 I have to remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask members that they take care to observe those measures, including when entering and exiting the chamber. Please only use the aisles and walkways to access your seat and when moving around the chamber. The first item of business is portfolio questions. The portfolio today is health and social care. I would ask any member wishing to request a supplementary question to press their request-to-speak button or to indicate in the chat function by entering the letter R during the relevant question. I would also say, the plea that is always made, that to get as many people in as possible it would be really appreciated if the questions could be short and succinct and the answers as well. Question number one has been withdrawn. Question number two, Megan Gallacher. To ask the Scottish Government what action it is taking to support and improve child mental health services. Minister Kevin Stewart. I welcome Ms Gallacher to the Parliament. We are undertaking a number of measures to improve child mental health services and are determined to address the significant impact that the Covid-19 period has had on the mental wellbeing of children and young people. In October 2020, we published mental health transition and recovery plan in response to the mental health effects of the Covid-19 pandemic. The plan contains a number of actions targeted at supporting children and young people and is supported by the £120 million mental health recovery and renewal plan that was announced in February of this year. Specifically, that work includes actions to improve specialist CAMHS services, address waiting times and improve other mental health supports and services for children and young people. We recognise that not all children and young people need specialist services like CAMHS, so we have provided £15 million of additional funding to local authorities to deliver locally based mental health and wellbeing support for 5 to 24-year-olds in their communities. We continue to invest in a range of other measures to support children and young people's mental wellbeing. That includes providing enhanced digital resources on mental health and wellbeing available via the Young Scots website and the expansion of the distress brief intervention programme to under-16s. When will the Scottish Government deliver its manifesto commitment to introduce national transition strategy to improve outcomes for children and young people who are experiencing mental health and their transition to adulthood? I am very new to this post. What I am doing at this moment in time is looking at all aspects of our mental health delivery, in particular with a focus on young people. I have already spoken to health boards around this, including NHS Grampian and NHS Lothian. I will continue to engage with boards and other partners and stakeholders to ensure that we get this right for children and young people in Scotland. The damning audit of CAMHS services in 2018 called for an end to rejected referrals. Three years on, at least 20 per cent of referrals to CAMHS are still consistently rejected. Having waited three years, why have the Government failed to end the damaging practice and when will they reform their referral system, as campaigners have been asking over the past three years? The Government accepted all the recommendations in the 2018 audit of rejected referrals report. We have worked to implement the recommendations by introducing a CAMHS service level specification, which sets out the levels of service that children, young people and families can expect from CAMHS across Scotland. We have agreed additional NHS board allocations of £29.2 million in 2021-22 in order to deliver improvements to CAMHS and to address waiting lists backlogs. Obviously, Covid has had an impact on service delivery here. Some boards have done better than others in continuing to see patients over the course of the pandemic period. I want to ensure that the best practice that is in place in many areas is exported to all boards in Scotland in order to ensure that we get this right for everyone in our country. To ask the Scottish Government what its response is to the Life Search, Health, Wealth and Happiness report of 2020-21. We welcome the health, wealth and happiness research for 2020-21. We have a range of research activity to understand the complex impacts of the pandemic on society that aligns with those findings. For example, we know that the pandemic has had a negative impact on many people's mental health and wellbeing, and we are committed to providing clear, comprehensive and accessible support. Our Clear Your Head website contains a variety of resources and tips to help people to take care of their mental health and wellbeing, including the benefits of physical activity and healthy diet. For those who need more support, we expanded the NHS 24 mental health hub so that it is now available 24 hours a day, seven days a week. The minister says that she correctly states that volunteer groups, charities and organisations such as Falkirk District Association for Mental Health, or FDAMH, provide vital independence support within our communities. Their work does, indeed, often complement and support the work of our NHS mental health services. The recent Life Research report, however, shows that 44 per cent of all Scottish adults are less happy now than before the start of the pandemic, with Covid-related fears, including financial health and further lockdowns, dominating the list of future worries. I have a simple question. Would it be possible to outline what support the Scottish Government will be making available to organisations such as FDAMH to help them to rise to the challenge of further supporting our communities, while we face the uncertainties of transitioning back into a normal life as possible? There has