 Felly, gynllun gynllun y yr ystod yw'r ystod iawn y gwynyn iawn, a ystod yw'r ystod iawn, yw Paul Sweeney. Felly, gynllun i'r ystod iawn i'r cyflwynoeth sy'n bwysig o'r cyflwynoedd i'r ffordd bach o'r rhan o'r ffordd ar gyflwynoedd ym maen nhw i'r sgolig ymddwyll i'r Unedig Nesaf. Rwyf wedi'n meddwl am welch i'r unedig a'r ystod iawn i'r ystod iawn i'r ystod iawn i'r inno one's interests least of all pupils, parents and carers who have already faced significant disruption over the past three years. It is disappointing that the unions have rejected the latest pay offer. Accepting the offer of 5 per cent would have meant that teachers received a cumulative pay increase of 21.8 per cent since 2018. This Government has a strong record of support for teachers and we are absolutely committed to supporting a fair pay offer through the Scottish Negotiating Committee's for Teachers, the body that negotiates teachers' pay and conditions of service. Paul Sweeney. The Cabinet Secretary will be well aware that teachers are not the only public sector workers forced to look to industrial action over pay and conditions. This year alone we have had cleansing and refuse workers to take industrial action, railway workers are still taking industrial action, healthcare workers look set to take industrial action for the first time in their history and now it looks like teachers will do the same. So when are this Government going to get their heads out of the stand, start treating workers in the public sector with some respect and pay them what they deserve to keep ahead of inflation? As the member will be well aware, this Government is absolutely committed to delivering a fair settlement for public sector workers. I think that that has been demonstrated in the work that is going on, particularly within the wider local government family. I would say to the member that the Scottish Government already has a fully committed budget. It has used its reserves in full to deliver the 2022-23 budget. There is no capacity to borrow to meet pay pressures and we are not permitted to raise taxes within year. As the Deputy First Minister has outlined to Parliament, there are a range of savings that have already been made to enable us to increase the pay offers to public sector workers and to mitigate the cost crisis, to fund any increased pay offer for teachers for their cuts that needs to be made to existing commitments. That work is on-going and I am determined to ensure that we have a good discussion and a fair and collaborative discussion with COSLA and with the unions as we take forward this in what is a very financially difficult and challenging time. To ask the Scottish Government what its response is regarding the impact in Midlothian South Tweeddale and Lauderdale to UK Government announcements regarding support for people facing poverty as a result of the rising cost of living and inflationary energy costs. Shona Robison Scotland is facing the most severe economic upheaval in a generation, significantly impacting people, businesses, public services and the third sector across our country. The Scottish Government has repeatedly urged the UK Government to focus its efforts on those most impacted, which did not happen in last week's budget, but instead has caused further economic chaos, which will lead to more people being in hardship. It is clear that the UK Government does not recognise the scale of the struggle for many households who are already facing a winter unable to afford essentials like food and heating their homes. Christine Grahame I thank the cabinet secretary for her answer. Since lodging my question, as the cabinet secretary has said, the pressures on my constituents have been compounded by the terrifying economic policies of those trusts. With the value of the pound plummeting, adding more costs to all imports, including food and interest rates skyrocketing. Does the minister therefore share my additional concerns now for my rural constituents who are already having prices higher than urban areas? Shona Robison Cabinet secretary. Christine Grahame Yes, I do. I met with the poverty commission this morning and it had people with lived experience from urban and rural Scotland. People are terrified, people are angry. We discussed the fact that felt like this UK Tory Government has effectively declared war on the poor with tax cuts for the rich, bankers' bonuses, inflation and interest rates impacting negatively on costs, going after people on universal credit who are already working and now massive cuts to the public sector budgets to pay for all of their mistakes of last week. We need powers, full powers, not just fiscal flexibilities to tackle poverty and protect people from the current cost of living crisis. I would not utter a word from those benches, by the way, given the state of the economy and what you are doing to poor people. I do not want to hear anything from those benches today about your people. Nothing, not a word, not a word. You do not have the right to come here and talk about poor people at all. It is outrageous. Christine Grahame is quite right to highlight what is happening to her rural constituents, but it is happening to everybody across this country, and particularly the poor, and they should be ashamed of themselves. Just remind members to speak through the chair at all times. 3. Neil Bibby To ask the Scottish Government when the Cabinet Secretary for Health and Social Care last met with NHS Greater Glasgow and Clyde and what issues were discussed. We last met on 26 September and we discussed matters of importance to the local population. I thank the cabinet secretary for his answer. The last time he visited the RAH in Paisley was in March this year, but, since the cabinet secretary's visit, things have gone from bad to worse, with even fewer patients being seen now within four hours at A&E. The sixth month's average, since his visit, is under 60 per cent. In March it was over 66 per cent. The NHS recovery plan clearly is not working, and nearly one in five beds have been cut at the hospital over the last 10 years. Staff have very serious concerns about services, and the patients they are caring for. What action will the cabinet secretary take directly for the RAH now to reverse this appalling decline and to ensure that people can access the healthcare that they need? Neil Bibby raises some very important points indeed. When I was at the RAH, I also met a number of staff representatives and staff themselves. I am grateful to staff at the RAH. Last week's published data at the RAH shows performance improving from the week before, which, of course, was not at acceptable levels at all. We recorded long, 12-hour waits that were significantly reduced from