming businesses. I understand that farmers who are paying under £20 per kilowatt-hour are now quoted at £83 per kilowatt-hour, which is a 315 per cent increase. Scotland farmers are crucial to ensuring that we have access to nutritious food, and local farmers have told me how they are being hammered in terms of rising production costs. Does the cabinet secretary agree that the UK Government needs to go further than the six-month cap and provide more financial certainty and stability to our farmers, or that food security will continue to be undermined and the prices on the shop shelves will continue to climb? Yes, absolutely. I do agree with that. As I said in my initial response, I've written to the new secretary of state at DEFRA, Rhaunie Llywodrae, and I'm requesting a meeting to highlight my concerns about food security. I'll also continue to press the UK Government to do more to ease the pressures that are being faced by farmers in the wider food supply chain. We are also seeking that clarity from the UK Government about what plans for protections such as the energy bill relief scheme after 31 March 2023 will look like to ensure that businesses have that certainty and security that they need to operate with confidence. From the work that we did with the food security and supply task force, there were recommendations within that too that only the UK Government can act on and deliver and, of course, we'll continue to press them for action and, indeed, a response to the task force asks. To ask the Scottish Government whether it will provide an update on the proposals for the rural visa pilot. Last week, the Scottish Government's rural visa pilot proposal gained cross-party support across the Scottish Parliament. The proposal has been issued to the UK Government and we await its response. We call on the UK Government to accept the recommendation of their own Migration Advisory Committee to deliver a migration pilot for rural areas. The proposal endorsed by the Parliament was co-developed by the Scottish Government, local authorities, rural employers, academic experts and partners. Our ask of the UK Government is clear. Work with the Scottish Government, local authorities and employers to establish migration pilots to meet the needs of Scotland's rural and island communities. In August, the NFU estimated that over £60 million worth of food had been wasted due to workforce shortages. Farmers are doubly feeling the effects of Tory policy by not having the workforce available to help them. Now they, like most of the country, are suffering from inflationary pressures exacerbated by Brexit, while the Tories forced on Scotland. Does the minister share my view that, unless the UK Government considers Scotland to be beneath their contempt, the very least that it can do is urgently agree to proposals for our rural visa pilot? Yes, I do. I thank Natalie Donne for that question. It is notable that both the chief executive and president of NFU Scotland have publicly called for the rural visa pilot proposal to be implemented. Scott Walker stated that it must be delivered in a quote, in tandem with UK Government expanding the number of seasonal worker visas and a review of the shortage occupation list. At the moment, the Conservatives are the only party in this Parliament yet to support the proposal, with Donald Cameron asking for more time to consider it in detail. I know that he and his colleagues will be looking to engage with that constructively, and I hope that they can do so, so that the Parliament can be speaking with one voice on this, which is such a critical issue facing our rural and island communities. To ask the Scottish Government what its latest engagement has been with the UK Government on the impact of Brexit on Scotland's food security. The Scottish Government takes the topic of food security in Scotland very seriously. I, along with my fellow Scottish ministers, have highlighted our concerns repeatedly to the UK Government about the effects of its bad Brexit deal. I wrote on 26 August to the UK Government to highlight the cumulative impact on the food and drink sector of labour and skill shortages and rising costs, and I have yet to receive a response to that. The Scottish Government will continue to use all devolved powers available to support the sector, however more needs to be done by the UK Government now to protect our food and drink businesses. I agree that the UK Government should be doing more and doing it as soon as possible. A recent letter from the Green Alliance to Kevin Baddanoff noted that, the recent lifting of tariffs and quotas without an equivalence on animal welfare or environmental standards for Australian producers means that UK farmers will now compete with imported food produced to standards that would be illegal in the UK. Does the minister share my view that Brexit continues to be a monstrous portrayal of farmers, growers and food producers in the sector in general for which the Tories should be beyond ashamed? I do not think that there is any doubt that food and drink businesses in the sector in Scotland have borne the brunt of the hard Brexit that has been pursued by the UK Government. We have seen the UK Government sign up to trade deals with Australia and New Zealand that will be damaging to Scotland's farmers and crofters, and that is even shown by the UK Government's own economic modelling. We also have worse deals with those countries than what the EU has managed to negotiate with them, and I think that it is really important to highlight an example of that. While the UK Government agreed to allow unlimited quantities of beef tariff free into the UK for 15 years, the EU-New Zealand FTA will maintain quotas permanently and apply a 7.5 per cent tariff. In addition to that, the quotas that New Zealand has secured in its FTA with the UK are also much higher than those in its agreement with the EU, and in the first year of the free trade agreement the UK will allow 12,000 tonnes of New Zealand beef into the UK, while the EU will allow only 3,333 tonnes, and that is for the entire EU 27. I really look forward to the time when the Scottish Government can work with the EU and work with others to develop and