been a range of work over the past year to support community organisations with additional pressures as a result of Covid-19, including through the community and third sector recovery programme and the community's recovery fund. In February, we announced an additional £120 million for a recovery and renewable fund to ensure delivery of the commitments that are set out in our mental health transition and recovery plan. As part of that, we plan to invest in community support services with a focus on prevention and community wellbeing and promoting the capacity and role of third sector organisations to deliver the best that we can. Fulton MacGregor, I move to question 4. Thank you, Presiding Officer. Does the Scottish Government know that it will provide an update on its treatment plans for people with long Covid? It is crucial that our decisions are based on the latest available evidence and clinical guidance. Our approach is for people to have access to the support that they need for assessments, for diagnosis, for care and, importantly, for rehabilitation in a setting that is as close to their home as possible. NHS boards across Scotland are co-ordinating and providing local pathways to ensure a multidisciplinary approach and a person-centred approach in their local area. Additionally, we invested more than £460,000 in Chest, Heart and Stroke Scotland to enable them to deliver long Covid support services that complement the support that is being provided by NHS Scotland. Fulton MacGregor, I welcome that answer from the Cabinet Secretary on what has been done. I have got a constituent who has continued to struggle with long Covid and he has raised the issue with me of a Scottish national register for long Covid patients. Can I ask if this is something that the Government will consider? He has also raised with me several times the issue of Covid clinics such as those that are in England. Can I also ask if this is something that the Government is still looking into? Yes, I would be happy to consider the register. The issue of clinics is not one that we have ever ruled off the table with. Fulton MacGregor, I am sure, was listening and watching First Minister's questions. He would have heard the First Minister address that very point. I can understand why members may ask for the establishment of long Covid clinics here in Scotland. I would say that it is important that we understand as much about long Covid as possible before we do that. It is also clear that one size does not necessarily fit all, just because not a report works or is being implemented in one part of the UK. We cannot just supplant that here in Scotland. What we are doing and what we have invested in is that multi-agency, multi-disciplinary approach using primary care and secondary care, but ensuring that support, rehabilitation and care that an individual needs is as close to their home setting as possible. I will continue conversations with those across political parties, but, importantly, with clinicians, to see how we can tackle the condition that we are obviously still learning more about. Dr Sandish Gohanig, I heard the response to the long Covid question at FMQs by the cabinet secretary just now, and I have to say that I am disappointed. GPs are under tremendous strain and pressure and simply cannot cope with long Covid in our 10-minute appointment slots. I have spoken in the press and there is very chamber about its devastating effects to my patients. The research that the First Minister spoke of will take two to three years to come back and is too long for my patients. Will the cabinet secretary please meet with me and engage on giving new money for new long Covid clinics using models that already exist and that we have adapted to suit all of Scotland, not just the central belt, to give those patients hope and the declaration of interest? I am a practicing doctor. I am, of course, happy to meet with Dr Gohanig and give that commitment to do so. What I would say is to take some exception to one or two characterisations, I do not accept that it is simply GPs that are picking up the burden. They, of course, are undoubtedly doing a portion of that. However, the point of the multidisciplinary support is that we try to provide holistic support. That is supported by a range of NHS services, such as wider primary care teams, occupational therapists, physiotherapists, speech and language therapy and indeed others. We have published the implementation support note, which again gives details of the pathway, not just through primary care but into secondary care too. What I would say is that I was looking at some of the detail around the long Covid clinics in England and, of course, I am happy to take that up with the member. However, I noticed that, in the evaluation that was published on 30 May by the peer support and advocacy group Long Covid Support, it found for those respondents that were seeking a referral to long Covid clinics that less than 30 per cent were satisfied with the experience. Indeed, some of those who were waiting for a referral had been waiting for as long as 127 days. It is not a case that, simply because something is being implemented in England, we can just supplant that and bring that here to Scotland. If he has ideas that, from his question, he clearly does, about how we may be able to adapt some of the good practice in any part of the UK, I am more than willing to meet him and listen to that and engage in that respect. Jackie Baillie The cabinet secretary will know that I asked the First Minister about long Covid clinics earlier today. Her response was pretty identical to a response that I received eight months ago, and the cabinet secretary's response just now does not reflect the experience of people on the ground. I entirely accept that we need holistic support, but, at the moment, there is little to no support at all