 The first portfolio this afternoon is rural affairs and islands if a member wishes to request a supplementary question. They should press their request-to-speak button or enter the letters RTS in the chat function during the relevant question. Again, I would call for succinct questions and answers in order to be able to get in as many members as possible. I call question number one, Fiona Hyslop. と ask the Scottish Government what assessment it has made of the potential impact on Scotland's agriculture sector of the UK government's upcoming new regulations regarding meat exports. The Scottish Government's assessment is that the European Union's requirement for meat to come from farms subject to regular veterinary visits will effect mainly the non-farm-assured livestock sectors, but it's going to create bureaucracy across the industry that would have been unnecessary had the UK Government chosen a closer relationship with the EU based on shared standards. The vast majority of cattle, sheep and pigs produced in Scotland are farm assured. The Scottish Government is working with DEFRA to try and find a pragmatic solution that will allow farmers and the meat industry to continue exporting and minimise trade barriers. I have raised this issue with the UK Secretary of State to raise coffee to urge a speedy solution. The results of the quality meat Scotland's annual export survey underlines the importance of European markets to those who produce Scotland's world-class meat. The Scottish Association of Meat Wholesalers has been clear in its concerns that businesses and I quote, stand to lose millions of pounds of export business unless DEFRA relent. The UK Government has already forced Brexit on Scotland's farmers and producers. They should be looking to make things easier, not harder. In the engagement that she has had with the minister, has the Secretary of State had any other information as to whether DEFRA are likely to amend the problematic set of regulations? I am absolutely aware of the concerns that the industry has. They have contacted me directly about this and just to highlight how stark the situation is that they are facing. I fully agree with the member that it is the UK Government's approach to this and to withdraw from the EU that have caused these burdens for Scottish farmers and for Scottish businesses. As I said in my initial response, I have raised this issue with the Secretary of State to raise coffee at the interministerial group that we had just at the start of this week. The officials led by the chief veterinary officer are working with DEFRA to develop a workable solution. I hope that that is still possible. I think that it is also important to highlight at this point how proud we can be of our own Scottish producers. The vast majority of Scottish farms belong to an assurance scheme, such as with QMS, which the member has raised as well. It is quite right that we celebrate that too. We are right in the middle of Lamont Calf's store sale season right now, where prices are linked to what fat producers believe that longer-term values will be. The timing of this decision could be hugely damaging to hill and upland farmers, the very ones who need more support than any and I know firsthand the stresses that this will be causing and the impact that it could have. Can the cabinet secretary tell the chamber if she was given any notification of this change by DEFRA or the UK Government? If not, does she agree with me that on issues of such grave importance to our livestock and meat sector that they have a duty to consult the devolved legislators? In relation to the member's question about the consultation, from what I understand DEFRA had said that they engaged with stakeholders, but we certainly were not involved in any formal consultation in relation to this until the most recent discussions that had taken place with the chief veterinary officer. Given the impact of decisions like this, we should be involved in that decision making and should be consulted at as early a stage as possible. To ask the Scottish Government for an update on the action that the Scottish Government is taking to withhold farming payments from convicted criminals. There is no provision within the current legislation governing the basic payment scheme to recover or withhold payments to an individual business if they are meeting the scheme requirements. However, we are considering whether future changes to legislation could introduce provisions to withhold payments to those who may not be fit in proper persons. Russell Findlay Thank you. The cabinet secretary will probably be aware of the reason why I ask is that in July a farmer who was jailed for the sexual abuse of three children had been awarded almost £50,000 in subsidies by the SNP Government. At the time, a Government spokesman indicated that they were considering if the law could be changed. Block such payments in future has been repeated today, but weeks later, the daily record revealed that the same individual was given another £36,000. Can the cabinet secretary give any indication as to when that loophole might be closed? The member raises an important point here, but it is critical to highlight that we do not have the basic payment scheme and the powers over that are devolved, and we have the powers to change the eligibility at the moment. We can only do that where it would simplify or improve the existing rules. Within the current powers that we have and the legislation that we have in place at the moment, it is not possible for us to do that, but as no doubt the member will be aware, we have a consultation that is open right now on future legislation that we are looking to introduce to the Parliament. I very much hope that he will take part in that consultation and make his views on that known. Of course, we will give that consideration when we bring forward the legislation. To ask the Scottish Government what information it has on whether there are households that took on a pet during the Covid-19 pandemic and are now struggling to look after them in light of the cost of living crisis. The Scottish Government does not hold data relating to pets purchased during the pandemic, and its owners may now be facing difficulties with providing adequate care for their pets as a result of the crisis. The Scottish Society for the Prevention of Cruelty to Animals reports that the number of calls received from concerned pet owners has increased by 218 per cent compared to just last year. Concerned owners looking for help and advice can contact the Scottish SPCA in confidence via their helpline. I think that it is really important that, if they feel they need that help, they do so. The helpline number is 03999999, or they can