deliver a trade policy that works in the economic and the other interests of people in Scotland. It is no surprise that on Wednesday 2 November from Shetland to Stranraa and from Kirkwall to Kelso, and here at Holyrood farmers and crofters will send a message to the Scottish Government that farmers need clarity from this SNP Government and food production needs farmers. This is not a celebration, as your civil servant described at the rain committee this morning. Cabinet Secretary, it has taken six years for the SNP to launch a consultation on agricultural policy and now farmers are being asked to discuss these massive issues with an information vacuum. Despite numerous requests, your department has failed to give clarity on how new power is created by the proposed agricultural bill will put food production at the heart of delivering the expectations that this Government expects. The rally is in four weeks, cabinet secretary. The Scottish Conservatives will be there supporting farmers and crofters, will the cabinet secretary be there to apologise for her lack of clarity, and will she commit to fully addressing farmers concerns? One thing I won't be apologising for is continuing to support food production in this country, unlike other parts of the UK. That was one of the central pillars of our vision for agriculture, which we published earlier this year, where we committed within that to supporting food production while looking to, of course, tackle the climate and the nature emergencies. That is the three key pillars of our support going forward. That is also why we committed to maintaining direct payments, recognising the importance of food production, which is, of course, important now more than ever, given the increasing food security risks that we face. To ask the Scottish Government what action it is taking to address the issue of absenteeism in crofting. In 2022-23, the Crofting Commission received an increase in budget, enabling it to expand its residency and land use team to increase its work in addressing absenteeism, and to bring crofts back into productive use. Through the Crofting Commission's development officers, work is underway implementing actions contained in the Scottish Government's national development plan for crofting, including bringing more crofts back into active use. As crofting landlords, Scottish ministers are considering what action can be taken on their crofting estates to increase active use, occupancy of crofts, and look at opportunities for new entrants. I thank the cabinet secretary for that answer and realise that the cabinet secretary is aware of the importance of crofting to the Highlands and Islands. Crofts falling into disuse as a result of absenteeism represent the barrier to young people acquiring a tendency to make use of the land and thereby remain in their community. Can she say any more about how the Government's legislative ambitions will create more active crofts and ensure that those who wish to productive use a croft can get access to land? I thank the member for that question. I also want to use the opportunity to reaffirm our commitment to modernising crofting laws that we set out in our programme for government this year. The crofting bill group was reinstated in May this year to consider crofting legislation, including the provisions pertaining to the enforcement of duties of crofters and owner-occupire crofts. That includes a residency duty and a duty to cultivate the croft or to put the croft to another purposeful use. A number of meetings have already taken place between June and September this year, with further meetings scheduled, and I look forward to the further development of that work so that we can really tackle some of the important issues that the member has raised. To ask the Scottish Government what discussions the Rural Affairs Secretary has had with the Public Health Minister regarding how it will ensure the safety and quality of food sold in Scotland in the event that the UK Government proceeds with its retained EU law, revocation and reform bill proposals. That is an area that causes us significant concern. Scottish ministers are advised on food safety and standards matters by Food Standards Scotland and the Minister for Public Health and myself meet the FSS-CEO regularly on a range of issues, and that bill will feature in the on-going discussions that we have with FSS. The Scottish Government considers the bill to be reckless, and I cannot emphasise enough the impact that the bill will have on the areas that the member has mentioned, as well as more broadly across my portfolio as well as others. Independently of Scottish Government, FSS considers that the bill will undermine our ability to ensure the safety and quality of food sold in Scotland, because unless existing legal protections set out in retained EU law are preserved, they will be removed from the statute book by the end of 2023. The sheer volume of food and feed legislation is significant, the timescales proposed by the UK Government are ridiculous and the current protections for consumers are put at risk by this bill. That goes much further than food safety, because the bill also dismantles our environmental and biosecurity protections, as well as so many other areas of devolved competence, and we will be doing everything within the powers available to us to prevent the progress of this bill in its current form. Willie Coffey. I thank the cabinet secretary for that detailed answer. As she is well aware, Food Standards Scotland has already warned about the risk to consumers here, and this UK bill will result in the removal of consumer protections relating to food that have applied in Scotland under our protection in this Parliament for years. Does she agree with me that this is another example of the UK Government interfering with and grabbing the powers of this Parliament? And what can the Scottish Government do to prevent a race to the bottom in quality food standards and to uphold the high safety and quality that we have enjoyed for many years in Scotland? This bill, as I have already outlined, does carry an unacceptably high risk that vital law simply drops off the UK statute book towards the end of next