the week before, and eight-hour waits also significantly reduced. I am really grateful for staff for what they have done. I will come to this Parliament next week. I am scheduled to give detail of our winter plan, but we will continue to invest in staffing and greater Glasgow and Clyde. For example, there has been a significant increase in staff since last year, both registered staff but also healthcare support workers who are helping on the social care side where we know their significant pressure to. I will continue to engage with staff, continue to expand the workforce, and we have record levels of NHS staff working in our NHS under this Government and I will update Parliament fully next week. During Holyrood's health committee yesterday, Medical Director of the NHS Greater Glasgow and Clyde, Dr Jennifer Armstrong raised concerns with MSPs regarding significant impact on mental health and primary care services as more families are pushed into food and fuel poverty. Does the Cabinet Secretary share those concerns, and does he agree that the UK Government needs to use the economic levers at its disposal to protect households struggling to pay their bills and heat their homes, rather than leaving it to the Scottish healthcare system to pick up the pieces? Yes, I agree. I am not sure why there were some moans and groans from the Conservative benches. As Bill Kidd is rightly saying, it was raised by Dr Jennifer Armstrong. It is fair to say that this cost crisis—this economic vandalism from the UK Government—is a public health crisis. There is no doubt about it whatsoever. If people have to choose between heating and eating, either of those choices will leave them worse off in terms of their public health. Of course, this Government will step up and do what we can in relation to anti-poverty measures. We will look to mitigate as much as we possibly can, but we know that the meaningful levers, fiscal levers and economic levers, lie in the hand of a Government that, frankly, no one has seen. It is about time that it came out of hiding and did the right thing. To ask the Scottish Government how it will work in partnership with landlords in the social rented sector to keep rents as affordable as possible for tenants. We are engaging actively with landlords in the social rented sector as we develop our temporary emergency measures, as well as the safeguards that will come alongside. We continue to seek close partnership working with them to determine the best way forward from April 1 next year to support this important work. Officials convened the first meeting of a short-life task and finished working group earlier this week, bringing together leaders from across the sector. The group will continue to support consideration of the decisions that we and social landlords will take on rental affordability and related matters next year. I thank the minister for that answer. I have met with local housing associations and my constituents who have raised concerns over potential unintended consequences of any rent freeze in the sector from April 2023. In their site, there could be an impact on the ability to continue to invest in their core stock, including delivering net zero to meet pay demands, to be able to borrow and service borrowing, to take it out to help build new homes that we all want to see, as well as potentially undermine the statutory consultation processes for setting rents that social landlords are required to complete. What is the minister's view of those concerns? Does he agree with me that dialogue and partnership with the sector would be the best way forward? I do agree that dialogue and partnership is necessary. Both myself and the cabinet secretary have had repeated conversations with the social rented sector, and we absolutely understand the multiple pressures that Bob Doris has rightly highlighted. I can assure him and the sector that this Government is committed to continuing to work with social landlords on how our emergency measures develop and how they interact with our ambitious housing programmes. I want to stress that no decision has been taken about the use of emergency measures after the initial period that runs to 31 March, and any such decision will be informed both by the cost of living situation as it develops and by our on-going active engagement with the sector that is already under way. I agree with Bob Doris and the concerns that he has raised. I understand that this is a very difficult area, but we have very long waiting lists for people desperate for a social house. Is the minister fully understanding the consequence that the Kingdom Housing Association has raised with me just this week that the house building programme will be impacted potentially by this change? How is he going to address that? Obviously, some of those issues will be debated in more detail next week once the emergency legislation is published. I hope that not only Mr Rennie but other members and the social housing sector will recognise that we have taken an approach that balances all of those factors. The Scottish Government is fully committed to working with the social housing sector, both on housing supply and on the important transition to net zero as well as other areas where their investment is necessary. The context in the social and private rented sectors is different, and that will be reflected in the way that we engage with those sectors and make future decisions. To ask the Scottish Government what action it is taking to safeguard patients and staff within NHS Lanarkshire in light of reports of the NHS board returning its risk level to code black. Scotland's health board operates its own escalation policy for the management of whole system capacity. That includes well-established processes with locally agreed trigger points for maintaining a safe service and ensuring patient safety. The Scottish Government is in daily contact with NHS Lanarkshire to monitor the situation. They have an improvement plan in place, which again we are closely monitoring. I am grateful to the cabinet secretary for that reply. I know that he has fed up listening to me on this issue, but just to put it on record, the code black emergency in Lanarkshire has lasted a total of 260 days between last year, October last year and this year. This year alone it is 189 days. That means that there is no capacity, it is unsafe for patients and staff, and I am grateful that he has agreed we need an emergency summit. Can we get an update on when that is likely to take place and can I get an assurance that trade unions will be invited because emails that I get from Mr Downey about his wife Rosemary, who was admitted to hospital last week, but waited over 10 hours in A&E. She should have been