also visit the Scottish SPCA's website to find out more about their pet aid scheme that can help pet owners with essential food supplies. I thank the cabinet secretary very much for that detailed answer. As she said, some of the figures are stark. I think that the Scottish SPCA reports that, in the whole of last year, there were 194 dogs taken into care, and in the first six months of this year, it has been around 700. Can she encourage or give advice to pet owners? Clearly, it is better if they do not have to hand over their animals to charities, but where else can they get food for their animals, for example, at food banks? I think that it is distressing to hear the figures that the member raises there. Of course, I think that it is really upsetting when anyone feels like they are in a position where they think that they have no other option than to give up a pet that, of course, is part of their family too. That is where I would just absolutely encourage anyone who is experiencing difficulties or think that they cannot cope or keep their animal to reach out for support, because there are people there who can help. I would like to specifically highlight the pet aid initiative that is being run by the Scottish SPCA to support people in pets who are struggling, because I recently met them in my constituency to hear more about the initiative, and that is through pet aid. They are supplying pet supplies and food through food banks and community larders. I know that they have it in a number of locations throughout Scotland at the moment, and they are also looking to expand that network further. The Scottish SPCA, of course, does not want people to be separated from their pets. It was really awful at the time when I met them to hear about some of the instances where people have been effectively starving themselves to try and feed their animals, and I do not think that that should be a choice that anyone has to make. The Scottish SPCA provides invaluable support and assistance, and, as I highlighted in my initial response, it can be contacted by phone or via their website. So, again, if anyone is struggling, I would encourage them to reach out and ask for that help and support. Thank you, Deputy Presiding Officer, and I would also like to highlight the work that Edinburgh Dog and Cat Home do in terms of providing support. During lockdown, increased demand for dog saw increased prices resulting in dog abductions surging and staggering 170 per cent, according to one charity. The current law does not do a good job of tackling the problem, the data is poor, the maximum punishment does not fit the crime and dogs are treated as objects instead of living beings. Does the cabinet secretary agree that we need much better options to tackle this heartless crime, such as my new dog abduction bill? That is where I appreciate the bill that the member is bringing forward, and I am, of course, more than happy to discuss that with him in more detail. We know that courts already will take into the kind of circumstances of any theft when they are sentencing, including if a loved family pet has been stolen. Of course, dogs and other pets are not the same as inanimate objects, and I know that when a theft of a pet occurs, it can, of course, cause significant upset to those involved. We know that microchipping is an effective method to identify animals, and that can help to reunite dogs with their owners where a dog has been lost or stolen. That Government made it compulsory for all dogs to be microchipped and for contact details to be kept up-to-date. I encourage all dog owners to ensure that their dogs are microchipped. I appreciate what the member is looking to do here. As I said, in the first part of my response, I am more than happy to consider those proposals when they come forward and to discuss that further with him. 4. Go Capsitute To ask the Scottish Government what its latest assessment is of the impact of Brexit on Scotland's food and drink sector. As a result of the UK Government's reckless approach to EU negotiations, Scotland's food and drink sector lost many of the benefits that it once had when trading with the EU. The full economic consequences of exiting the EU are still to be realised. However, businesses now face additional expense when trading, and some food producers have found that their goods can no longer be exported to the EU. Many of Scotland's food industries are still suffering from lower exports to the EU, including 52 per cent fall in exports of fruit and vegetables, and there has been a 25 per cent fall in exports of dairy and eggs in the first months of this year, compared to the same period in 2019. 4. Go Capsitute I am thankful for that answer. Dr Liz Cameron of the Scottish Chambers of Commerce recently stated that Scottish exporters are telling us that they continue to face growing challenges trading with countries in the EU post-Brexit. Given the absence of any meaningful effort to alleviate the impact on Scottish businesses of the UK Government's economically inept and ideologically driven Brexit policy, can I ask the cabinet secretary whether she thinks issues of competence or a thinly veiled contempt for Scotland drives UK Government decision making on those issues? It is really disappointing when we look at the series of decisions that have been taken and the catastrophic impact that they continue to have on Scotland and on our businesses, too. We can see that in the figures that I have outlined in relation to our exports, but we also continue to see the damage of that when we consider, for example, our workforce and the labour shortages that we are seeing right across our food and drink industry, as well as across many other sectors in Scotland. 