year. My colleague the cabinet secretary for constitution, external affairs and islands, Angus Robertson, is pressing the UK Government to reconsider the bill and its implications for the devolved Governments, because unless it has changed and unless current standards remain on the statute book, Scotland's reputation for high-quality food and drink is very much at risk. I also think that it is worth bearing in mind some of the comments that really highlight the significance of what this bill will mean from Food Standards Scotland, where it has advised that major risks and impacts to Scottish consumers in relation to food safety and standards will exist if the bill is progressed in its current form, adding that, even if high legal standards continue to apply in Scotland, the internal market act means that there would be no way of stopping goods from elsewhere in the UK being sold in Scotland produced under lower legal standards. This SNP Green Government has already shackled Scotland's farmers to EU law with an example of gene editing, and it is not interested in building a farm policy aligned to Scotland's need. The UK Government offered to extend powers and the UK Agriculture Act to help devolved administrations to create its own farming support system, and while Wales and Northern Ireland accepted that offer, the SNP Government declined. NFU president Martin Kenyry says that he remains frustrated that, despite several requests from NFU Scotland and other stakeholders, they have yet to receive clarity on the new agriculture bill. Cabinet Secretary, when will you start prioritising farmers ahead of constitutional grievance? I think that that is just a complete nonsensical comment from the member, which I would just completely disagree with. Of course, we are putting our farmers and crofters at the forefront of our policy. That is why we are co-developing it with them to ensure that we have a policy that works. To ask the Scottish Government what plans it has to support the rural economy in areas that are impacted by a long-term population decline. We are investing £8.3 million this year to deliver the national islands plan and developing an addressing the population action plan to provide the policy framework to support population retention across rural communities. We are also investing £11.6 million through our rural community-led fund, developing a remote rural and islands housing action plan and investing in digital infrastructure, despite responsibility for broadband being reserved to the UK Government. Additionally, Parliament has recently endorsed a bespoke rural visa pilot scheme. The employer-based migration proposal has been developed with representatives from employers across islands and rural communities. I thank the minister for that answer. Can the minister confirm that the £5 million for the abandoned islands bond is still ring-fenced for tackling depopulation? If plans for utilising that resource will be set out in future financial plans? I thank Carol Mawkin for that question. Obviously, we are working with our island communities to develop proposals around ensuring that we can address depopulation. All financial issues at the moment are going through the lens of the emergency budget review and the details of which will be published as soon as possible. Depopulation is often a multi-faceted problem that requires a range of levers to address. Many of those such as matters pertaining to immigration are reserved. The Scottish Government has clearly set out a case charting a different course to the UK immigration policies that, quite frankly, do not take into account Scotland's unique circumstances and are therefore harmful to our communities. Can I ask what the cabinet secretary thinks? The basis is for the opposition of the UK Government to initiatives that are essential to Scotland's wellbeing through supporting economic growth and the delivery of public services, as well as enhancing and sustaining our communities. A lack of understanding of Scotland's rural needs. Depopulation is a complex issue, and therefore there are no simple solutions as such. It is essential that we work with regional, local and community partners to develop a sustainable approach to enhancing and sustaining our communities. We are proud in Scotland to have legislation such as the Islands Act, which ensures that we take into account the unique nature of communities and develop solutions in a collaborative manner. Without such a close working relationship, I struggle to see how the UK Government can understand the needs of our communities and confess to knowing what is best for them. Question 7, Liam McArthur. As the Scottish Government what steps it is taking to improve the resilience of island communities? By considering population levels, promoting sustainable island economies, supporting wellbeing, health and focusing on reducing fuel poverty, the national islands plan is critical to improving outcomes for island communities and ultimately that resilience. To ensure that we respond in real time to any issues as they arise, I frequently engage with my colleagues across all portfolios to ensure that reporting on island resilience matters is timely and effective, and that provides me with the assurance that I need on concurrent risk and allows us to explore any potential mitigations. My islands officials also correspond with island communities to provide that on-the-ground information regarding any major issues. Liam McArthur. Thank you, and I welcome the work that is on-going. Having thankfully abandoned the ill-conceived and overly simplistic proposal for island bonds, it appears that ministers now intend spending the money £300,000 this year on practical policy tests to inform a future action plan. This is unlikely to have them dancing in the aisles. It will also do nothing to improve transport links, broadband provision or the availability of affordable housing. So will the Cabinet Secretary agree to ditch the tests and focus these limited resources on, for example, expanding into aisles air services in Orkney or providing additional support to students wishing to come to our islands to study and who, in the past, have often then stayed to build