for constituents in my area. People are suffering from long Covid, and they need help now, not at some point in the future. Can the cabinet secretary tell me what he can do to set to speed up the establishment of specialist clinics? I would say to Ms Baillie again that I would disagree with some of the characterisation of her question to suggest that they do not have any support whatsoever. Does a disservice to the support that is being provided by GPs, by other primary care health providers, by secondary care health providers—so it is not a case that those individuals with long Covid—if Ms Baillie would listen as opposed to shouting to me from a sedentary position— she might actually be able to engage better in the issue, because it is not the case that they are not getting any support whatsoever. In terms of specialist clinics, I have just read some lived experience and some of the feedback from those with long Covid in England, who are not satisfied with the support that they have been receiving or not receiving from long Covid clinics in England and Wales. Of course, I will engage with Ms Baillie. I have already engaged with her on occasion. I will continue to engage with her throughout the period. I am happy to have that conversation with her about what more support we can provide, but I am afraid that it is not simply as simple as saying that we can just supplant a model that is in England up here in Scotland. We must take into account the unique geography of our country, of course, and the unique healthcare setup of our NHS here in Scotland, but I am convinced that we can and should engage in that matter to see what more support we can provide for those who are suffering from long Covid. To ask the Scottish Government what action it is taking to support unpaid carers. I welcome Jenny Minto to Parliament and can extend an apology to Ms Mocchan, because I should have welcomed her earlier. We fund co-ordination of carers week in Scotland to highlight carers' immense contribution to our society and the extra pressures many have faced during the pandemic. During the pandemic, we have invested an additional £1.9 million in extra carers support via carer organisations. We are committed to ensuring carers' rights under the carers act, deliver real change for carers, including through the extra £28.5 million for local carers support in this year's budget. We will engage with carers as we deliver in our commitment to establish a national care service that provides better support for unpaid carers. We have also invested around £358 million in carers allowance and carers allowance supplement in 2020-21 and over £860,000 in young carers grant between 21 October 2019 and 31 January this year. Young carers can also benefit from the YoungScot young carers package that provides non-cash benefits to young carers aged 11-18. We will shortly bring forward legislation to make a further coronavirus carers allowance supplement payment in December this year. That is in addition to the increased payment made to carers who qualified for carers allowance on 13 April 2020. That means that eligible carers north of the border continue to receive more than those south of the border. Our discussion paper, published in March this year, sets out our draft aims for Scottish carers assistance, and we are developing options to ensure our replacement for carers allowance delivers for unpaid carers in Scotland. I hope that the next answer could paraphrase some of the activity. I would like to thank the minister for that very detailed answer. In Argyll and Bute, third sector organisations such as DOHIS provide fantastic support to unpaid carers. Organisations like this were delighted with the Carers Rights Act 2018, yet investment in those organisations do not cover costs. Can the minister—I was promoting him as well—outline what support is available for organisations that support unpaid carers? Will the Scottish Government consider the views of such organisations as part of the consultation process for the national care service? I absolutely agree with Ms Minto that local carers support organisations like DOHIS carers centre do a fantastic job for carers, and they have responded amazingly to difficult circumstances during the pandemic. Those services are commissioned by local authorities and integration authorities to provide advice and support for carers under the Carers Act 2018. The additional £28.5 million for local carers support in this year's budget brings the total carers act uplift in the local government settlement since the act took effect in 2018 to £68 million per year. We also fund the national carer organisations to help carers centres to share approaches and learn from each other. I can say to the chamber that, in designing the national care service, we will work with carers, people needing support and with the organisations that commission and provide care to ensure that the new service delivers the improvements that we want to see in people's lives. Unpaid carers have been struggling through lockdown and through the lack of respite because of other supports being withdrawn. Indeed, enable Scotland has heard from carers who have only managed to get any respite at all when they were hospitalised themselves. That is quite, frankly, shocking. Beyond one-words and carers week on respite, can the minister advise what has been done additionally in terms of additional respite hours for carers? Does he agree that we need a new comprehensive support strategy as outlined in Scottish Labour's carers manifesto, including a right to respite? I should say to the chamber that under protection levels, zero to three day centres and residential respite services can operate in line with the relevant guidance. I know that, in some areas, that is not happening as fast as others. I have written to local authorities and to health and social