5. Colin Smyth To ask the Scottish Government when it will publish the outcome of both the statutory review of SNARING and its additional review, which we consider a potential ban on SNARING in Scotland. We published the outcome of the statutory review on SNARING earlier this year on 1 April, and it can be found in the Scottish Government web pages. As Mr Smyth mentioned, I commissioned a review on the animal welfare aspects of SNARING and also the implications of a ban on SNARING and what that would do to land management activities in Scotland. I expect to be able to publish the findings of the review soon, including any decisions made regarding the future of SNARING in Scotland. Colin Smyth I thank the minister for that answer, although the recommendations of the review that was published in April seem to implement the recommendations of the previous review in 2017 that have not yet happened, so I do hope that they will be delivered this time. Can the minister give it a clear assurance that there should be any proposed legislative changes arising from the wider review of SNARING, which I hope is a full ban, while the timescale for publishing the review and any necessary consultation allow any proposed changes to be incorporated in the World Life Management Grills Bill, which is clearly the obvious place for them, rather than having to wait for separate legislation in the future? I am happy to confirm that, should my decision be that legislative changes needed as a result of the review, that will correlate with the wildlife bill and be included therein. NatureScot predicts that the Cappacale will become extinct in the next two to three decades, and the British Trust for Ornithology notes that the curly populations have been rapidly declining over the last two decades. Predation by species such as fox is one of the foremost challenges faced by these rare birds, so can I ask the minister how she intends to confront biodiversity loss and protect species such as the Cappacale and the Curlough, while her Government systematically dismantles the tools such as SNARING for ethical predictor control? I understand why, on the one hand, many people feel that SNARING is the instinctively feel that it is cruel. However, I also understand on the other hand that land managers require access to control methods for legitimate purposes, including conservation, as Rachel Hamilton said, is exactly those considerations. Why I commissioned the review, and as I said to Mr Smith, I will consider the outcome and publish it shortly. On 25 November 2021, in answer to my colleague Colin Smyth in his ministerial role, he indicated that the Scottish Government would extend the scope of the SNARING review to include a potential outright ban on SNARING in Scotland. Can I just double-check? Is that still on the cards? Yes, it is, Presiding Officer. The statutory review is one that is statutorily required to take place every five years, although I might be getting that number of years wrong. I commissioned that separate review that Christine Grahame refers to, which went beyond the statutory review terms and would look at the potential and the impacts of banning SNARING in Scotland. That is the review that I will hope to publish soon. To ask the Scottish Government what further financial support it will provide to our Gailan Bute to help tackle depopulation of rural areas and islands. Despite our capital allocations being significantly restrained as a result of the UK Government's own spending review, we continue to invest in our rural and island communities. This investment is provided through a range of programmes such as the affordable housing supply programme, our rural and island communities into action fund and our Gailan Bute growth deal. However, it is crucial that we acknowledge that the Scottish Government alone cannot tackle the critical challenge of depopulation. National Government, local government, third community and private sectors all have a role to play if we are to collectively tackle depopulation. The cabinet secretary will be aware that our Gailan Bute is indeed the second largest local authority by area in Scotland, but it is suffering from significant depopulation. While the population increased across Scotland, it decreased in the same time in our Gailan Bute, most notably by 34 per cent in the 25 to 44 age group. There are two infrastructure constraints. The first is the lack of a reliable service from ferries and the second is the on-going problem at the A83 at the rest and be thankful. In the latter case, can the cabinet secretary tell me when a medium and long-term solution will be found for the A83 and has the funding for that been identified in the budget? Those are questions that, of course, I would be happy to raise with the transport minister if the member hasn't already done that directly. However, I think that I would come back to the initial part of my response to the member in relation to the fact that we recognise that when it comes to the challenges of depopulation it's not something that we can fix alone. It also takes work on a variety of fronts to tackle the sheer scale of the challenges that we know we've got, whether that's transport infrastructure, digital infrastructure and addressing housing. However, I would also emphasise that I'm part of the ministerial task force that's looking at this. We're also going to be bringing forward a depopulation action plan, which I am leading on elements of that alongside my ministerial colleagues as well. We are intent on trying to tackle those issues and around all those problems, and doing what we can across the piece as well as across other parts of government too. I call by way of supplementary for supplementary Beatrice Wishart, but I do flag up to Ms Wishart what the question is actually about, which is what further financial support it will provide to Argyllyn Bute to help to tackle depopulation of rural areas and islands. In addition to Argyllyn Bute, other areas are experiencing population decline. In Shetland, we've seen infrastructure such as fixed links has proved positive in reversing depopulation, so what additional financial support can the Scottish Government provide island areas for tunnel or fixed link infrastructure to help to tackle depopulation? Thank you, Ms Wishart. Very deftly done. I do feel that it's always important to bring questions back to the actual supplementaries, back to the question on the business bulletin, but minister, Cabinet Secretary, I'll leave the next question for you yourself. I would again just highlight and come back to my first response to Jackie Baillie's question when I mentioned the significant capital restraints that we're facing in relation to our budget as well. Again, that's where working across government, working with the third sector, working with local government is really important in tackling all the issues that I know communities on our islands face. Representing Argyllyn Bute, it's important to recognise that the HIE's business panel survey noted that 53 per cent of businesses felt that workforce challenges were a perceived risk to their viability. Migration has a critical role to play in tackling population and workforce challenges, and sadly Labour is now actively engaging in a race to the bottom on immigration. Does the cabinet secretary agree with me that the need has never been clearer that Scotland must have its own immigration system to meet the needs of our rural and island communities, including Argyllyn Bute, to reflect our values and repair the damage of Brexit? Absolutely. Migration is a crucial part of the required approach to addressing our population challenges, and we know that the UK Government immigration policy does not reflect