lives and build careers? First of all, I just want to respond to the member by saying that the detail of any proposals are still to come forward. I do not think that it is necessarily right to encourage me to ditch something before seeing that detail. As well as the fact that what we were proposing to bring forward is based on the feedback that is heard by island communities through the extensive consultation that we undertook. I would encourage the member and I am more than happy to discuss it further with him in terms of what those projects might look like, but any work that we take forward is based on the needs of our island communities. However, I also want to draw attention to the fact that help for our island communities does not just come from the rural affairs and islands portfolio alone. When you look at our housing programme, the transport programme and all the funding that is being channeled through that, there are a number of interventions that are currently underway and that are currently planned to, which will help with that overall resilience. Island and rural communities are among the most vibrant, but the cost of living crisis could pose a threat to many of them. It has been reported that households in Argyllun but will need to earn more than £72,000 a year to avoid fuel poverty this winter. The key levers to address this crisis rest with the UK Government. Does the cabinet secretary share my view that the best way to ensure the resilience of island and rural communities is for them to be rid of the chaos of Westminster and the callous politics of the Tories? I would agree with the points that the members made on both counts there, because I think that we have seen time and time again how decisions made in reserved areas simply do not take into account the unique circumstances of rural and island communities and the very specific circumstances that they can face. I think just one example of that. We discussed a bit of this when I appeared in front of the rain committee this morning, but when we look at the shared prosperity fund, it is just one example of many. Where the highlands and islands are recognised as one of the highest priority areas, earmark for European structural funds, it is the opposite when we consider the UK Government's levelling up agenda. £183 million a year is required to replace EU funding, which equates to £549 million over the shared prosperity fund period of three years. However, instead of receiving that £549 million, Scotland will receive just £212 million, and that is over the whole three-year period. That creates a 60 per cent reduction in funding in real terms. It is because of this lack of regard by the Tories that the Scottish Government continues to press them to take that further action to support our households through this cost of living crisis. Question 8, Jamie Greene. Thank you. To ask the Scottish Government what its response is to the emergency stakeholders meeting on September 12 regarding its proposed new agriculture bill. Our public consultation on delivering our vision for Scottish agriculture proposals for a new agriculture bill is open until the 21st of November this year. It will inform the next steps in our commitment to co-design via the agriculture reform implementation oversight board, and I would encourage everyone to engage in that consultation to ensure that their views are captured. It is important for stakeholders, for government and wider society to come together and discuss those issues and work towards shared outcomes as part of the Scottish Government's co-development approach. I trust that this new industry group will feed back to enable that discussion with the stakeholders representing the wider rural economy in the ARD stakeholder group. Jamie Greene. I think that co-design only refers to the relationship between the Government and the minority party that is propping it up, because senior NFUS figures describe the agriculture bill as reading more like a green party manifesto than a true agriculture bill. We very little mention food security and food production, which surely should lie at the heart of any such bill. Relationships between the farming community and the Scottish Government are at an all-time low in the eyes of many in the industry. Given that the SNP Government has had years, years to come up with a plan for the future of Scottish farming, why does the cabinet secretary think that so many farmers are so vocally disappointed and angry about the Government's proposals for their future? I do not know if the member has been through the detail of the consultation that we brought forward, but it sets out the future framework that we are looking to establish and looks at the enabling powers that we will need as part of any future legislation. We discuss the importance and highlight the importance of our food production and food security. That is an area that we specifically identified and highlighted within our vision for agriculture, which we are intent on delivering. The cabinet secretary will know that, even when that agricultural bill is passed as a framework bill, it will not provide the detail that farmers are looking for in future agricultural support. Does she accept that they need to see that detail even before the bill is finally passed to allow them to plan the future of their business? I absolutely do accept that, and we will be working towards delivering that and more information on that will become available in due course. Thank you, cabinet secretary. That concludes portfolio questions on rural affairs and islands. We will now move to portfolio questions on health and social care. I will allow a very short pause while members move quickly to change their positions on the front bench. I remind members that questions 3 and 4 are grouped together, and I will take any supplementaries on those questions once they are answered. If a member wishes to request a supplementary question, they should press the request-to-speak button during the relevant question or indicate so in the chat function by entering the letter R. Again, I would press for succinct questions and answers to match in order to get in as many members as possible. Question 1, Maggie