care partnerships in this past week to try to get things moving. Mr O'Cain can be assured that I will continue to do my level best to ensure that that day respite is there for carers. Beyond that, we are working with carer organisations and others on our forthcoming £1.4 million holiday voucher scheme to benefit carers, people with disabilities and families on low incomes. I am more than happy to have further discussions with Mr O'Cain on the issue, because, like him and many others in the chamber, we need to get back to some kind of normality and allow folk to get the break that many so desperately need. Question number six was not lodged. Question number seven, Christine Grahame. Christine Grahame, maybe try another concert? Maybe Christine Grahame tried the seat across the aisle from the one that she is currently at. I am being advised by the clerks. Oh, it is on. It is on. It is on. Come on. My apologies, Deputy Presiding Officer, and thank you for your tolerance. To ask the Scottish Government whether it will review the efficacy of both the NHS Covid-19 vaccination helpline and the missed appointment system. In the interests of brevity, yes, we will do that, of course. I would like to take this opportunity to thank everybody who is involved in the vaccination programme, including those that are often at the end of the helpline helpline. The helpline averages around 17,000 calls per day. They do an excellent job, but, yes, of course, we will continue to keep that helpline and the missed appointment system under review. Christine Grahame, I thank the cabinet secretary for his response. With reference to the vaccination programme, I understand that the cohort of 18 to 29-year-olds next to being vaccinated must be 18 by or on 17 May 21. Can I ask how those who attain 18 years after that date will be contacted for vaccination, especially as many of them will be returning to college and university? I thank Christine Grahame for an important question. For those 18 to 29-year-olds who are eligible to register on the online portal, you have till tomorrow to do so, so I urge as many of them as possible to do so. That will allow you to receive your appointment details by text or by email. In fact, a number of those appointments have already been, have gone out of the system. For those who have fallen to the cohort that Christine Grahame mentions, if you do not register on the portal, you will still get a letter, as you can imagine, so nobody in that cohort, 18 to 29-year-old, will be missed out. If you want to change the health board area for which, when you would like that appointment letter to go to, you can do that by calling the helpline. To ask the Scottish Government what its response is to the research led by Newcastle University and published in the Lancet into outcomes for arising from minimum unit pricing. Minister Marie Todd. I welcome the findings of the research led by Newcastle University, which conclude that minimum unit pricing is an effective policy option to reduce off-trade purchases of alcohol. That is consistent with findings from the comprehensive evaluation that Public Health Scotland is leading on. We have always believed that that policy would reduce alcohol sales and we have early encouraging signs that that is now feeding through to reduced harms. Alcohol specific deaths for 2019 were 10 per cent less than the previous year and notable reduction that has only happened on a handful of occasions since 1979. I understand that the member has been keen to see positive results from the introduction of minimum unit pricing and I trust that those findings are also welcomed by him. I can confirm to the minister that they are and obviously vindicate the decision of those of us who supported the policy from its inception. However, in the report there was one caveat that is a cause for concern reported in the Scotsman and elsewhere and that the exception to this was those in high purchasing low-income homes who did not seem to change their habits. One of the studies authors Professor Eileen Cainer from the university who is also director of applied research collaboration said that it was concern that households did not adjust their buying habits and spending simply increased as a result of the MUP policy. Now, that was always a concern. If low-income households have simply increased their spend on alcohol from fixed incomes, that is at the expense of other things and consequential considerable long-term harms. So I wonder what the response of the Scottish Government is to that and whether there is anything further that can be done and also whether in fact the Scottish Government intends to review the level of minimum unit pricing at some point in the near future. Minimum unit pricing targets those that drink the most and will impact on all income groups. Those that drink the most will spend the most on alcohol and this study showed that minimum unit pricing was well targeted at those who purchased the most alcohol. Low-income households are absolutely correct that they purchased high amounts of alcohol and did not seem to reduce the amount of alcohol that they purchased and their expenditure on alcohol increased. That was not the same for the next lowest income group. Obviously, low-income households that purchased only small amounts of alcohol did not increase their expenditure when the minimum unit pricing was introduced. There will be a thorough evaluation of minimum unit pricing. As we make a decision, as you know, there is a sunset clause in the legislation, so we will need to, we will only continue the legislation if the Parliament votes for it. I will confirm that we will be looking at the level of pricing for each unit between now and when that occurs. Thank you Minister. That concludes portfolio questions. I'll just give a moment's pause to allow time for the front bench to change seats.