the needs of Scotland's rural communities. That is exactly why we have brought forward the rural visa pilot proposal. That is a bespoke approach, and it is not just something that we have developed and delivered ourselves. We have worked on that, and it has been supported by a range of partners, including through our local authorities. I know that Shetland's Islands Council, for example, has previously commented that it considers that to be an extremely important step when it comes to addressing the demographic challenges and skills shortages, which simply have to be among the most serious issues that are facing our economy. I know that members sitting around the chamber today will already be aware that the rural visa pilot proposal was endorsed by a clear majority in the Scottish Parliament during the parliamentary debate that we had on that topic in September. That is where I would strongly encourage the UK Government to be more receptive to the democratic will of this Parliament and to allow that proposal to go ahead. I refer members to my register of interest. Having attended the statement yesterday, I think that I know the answer to this question. To ask the Scottish Government whether it is proposed, new agriculture bill will be introduced before 2024. Cabinet Secretary, yes. Oh, well, that was predictable. Let's see if we can get a yes or no answer for this question then, Presiding Officer. The Cabinet Secretary yesterday failed miserably to answer my question on whether farmers were going to be any more aware of the conditionality of future farm sport. Cabinet Secretary, forever the optimist that I want to try again, can you confirm that all farmers will have access to all the agri support streams that replace the single farm payment and that they will not be excluded by their location or land type? Yes or no answer, Presiding Officer, would suit me. First of all, I would say that my initial response was only predictable again because you were here for the parliamentary statement yesterday, and I had already committed to introducing the agriculture bill to Parliament next year. Again, I would come back to the fact that what I outlined yesterday in relation to what we are bringing forward in 2025 is a rollover of the schemes that we have at the moment. Just to make crystal clear, we want the enhanced payment when that is introduced, and that is the first element of the new framework that we would be looking to introduce. That would be available for everyone, and that is why we are working with our stakeholders to produce the appropriate measures for that payment through our national test programme, testing actions for sustainable farming. We know that many farmers and crofters have already been leading the way, and it is only right and fair that that work is recognised, as I outlined yesterday. The enhanced payment will not only seek to recognise and reward those people who have been pioneering that work, but it will also aim to support and incentivise the continued efforts of others, too. That is where I would again strongly encourage all farmers and crofters to join the national test programme, which is testing the actions that could form part of that enhanced payment, to ensure that that is developed in a way that is accessible for everyone. Thank you. The cabinet secretary should be aware of the importance of livestock farming in Orkney and will also be aware of the growing concern about the fallen suckla cow numbers in the islands. What assurances therefore can she offer that the agriculture bill will actively support retaining the critical mass of the Orkney beef herd and help build desperately needed confidence within the wider farming sector in our islands? Well, the bill, as it has been put forward in the proposals within that that are currently out to consultation, includes powers to enable us to continue to support beef and sheep farmers, and that includes those farming in our most marginal land. We know that grazing livestock is absolutely vital for food production, but we also know that it is vital for our biodiversity and for various habitats and species, so that is why we are committed to providing that support. I would also like to take the opportunity to mention the agriculture bill consultation, but we will be extending that by another couple of weeks, so the consultation had been due to run until 21 November. It will now run until 5 December, and that is also specifically because we will be holding an in-person consultation event in Kirkwall on 28 November, but I will be happy to circulate further information of those events. Thank you, cabinet secretary. That concludes portfolio questions on rural affairs and islands. We will now turn to the next portfolio after a very short pause to allow front bench teams to change position. Thank you. The next portfolio is health and social care. If a member wishes to seek to ask a supplementary question, they should press the request-to-speak button during the relevant question or enter the letters RTS in the chat function during the relevant question. Again, I would ask for succinct questions and answers in order to get in as many members as possible. I call question number one, Gillian Martin. Thank you, Presiding Officer. To ask the Scottish Government how it is supporting the training of advanced clinical practitioners. Advanced clinical practitioner in the broadest sense is a term that can be applied in the context of a range of healthcare professionals. Those practitioners are able to take on expanded roles as a consequence of advanced educational achievement, which is reflected in the scope of this practice in Scotland. We now have an established advanced nursing practice education and training network that will be committed to training 500 additional advanced nurse practitioners by 2021, a target that was exceeded and made possible with £4 million Scottish Government funding to all regional NHS boards for trainee advanced nurse practitioners across all nursing fields and all settings, including acute community care homes and prisons too. Gillian Martin. Thank you, cabinet secretary, for that answer. I have largely answered my supplementary question and I just want to mention that I spoke to an ACP working in an A&E department who told me that with the training of more ACPs, the burden on consultants would be significantly reduced and A&E waiting times improved. Is the cabinet secretary minded to look at developing this particular strand of training and recruitment with those things in mind? I wanted to continue to invest in our advanced nurse practitioners and other advanced clinical practitioners. I was myself at A&E in Wishaw today and got to speak to an advanced nurse practitioner. It