Chapman. To ask the Scottish Government what its advice is for patients who move from one regional NHS board to another while on a waiting list for essential surgery. Patients who move to another health board area will join the waiting list of the receiving health board. While waiting times vary across health boards and specialities, I would not expect that to have a negative impact on the length of time a person should expect to wait. Clinicians in the new new board may wish to reassess the patient to ensure that it is safe to go ahead with their procedure, especially where there has been no prior assessment or there has been some time that has elapsed since an assessment was carried out. Again, I would not expect that to be done routinely without good clinical reasons. Patients with an urgent clinical need, of course, will always be prioritised. In all cases, I expect health boards to make every effort to ensure equity of care that any disruption to the patient's journey are minimised. Maggie Chapman. I thank you for that answer. A constituent of mine who was first referred in October 2019 has been waiting all the whilst in pain for surgery since March 2020. They recently had to move, fortunately still within the north-east region, but they have had to transfer from NHS Grampian to NHS Tayside. To get onto the Tayside waiting list, they have to undergo a fresh assessment. Can the Cabinet Secretary outline how patients can ensure they do not have to redo assessments at a cost of time, energy and resources to both themselves and the NHS in order to get onto their new health boards waiting list? What guidance can we give to patients who might be willing and able to travel to another health board that has available capacity so as to expedite their surgery or other treatment? I thank Maggie Chapman for her question. I say that my thoughts are with her constituent and what is a very difficult time for her constituent. There should not be any detriments to patients who move to new health board areas. In terms of the assessment being done, I do not know the full detail of Maggie Chapman's constituent's case, but I am happy to receive it. As I said in my original answer, those assessments will not be done routinely or necessarily. There may be a good clinical reason. I do not know because I do not know the detail of the case, but I would expect there to be no undue impact on the time that her constituent has to wait for the procedures. I will ask my officials to lay us with both boards in this specific case. In terms of our answer to her second question, there will be a review undertaken of NHS waiting times guidance. That working group has been established. Again, I am happy to keep Maggie Chapman and other members updated. I am sorry on our very final point about if there is the possibility to move to another board for that procedure to take place. That can be a board-to-board discussion. For example, financial help is available for travelling and accommodation in certain cases. Will the minister guarantee that any patient who moves from one regional NHS board to another while waiting for any outpatient or inpatient services will have their current length of wait time taken into account with their new board schedules treatment and that those patients are not simply moved to the foot of the waiting list? That routinely would not happen. The clock would not reset back to zero routinely. However, as I said to Maggie Chapman, I would expect that an assessment may be necessary, particularly if time has elapsed between the original assessment or the last assessment in this particular moment. No, routinely patients would not have their clock reset to zero now would be concerned if that was happening in any health board routinely. I would like to ask the Scottish Government what work it is undertaking to ensure that patients have access to care packages to help aid recovery at home as soon as possible after a hospital stay? The Scottish Government is committed to ensuring that people receive the right care in the right place at the right time, avoiding delays and discharge wherever possible. To support that work in 2022-23, we have issued a range of funding packages, including £124 million to enhance care at home, £200 million to increase the early rate of pay to £10.50 million, £20 million to support interim care arrangements and £40 million to enhance multidisciplinary teams. We are also investing a further £3.6 million in the development of hospital at home, which can provide acute hospital level care at home, avoiding the need for an acute admission and lengths of stay. That funding is in addition to £4.5 million invested in taking our total investment to over £8 million. I have recently written to NHS Tayside, the IJB, the Cabinet Secretary for Health and Sport, on the use of a constituent of mine, whom I will not name, who has been waiting an excessive long period of time for his wife to be returned home after having a stroke. She has all the equipment in place, but they cannot seem to put a care package in place for her. The challenge appears to be cent on staffing capacity, which has clearly been impacted by Brexit. In the face of this, can the Scottish Government set out what action it is taking within its powers to support health boards and IJBs to recruit the staff that they need? Presiding Officer, I thank Mr Fairlie for raising this distressing case for his constituents. I understand that you have written to the cabinet secretary and will respond shortly. I will certainly ask my officials to investigate the situation as it stands if you could provide us with more detail. It is vital that we continue to make every effort to maximise the capacity of the social care system. In addition to the financial investments that I have outlined of £528 million and as part of our winter planning preparedness, we have been working with COSLA to develop our joint plan for winter. The Government has a long-standing commitment to the principles of fair work for social care, as I outlined in my earlier answer. We are fully committed to improving the experience of the social care workforce, including increasing levels of pay and delivering consistent fair