sent by a consultant in December and does not have that appointment yet, but his concern is not only for his wife but also for the staff who are on their knees. Will the trade union be involved at that summit? I am not fed up at all from hearing from I know she's raised this issue on a number of occasions with me recently. She has every right to do so because I am extremely concerned about the situation. Of course, our national health service, given the pandemic pressures we're facing, but particularly in NHS Lanarkshire, where those pressures are significantly acute. To Monica Lennon, my office, if they haven't reached into her already, they will be reaching into her this week about possible dates for that meeting, I think that MSPs and MPs from across the political parties will be invited. I'll certainly consider whether that meeting is the most appropriate to invite trade unions to or if there should be a separate wider meeting because I meet regularly and engage regularly with our staff side trade unions and they are a key stakeholder in terms of getting Lanarkshire out of that highest level of escalation into a more sterier footing. Graham Simpson Thank you very much. In NHS Lanarkshire it's not just problems in A and E. We've got real problems with delayed discharges where the average weight is 33 days. GP practices are also suffering as well. There's one particular one in East Kilbride where patients just cannot get to see a GP, it's emergency only. That's not acceptable. Can I urge the cabinet secretary when he does hold this summit to make it more wider than just A and E because there are severe problems in Lanarkshire across the board? Graham Simpson The meeting isn't just about A and E and of course delayed discharges have an impact on A and E because of course the capacity issues affect flow which then have an impact on the front door of any of Lanarkshire's acute sites. The conversation, which again I'll make sure it's broadened out to MSPs and MPs of all political parties, will be on the whole system healthcare and social care. We'll continue to invest in NHS record levels of investment by the Scottish Government in our NHS and I have to say to Graham Simpson if he has any influence, which I suspect I do, but if he has any influence with the UK Government I would ask that he pleads with them not to take a hatchet to public services as they're threatening to do at the moment because of their economic vandalism of this country. Question number six, Sue Webber. Thank you, Presiding Officer. To ask the Scottish Government whether it will provide an update on the funding of extracurricular activities in schools. Cabinet Secretary, surely Anne Somerville. Decisions about extracurricular activities in schools are made locally and funded in a variety of different ways. For example, the Scottish Government has provided over £12 million this financial year to local authorities to support opportunities to be active before, during and after school through the Sports Scotland Active Schools programme. We have also provided £12 million this academic year in addition to the significant sums already being invested by local authorities in music so that learners can access free instrumental music tuition in schools. Sue Webber, I thank you for that answer. Last week it was reported that the £9 million funding for the Youth Music Initiative was to be cut with immediate effect. It was then reported that the funding was to be paused before finally being confirmed that it was secure. This flip-flopping caused legitimate concern and confusion since this funding is vital for our talented young people. Despite those concerns, the SNP refused to touch the £20 million that they have set aside for a referendum to feed their constitutional obsession. Can the Minister provide some much-needed clarity on the Scottish Government's plans for the funding of the Youth Music Initiative? £20 million often referred to us for next financial year, so if we are going to have a discussion about this year's budget, let's have a discussion about this year's budget. As was confirmed by the Minister for Culture on 15 September, the funding is secure, and Cater Scotland has issued contracts to delivery partners on 21 September. I agree with the member that the Youth Music Initiative plays a vitally important role in nurturing talents, and that is why I am pleased that it is being supported. Quite frankly, I will take no lessons from a Conservative on financial management, given the state of our economy, the state of the UK finances and the impact it will have on our public services right across Scotland, including education. To ask the Scottish Government what accountability mechanisms are available to communities who believe that they are receiving inadequate GP services. Cabinet Secretary, how much is it? As the member will be aware, GP practices are run by independent contractors. They must have arrangements in place that operate in accordance with section 15 of the Patient Rights Scotland Act. In the first instance, patients should raise their concerns with the GP practice manager. That allows concerns to be addressed at the level where they can be most easily remedied if they are not satisfied with that response. They can of course go to the SPSO for consideration. If patients have concerns about how their health board is providing GP services, they can raise a complaint through the NHS Complaints Handling Procedure. I thank the cabinet secretary for that answer. I have been inundated with concerns from constituents in Moffat and Lockerbay who are struggling to access GP appointments. They report that their frequently times when no GP is available to see anyone face to face, offering only telephone consultation and forcing people towards A and E. Myself and other local representatives, including the chair of Lockerbay community council, who is in the gallery today, have raised concerns with the health board, but they refuse to intervene. What can be done? I thank Oliver Mundell for raising that particular issue. Perhaps for the sake of brevity, I will take this offline and get more detail if Oliver Mundell is able to provide it. I will ensure that my officials are in touch with the NHS Dumfries and Galloway to discuss how it will be supporting the practice to improve patient experience. We expect people where it is clinically necessary that they should get that face-to-face appointment. It may be that they are not being seen directly by the GP because it is more appropriate for them to be seen by another member of the practice. Nonetheless, Oliver Mundell has raised some serious concerns. I will get more detail offline and revert back to him with what we can do to support his constituents.