was very clear from the excellent work that he was doing that that freed up some time of, for example, some of the consultants, medical force and other nursing staff to be able to look at other cases. They are worth their weight in gold and more, I would suggest. Therefore, we will continue to make sure that we invest in advanced nurse and advanced clinical practitioners. I have a supplementary question from Carol Mocken, who is joining us online. Training advanced clinical professionals is vital to ensuring that the NHS develops and improves the level of care that it provides. Allied health professionals from across Scotland, including many of the nearly 100 who were in this Parliament last month, are seeing the pressures facing specialised NHS staff on a daily basis. HPs are our third largest workforce and their skills can and will improve patients' outcomes. Will the minister commit to listening to and working with HPs to ensure that they are supported and adequately resourced so that NHS service planning includes pathways for HPs to further develop advanced clinical roles, ensuring clinical leadership from HPs across the whole of health and social care? I agree with almost all of what Carol Mocken has to say. I think that our HPs play a tremendous role whether it is in our acute settings or indeed within community. I am committed to continuing to work with those professional bodies that represent our allied health professionals, continuing to invest in them and we are appropriate absolutely making sure that we invest in their further education and training. Just as a point that Gillian Martin rightly made, we know that, given the demands on the health service, the wider and broader way in which we can spread that workload, the better for everybody involved. I agree very much with Carol Mocken and I am happy to discuss this further with her offline if she wishes. To ask the Scottish Government what additional strain excessive alcohol consumption is having on the NHS. Excess alcohol consumption is an important public health challenge in Scotland. It contributes to an increasing risk of developing a number of conditions, including cancers, heart disease and stroke. In 2020-21, there were 35,124 alcohol-related hospital admissions in Scotland. That has decreased from previous years, although the Covid-19 lockdown measures are likely to have contributed to that. I thank the minister for the statistical update. After I wrote an article recently in Holyrood magazine about my own very personal family experience of alcohol, a constituent wrote to me with some on-the-ground feedback about what is actually happening in alcohol services. She said that the lack of societal responsibility for our national shame is clearly demonstrated through a lack of co-ordination of services. When there is no co-ordination, there is no responsibility. We should never have to beg to be cared for. It is humiliating. I simply ask why are so many people being let down at the moment by alcohol treatment services? Why are so many people not being treated? Why are so many people not being listened to? This experience, shared by my constituent, I am sure is shared by thousands across Scotland and it is simply not good enough. Alcohol and drug-related harms are vitally important public health issues in Scotland. That is why we established a national mission to improve and save lives. At the core of that mission is ensuring that every individual is able to access the treatment and recovery that they choose. We are working to ensure that people with alcohol use disorder continue to receive the same quality of care as those with problematic drug use do. The forthcoming alcohol treatment guidelines, which have been delayed multiple times—we are working with the UK Government—will provide support for alcohol treatment similar to the medication-assisted treatment standards for drugs. We are also developing alcohol treatment targets alongside stage 2 of the drugs target implementation in 2024. We are absolutely aware of the challenges facing the community in terms of accessing care. We are investing in residential rehabilitation. That will benefit people who are experiencing alcohol challenges as well as those with drug addiction. Alcohol absolutely remains a priority for the Scottish Government. Our alcohol and drugs teams work very closely together on those issues, sharing our knowledge around what works, on ways to reduce the impact of addiction and on routes through treatment. In the summer recess, I visited moving on inverclyde, which is a community-based service supporting people who are in recovery from addiction and supporting families who have lost a loved one to alcohol or drugs crucially, often contributing to the reduction of strain on our NHS. Inverclyde is one of five local authorities where alcohol-specific death rates have consistently remained above the Scottish average for the past five years. In response to those figures, Dr Alistair McGillchrist, chair of the Scottish Health Action on Alcohol Problems, has called on the Scottish Government to increase funding and resources for alcohol services. What additional support will be made available to ensure that people have access to life-changing and saving support that is often delivered in the third sector, particularly given the challenges that many charities are facing just to keep the lights on and the doors open with the cost of energy and resources? The first thing for me to say here is that every death from alcohol is an absolute tragedy. At the moment, we lose 24 people a week from direct alcohol-related deaths in Scotland. That is simply the tip of the iceberg because behind those statistics of direct alcohol deaths, there are also a number of deaths where alcohol is a factor, where cardiac deaths and accidents and all sorts of other deaths, cancer as well being a big issue. We are absolutely investing in addiction services as a whole because of the national drugs mission and we are determined to improve the situation for people who are facing alcohol-related harms. As I said in my answer to the previous questioner, we are awaiting national treatment guidelines, which we are working on on a four-nation basis. Once those are in place, we will be able to develop targets and we will be able to scrutinise what is happening on the ground and invest impactfully in areas where there are gaps to absolutely ensure that the situation improves. As well as the work to directly improve access to addiction care, we are working on a whole population basis to ensure that the long-standing and challenging relationship that we have with alcohol in Scotland is altered in future. One of the main flagship policies in that is minimum unit