work conditions to staff working with more than 1,200 employers delivering social care in Scotland. On that basis, we have extended the staff support fund to ensure that social care staff who are required to isolate if they test positive for Covid receive their full pay over the winter months. We will continue to work in partnership with local government, with health and social care partners to do all that we can to support them, to try and ensure that we recruit and retain staff so that we do not have those situations. The case that Jim Fairlie has highlighted is replicated across the country. As of 26 September, there are 90 people in North East Fife who are waiting for a care package. Either stuck in hospital or stuck at home, that needs to change. The trouble is that, what the minister said, he has been saying for years, ever since Shona Robison promised that she was going to get rid of delayed discharge altogether. Why are the plans that he has set out making absolutely no difference? I think that what we are laying out is making a difference, but what Willie Rennie fails to understand is that there has been a huge impact on our health and social care systems because of the pandemic. We are still in the midst of that pandemic, which some folks forget. We have situations whereby there are situations in which staff are off ill, with Covid and other reasons. Of course, as Mr Fairlie rightly pointed out, our health and social care system has faced a Brexit shock, with one care organisation that I have spoken to losing 40 per cent of its staff because of Brexit. We will continue to put in place our winter planning. We will co-operate with local authorities and health and social care partnerships. The cabinet secretary and I are in a constant round of discussion with the service providers across the country so that we can help them as best we can. Unfortunately, what we cannot do is bring back all those folks that we lost because of the Brexit situation. New research from YouGov has revealed that only 28 per cent of Scots would consider a career in the care sector, with around 40 per cent citing low-pay stress and a perception that the sector is physically demanding. Most shockingly, 9 out of 10 care workers described that the place of work is understaffed. I heard what the minister said about the winter announcement yesterday, but what we had as the headline in social care was a repeat of the £10.50 per hour wage, which equates to £48 a derisory pay rise. When is the Government going to get serious, engage with staff and unions on the ground and respond to that call for £15 an hour? I think that what Mr O'Kane fails to say is that if we were to raise pay to £15 an hour at this moment, that would cost £1.75 billion, £1.75 billion. Mr O'Kane knows that we are already in a stressed situation when it comes to budgets because of the continued cuts of the Tory Government. We will continue to do all that we can to raise pay. I do not want all the shouting from sedentary positions. We will continue to raise pay and support our social care staff. We have raised pay twice in a year. We keep that under constant review and will continue to do so. On the point about career progression and attracting people to the social care profession, that is one of the key planks of our national care service proposals. To ensure that we get pay and conditions right, but also to ensure that there are career pathways for folk who enter that profession. That is what young people want to see. Those are the folks that we need to see entering care because we need to grow our own thanks to the fact that we have lost so many folk because of the Brexit situation. I would point out to members that we are now 13 minutes into this time session, and I have another six questions to take, so I think that everybody can do the maths with that. To ask the Scottish Government whether it will provide an update on the target to eliminate two-year waits for out-patient appointments in NHS Scotland. The first of the targets set in July to address the impact of the pandemic on planned care was to eliminate two-year waits for out-patients in most specialities by the end of August. Public Health Scotland data shows by 31 August that a majority of specialities had no patients waiting more than two years. In fact, 76 per cent of specialities had fewer than 10 patients waiting more than two years, and 71 per cent of territorial health boards had five patients or fewer waiting more than two years. Boards are, of course, working hard to reduce the number of out-patients waiting over two years as quickly as possible. I am grateful to our NHS staff who have helped in this effort. I thank the cabinet secretary for the answer. Back in June, the health secretary set a series of targets along waits for NHS Scotland. He only pledged to eradicate two-year out-patient waits in most specialities rather than all together. The fact is that we now find more than 2,000 Scots have been languishing on out-patient waiting lists for more than two years. That means that the long out-patient waiting is seriously far from being eliminated, cabinet secretary. Does the cabinet secretary concede that the original targets have failed when we can expect to see out-patient two-year waits eliminated for good? I am not sure how Alexander Stewart can stand there and repeat what the target was, which was to eradicate two-year out-patient waits in most specialities. Agree with me that that has happened in most specialities and then ask me if the target has failed. That, to me, does not make any sense. I am surprised that, when the statistics were published, Alexander Stewart—in fact, I do not think that any member of the opposition could utter a word and say even a syllable of thanks to NHS staff who have worked so hard to help to reduce the two-year out-patient waits across the board. In the vast majority of health boards, there are two health boards that account for 90 per cent of the two-year out-patient waits, Ayrsham, Arn and Grampian. I can give an absolute assurance to the member that we are working intensively with both of those health boards to ensure that they get that extra support to help them. However, let us not