pricing of alcohol. The whole Parliament will be asked whether we continue that and if we continue it, what price we should set it at and if we should review that cost. However, there are a number of other policies in the pipeline, including alcohol advertising and a whole suite of policies that we are determined to use in order to tackle that long-standing blight on our national landscape. Scottish Government, what support is in place for people with long Covid? All NHS boards are providing support for people with long Covid across local primary care teams, community-based rehabilitation services and referrals for further investigation in secondary care settings. Of course, we are clinically appropriate. For example, in September, I was pleased to meet the multidisciplinary team responsible for NHS Lanarkshire's long Covid rehabilitation pathway, which covers the member's constituency. That is delivering a single point of access for assessment and coordinated support from services, including physiotherapy, occupational therapy, psychology and speech and language therapy, depending on what is, of course, most appropriate for the individual's needs. I thank the cabinet secretary for that response and for his response to my recent written question on the matter. I welcome the development of the centre in Lanarkshire. Over the last few months, I have been dealing with a constituent, Tracey McMillan, who has been in touch with her son, Jonathan. I know that Tracey has also been in touch with the cabinet secretary direct. Jonathan is in the third year of suffering from long Covid and has been bed bound for over a year. As such a tragic set of circumstances, she should be attending sixth year of high school, applying for university and having fun, but instead she cannot get out of bed most of the time. His parents have found it extremely difficult to get any support through the NHS or to get a diagnosis. They found that primary caregivers have no one to refer them to and the family have had to turn to private providers, where he has recently been diagnosed with mass cell activation syndrome, which is common in long Covid, and symptoms can hopefully be treated at a considerable cost. I therefore ask the cabinet secretary if the Government is undertaking any meaningful research into long Covid and when will multidisciplinary teams of knowledgeable healthcare professionals be established to help people like Jonathan with diagnosis and medical intervention? I thank Fulton MacGregor for raising Jonathan's case in Parliament. I have met Tracy in June, a constituent of Fulton MacGregor, and I know from speaking to her just how challenging the symptoms are and what a detrimental impact they have on her son Jonathan. I have also written to Jonathan my understanding that he has been offered NHS support through the pathway that I referred to in my previous answer to Fulton MacGregor. In terms of the specific question on mass cell activation syndrome and research, the Scottish Government has worked with a range of specialists, including immunologists, to develop an implementation support note that provides practical information for clinicians on the identification, assessment and management of the long-term effects of Covid-19. That includes information on mass cell activation syndrome. We have funded nine Scottish-led research projects and long-term effects of Covid-19 with a total funding commitment of £2.5 million. The studies aim to improve our understanding of the long-term effects of Covid-19 on physical and mental health in Scotland and inform the clinical interventions to support recovery and rehabilitation. While none of the projects focus specifically on mass cell activation syndrome, our chief scientist office research funding schemes are open, and applications on the syndrome are indeed welcome. Applications would go through the CSO's standard independent expert review process to allow funding decisions to be made. In October 2021, 90,000 Scots were suffering with long Covid. In May 2022, the Scottish Government announced £3 million from its long Covid fund to be allocated in 2022. The number of Scots with long Covid is now 200,000. That is more than the population of Aberdeen. My question is how much of that £3 million has been allocated and specifically for what purposes. Does the cabinet secretary accept the number of long Covid cases in Scotland to continue to balloon like over the 12 months previously? In terms of the specifics, I will write to Dr Sandish Gulhani with the detail not only of how much has been allocated but of how much has been allocated per health board if you would find that useful. Indeed, we can give him some detail of each of those projects as well. He will know that that is a £10 million commitment over three financial years. However, the important point to make here is that there is no doubt that there has been a rise in those who are suffering the long-term effects of Covid. We have seen that in the Scottish Health Survey and the O&S Survey data that comes forward too. Therefore, I would expect health boards to readjust their spending in light of where there are additional demands. He will know that there is exceptional pressure on our health budget. In fact, my health budget is worth £650 million less than when it was set in December just down to inflation repressures. Of course, those are difficult financial circumstances, but where we have an increase in demand, as we have seen with long Covid, I would expect health boards to adjust their spending appropriately. Long Covid Scotland published a harrowing report last week, revealing that only one person out of the hundreds that replied had fully recovered, and relapses were common in four out of five experiencing symptoms. Those are not just statistics, we are talking about our friends, our families and our neighbours. Let me come back to money, because when you announced the £3 million for long Covid services, 79,000 people were diagnosed with long Covid. According to the O&S, a year later, that has increased to 202,000 people, a staggering 155 per cent increase. Rather than leaving cash-strapped health boards to pick up the slack, will the cabinet secretary increase the budget to meet that significant additional demand? As I have said to Dr Sandra Cohan in my previous answer, of course, wherever there are demands or increases in demands, we expect health boards to readjust their spending accordingly. We would expect them to do so. What I would say to Jackie Baillie, and I think that she is quite aware of this, is that I have had to reprofile £400 million worth of funding in order to make sure that we deal with the inflationary pressures that have impacted on our budget, and also to