take away from the fact that, when those targets were announced, within 60 days we have seen remarkable progress right across health boards. I hope that the member will join me in thanking NHS staff for their incredible efforts in that regard. To ask the Scottish Government whether it will provide an update on what new steps it has taken to tackle NHS waiting lists. I will not repeat what I said in the last answer, but we are working also quite intensively with the Centre for Sustainable Delivery, which will be known to Pauline McNeill. It is working with boards to accelerate the implementation of high-impact changes, including active clinical referral treatment and patient-initiated review. Those improvement programmes will support delivery of the targets that I have just mentioned and provide sustainable solutions for the future. We are also working with CFSD and boards to embed regional and national working to ensure that long-waiting patients can access treatment more quickly, even if that means that they have to travel in order to do so. Pauline McNeill, I want to follow up on asking him about internal waiting times. For example, an oncologist raised concern with my office last week in Greater Glasgow about cancer-related scans, which should normally be returned within one week, now taking up to eight weeks. Clearly, if oncologists are waiting for the results of important scans, it will have a knock-on effect for patients in what is a priority area of treatment. Can the cabinet secretary assure me that he is aware of this or that he is acting on it? And what assurances can he give oncologists in the city of Glasgow or Greater Glasgow on Clyde Health Board that worried patients scans will be returned in a much reduced timescale? That is an issue that we are aware of. I think that I have spoken before in this chamber about some of the challenges that we are having around the medical oncologist's workforce. She is right to raise that. I would say to Pauline McNeill that I am happy to give her more detail off-table about some of the actions that we are taking, specifically with Greater Glasgow and Clyde, in relation to diagnostic, cancer diagnostics, of course, but some of those other key diagnostics. Again, we have invested particularly in those areas where we know diagnostics and diagnosis can take much longer than any of us would want to. For example, some of the actions that we are taking in relation to endoscopy and urology, and I will give more detail to Pauline McNeill. Of course, equally, if she has a specific constituency case that she is concerned about, we would be happy to follow that up with the appropriate board. I welcome the latest statistics that show an increase in the number of patients being seen within target times. Can the cabinet secretary confirm what work is on-going to ensure that upward trajectory continues? We know that we are going into a very challenging period, but in a very challenging period, but the winter months will present a significant challenge on top of what we are currently facing. The working that we are doing with boards is to try to ensure that, as much and as far as possible, we can protect some of that capacity for elective care. We know that elective care has taken a real hit because of the pandemic over the course of the past two and a half years. We are maximising theatre productivity, and we are looking to see how we can ring-fetch that capacity. The Centre for Sustainable Delivery is moving forward with its national elective co-ordination unit, which will help to make sure that we are making the best use of theatre capacity across boards where possible. We are also funding boards to the tune of around £8 million in the course of this winter to help to recruit 750 additional nurses, midwives and allied health professionals, which I hope will help to boost our workforce over the course of the winter. To ask the Scottish Government what recent discussions it has had with NHS Borders. I last met NHS Borders on 22 September. We discussed matters of public health concerning the local population. Will the cabinet secretary join me in congratulating NHS Borders and all staff on the recent announcement that 100 per cent of patients diagnosed with cancer are treated within the Scottish Government's target of 31 days, and that almost 97 per cent of eligible patients, given an urgent suspicion of cancer referral, have received their first treatment within the Scottish Government's 62-day target? I think that that is excellent work on behalf of NHS Borders and the staff. I agree wholeheartedly with Christine Grahame, and it is right that we do give congratulations, pay tribute to our NHS staff who have had the most difficult challenging two and a half years of their professional careers. It is right that, where we are seeing that progress, we congratulate NHS staff for that. What I would say to Christine Grahame is that notwithstanding that excellent progress in Borders, I am not satisfied at the levels that we currently have in relation to our 62-day target across the board. One of the areas that I have asked officials to explore closely is that, for those boards that are doing well and are accelerating much like NHS Borders, can other health boards learn from what Borders is doing and hopefully implement that in their boards, too? To ask the Scottish Government whether it will provide an update on the provision of maternity services. Minister Marie Todd. The Scottish Government continues to improve provision of maternity and neonatal services through implementation of the best start, a five-year forward plan for maternity and neonatal care in Scotland. Following a pause due to Covid, we have now received implementation plans from all boards showing an on-track trajectory for completion by the revised end date of 2024 for the majority of the recommendations and for 2026 for continuity of carer. In a recent letter to the Galloway community hospital action group, you wrote, and I quote, "...we expect all boards to provide maternity services that are delivered as close to home as possible. Constituents in my constituency have been waiting four long years with mothers given birth on the roadside but still