make sure that our NHS staff get a fair pay deal. I think that she has stood up in this chamber, certainly publicly. She has criticised some of that reprofiling for mental health, social care and primary care. All really, really difficult decisions are not ones that I took any pleasure in making or taking, but having to do so because we live within a finite budget. So, if Ms Baillie has an idea of where else we should reprofile money for, to put it into, for example, long Covid, then of course I am more than happy to have that discussion with her above table. Question number four, Alex Rowley. Presiding Officer, to ask the Scottish Government, in light of the reported present staffing crisis, how will it adequately staff for the proposed national treatment centres? Committed to recruiting 1,500 additional staff in this Parliament to work across our national treatment centres, the Scottish Government is providing a range of recruitment support, training and development activity to assist health boards with securing the right mix of new and experienced staff. That includes additional funding to support international recruitment, provide additional postgraduate speciality training, places in medicine, funding training opportunities through the NHS academy, including training for new perioperative staff and actively considering future staffing needs as part of that on-going workforce planning activity. We have also taken action to support retention of experienced staff and to develop new pathways into NHS Scotland careers. Alex Rowley. Presiding Officer, the Cabinet Secretary says that he is committed to putting 1,500 additional staff in. You might want to see how that is going. Can you also set out a timetable? In recent weeks and months I have met staff at a local level in Fife and across the region, I have met the local trade unions and they asked this question. Is there not also a need for greater transparency, although people acknowledge the difficulties that have happened and that the NHS is under? They have to have confidence that the Government is on top of that. If the very staff that are working on the front line do not have that confidence, then how can you expect anyone else to have it? I speak to staff regularly—in fact, I was doing so today during a visit to Lanarkshire, to be sure, as A&E department. What I would say to Alex Rowley is that this Government has got a really proud record in terms of our NHS staffing. Growing that staffing, of course, we have NHS staffing at record levels. What we have committed to do next year is when it comes to our regular stats, we will publish the detail of how the recruitment is going for the NTCs. I will again just state that commitment that we are talking about 1,500 additional staff for our national treatment centres in terms of the information that I have to hand. I can say, from my discussions with the local health board, that the recruitment for the Fife national treatment centre is going well and very much on track for its opening next year. The 10 national treatment centres should deliver at least 40,000 additional elective surgeries and procedures a year by 2026. Luke Farrow, an orthopedic surgeon and research fellow at the University of Aberdeen, told BBC Scotland that getting the treatment centres online is an absolute priority every week the backlog gets worse. Mr Farrow also stated that there must be planning to ensure that the 1,500 staff for the national treatment centres are not taken from elsewhere in the NHS, which would merely serve to worsen wider recruitment issues. The treatment centre in Livingston for NHS Lothian will need 400 staff, but NHS Lothian has warned that there are significant risks and challenges around this level of hiring. Can the cabinet secretary confirm that none of the 1,500 staff that is required for the national treatment centres will be taken from within the current NHS staff? I said to Alex Rowley that we expect the 1,500 staff to be additional staff. It is worth noting that commitment to recruit 1,500 additional staff equates to less than 1 per cent of the total NHS workforce. The risk of destabilisation is therefore slim, although, of course, we will engage with boards, as we would do with Lothian in order to monitor any local challenges, and there are challenges. There are areas where we look at the recruitment of staff, where there are significant challenges, not just in urban settings such as our NTC in Edinburgh, but of course in our remote and rural communities in particular. We will have that regular engagement, but I think that I can give a firm commitment that, when we are talking about additional staff, secondly, the risk of destabilisation is very slim indeed. Boasting about recruitment track records and talking about the current crisis has been a challenge, I think that it underestimates the real crisis that we have got in our NHS. Just this week, we have heard about the astonishing weights at ANEs. Just this week, we have heard about the crisis in our mental health services, but the minister talks as if he is managing the system well. When is he going to get real about the crisis in the NHS? When is he going to sort it out? That was another Willie Rennie intervention full of constructive ideas, solutions and suggestions. What I would say to Willie Rennie is that nobody underestimates, not me and the Government, the challenge that the NHS is under. That is why I spend every single waking moment trying to do our best to resolve some of the issues that we are facing, not just in the NHS but also in social care. That is why the Government has invested record funding into our NHS and social care. We have record staffing in our NHS. That is not a boast. That is simply to demonstrate that we are taking action in order to help our NHS at the period of difficulty real challenge. That challenge is only going to increase, we know, over the course of winter. If Willie Rennie does have any constructive suggestions in terms of shaking his head to say, no, he does not, but if he does, I am more than happy to sit down with him and have that discussion off-table. In light of Keir Stammer's truly irresponsible comments on reducing migrant workers in the NHS, how can the Scottish Government ensure that Scotland attracts the finest talent from overseas to address the immediate staffing shortages in our health service? I would agree with Stephanie Callan. I thought Keir Stammer's comments on overseas workers was inflammatory. I think that it has no place in Scotland. Our NHS family should be proud of the fact that it is diverse. We have people from all across the world who choose to work within our NHS. They come here and they provide excellent care to those in need, whether