no serious discussion surrounding the return of maternity services in Wictonshire by NHS Stonefries and Galloway. What reassurances can the minister give expecting mothers in this part of my constituency of Galloway and Weston Fries?" I know that she is very aware of this. There is an undeniable need for a midwife-led maternity service at the Galloway community hospital in Sinrar to prevent a journey of 150 miles and three-hour round-trip. Can you outline what the Government can do as a matter of urgency to reinstate such a service? I thank the member for that question. He is aware that Scottish Government officials and professional leads, including the chief midwifery officer, are in regular contact with the head of midwifery at NHS Dumfries and Galloway to discuss those issues and to explore what support we as Government might provide. He is also aware that Dumfries and Galloway integration joint board, which is responsible for the planning and delivery of the vast majority of health and adult social care services in the region, has asked the health board to consider options for delivery of maternity services in Galloway and to report to the IJB. I understand that that is to be discussed just next week, I think, on 13 October. I have asked to be kept informed of progress and the outcome of that process. I am also planning to visit the Galloway community hospital towards the end of the month, Monday 31 October. I will be meeting with the Galloway community hospital action group at that time and hope to discuss those issues with them. To ask the Scottish Government what action it is taking to address the reported prevalence of alcohol-related cancers in Scotland. The recently published SHAP guidance for health professionals highlighted the risk of developing a range of cancers increases as alcohol consumption increases. We are working with SHAP to promote this guidance. We are investing £10 million to improve how cancer is treated in Scotland, which includes alcohol-attributed cancers. We will launch a new 10-year strategy in April, which will take a comprehensive approach to improving patient pathways. We are taking action to reduce alcohol consumption right across the population, including consulting on potential alcohol marketing restrictions this autumn, and continuing our evaluation of minimum unit price. I thank the minister for her answer. One of the things in the SHAP report in terms of the guidance was highlighting that one in four alcohol-attributable deaths in Scotland are due to cancer. It is really important that we do everything that we can to highlight that to the public. The report that the minister mentioned makes a number of recommendations for intervention. I just wonder if there is anything more the minister can say about what the Scottish Government plans to do to make health professionals and the public more aware of those risks. However, I want to take the opportunity to welcome the comments that the minister made about advertising. The Scottish Government works very closely with Scottish health action on alcohol problems SHAP. Health professionals right across Scotland have been issued with SHAP's guidance highlighting the link between alcohol and cancer. The guidance suggests that professionals can reduce alcohol-related cancer risks by helping patients to reduce their intake. We are developing a new 10-year cancer strategy to launch in spring 2023, which will take a comprehensive approach to improving patient pathways from prevention and diagnosis right through to treatment and post-treatment care. That will include alcohol-related cancers. I welcome the member's focus on this issue, as all the members in the chamber will know. Directly attributable alcohol deaths rose to 24 a week in Scotland this year, which is an absolute tragedy. However, it is simply the tip of the iceberg. It does not include the number of people who are dying from cardiac-related illness and cancer, both of which alcohol is a major contributory factor. Absolutely. The Scottish Government has no plans whatsoever for the introduction and reintroduction of prescription charges. We have been absolutely clear that prescription charges are a tax on ill health and that any medication prescribed to a patient should be dispensed free of charge, unlike in England, where charges apply. We are seeing patients paying £9.35 per item, not per prescription, but per item. The minister agrees with me that the three prescriptions are a significant investment in improving health, especially at a time when the prescription charges are costing £9.35 in England during a cost-loving crisis. People should not be deterred from accessing the vital treatment and medicines that they need. Does the minister share my astonishment that the leader of the Scottish Labour Party refused to back the suggestion that the abolition of prescription charges should be a Labour party policy when invited to do so by the First Minister in Parliament last week? I absolutely share your astonishment that prescription charges are a tax on ill health and a barrier to better health for many. Charging for prescriptions would mean that many people with chronic conditions or even people receiving treatment for cancer could be liable to pay that enormous charge. Not having to choose between food shopping or vital medicines is not a position. Having to choose between food shopping and vital medicines is not a position that people in Scotland are faced with, unlike in England where patients are charged £9.35 an item. We continue to demonstrate our commitment to the provision of free healthcare advice and treatment when needed with the introduction of the NHS pharmacy first service, available at all community pharmacies, a service that is available to everyone who is registered with the GP ordinarily resident in Scotland. On Labour party policy, I have to say that even the Scottish Conservatives dropped their opposition to free prescriptions in 2017, recognising the popular support for the policy introduced by the SNP administration in 2011. Thank you minister. That concludes the health and social care portfolio questions. There will be a short pause before we move on to the next item of business.