they are nurses, doctors, cleaners, admin staff, porters or anybody in between whatever their role. Whether you have been in Scotland for 20 years or for just a couple of weeks, not only is Scotland your home, but we are proud to have you as part of the NHS family. The Labour Party, instead of chunking from the sidelines, should care less about the front pages of certain right-wing newspapers and do like we do in the Scottish Government and care more about the front line of our NHS. To ask the Scottish Government whether it can provide an update on the steps that it is taking to encourage more GPs to work in rural practices. We are fully committed to ensuring that all communities in Scotland receive safe, reliable and sustainable healthcare services, including in general practice. The Scottish Government does offer a wide range of initiatives specifically to extract GPs to rural areas. Those include golden hellos and bursaries for newly qualified GPs to take up posts in hard-to-fill rural locations. I would add that our new SCOTGEM programme, our graduate entry medicine programme, focuses on general practice, and rural working is proving very popular. It had its first cohort of 44 students graduating earlier in June of this year from Dundee in St Andrews University. The current recruitment strategies are clearly not working. In the rural area, I represent, GP practices have had to close as they were unable to recruit more GPs. Other practices have stepped in, but they too are struggling due to recruitment issues and are having to rely on expensive local GPs. That situation is replicated across rural areas throughout Scotland. I want to ask the cabinet secretary not to repeat previous answers as we need something different. What more is the Scottish Government doing now to address rural GP recruitment issues, what incentives are there for doctors to specialise in general practice, and how many additional places will be made available at Scottish universities to help to fulfil future vacancies? We have a commitment in our manifesto to increase medical graduate places by 100 per year, and we are fulfilling that commitment. We are doing something very tangible, but it is so important that we are able to ensure that a percentage of those individuals graduating end up in general practice. Our GP ST Bursary has been a phenomenal success. It is contributing towards 800 more GPs in Scotland that target that we have set between 2017 and in an effort to make GP training a more attractive career option. Scotland offers a one-off taxable bursary of £20,000 for GP STs and the criteria of being post in locations that are historically hard to fill. Notwithstanding that and what I have already said in terms of what we are doing, I do recognise the points that Shanadiwy and others have made. We are very actively and proactively looking to recruit from other parts of the UK. She may well have seen that we have a marketing campaign where Scotland is an attractive destination to work for GPs and other medical staff to come to Scotland to set up a life here and to work here. In fact, in the latest round of that marketing campaign, our team attended the joint RCGP Wonka Europe event held at the Exile Arena in London. It made over 80 contacts with delegates who shared with them a desire to come and work here in Scotland either now or in the future. We are straining everything new possible. We have a number of incentivisation programmes in place, but it will be hard graft and hard work that I am convinced that we can continue to do that will ensure that we have as many GPs coming to train here, to work here, build a family here and I am happy if there are specific instances that any members wish me to look at that I am happy to do so. It is not just rural areas struggling to fill vacancies but also island posts. What can the cabinet secretary say to a local doctor promoting a GP role in the community of Hillswick when a BMA Scotland survey finding that there is nearly 50 per cent of junior doctors are considering leaving the profession and squaring that with the 2007 SNP manifesto commitment to encourage people to train in rural medicine and commit to working in rural areas? It is important that we do not lose sight of the impact that I am afraid interventions like Brexit have had. I know that that is particularly relevant to islands such as Shetland where I know quite a considerable number of doctors and medical staff were from Europe, notwithstanding that, of course, because that has been taken forward full-scale by the UK Government. I will not reiterate and repeat what I have already said in relation to the incentivisation schemes that we have in place, but I am happy to discuss those issues with Beatrice Wishart if she thinks there is more that we can do, particularly for our island communities. However, my dialogue with Shetland, with Orkney, with our colleagues in Western Isles and the Highlands and Islands is one that continues with regularity. I welcome the steps that are being taken so far, but can the cabinet secretary expand on the challenges that are faced in recruiting GPs from overseas, which, if overcome, could help with the GP numbers in rural areas and the Highlands and Islands? It is an important question from Jackie Dunbar. It is a source of quite constant frustration, I think, for most Government ministers that the immigration system that the UK Government currently has just does not meet the needs. Neither of those living here in Scotland, but I suspect that it is doing damage to the profession in England as well as the wider UK too. I have raised the issue and intend to do so again around the Home Office immigration rules. We know that they have particular issues in relation to tier 2 visas that are impacting on international medical graduates working in the UK post-GP training. They are often left in a position of potentially being in the country illegally if they cannot find a sponsor within a few weeks of completing their training and they are unable to apply for indefinite leave to remain. Something has to change. I will be writing and intervening again on this issue with the Home Office, seeking a meeting on this important issue. While the Scottish Government will continue to press the UK Government on these issues at every available opportunity, my officials are also working with stakeholders to pull together some of the best practice guidance to assist practices who wish to become sponsors to enable these highly skilled professionals to continue their careers in the NHS in Scotland. Thank you, cabinet secretary. That concludes portfolio questions on health and social care. There will be a very short pause before we move on to the next item of business.