 The next item of business is consideration of business motion 9246 in the name of George Adam on behalf of the parliamentary bureau on a change to today's business. Any member who wishes to speak against the motion should press their request to speak button now. I call on George Adam to move the motion. Thank you, Presiding Officer, and moved. Thank you, Minister. No member has asked to speak against the motion. Therefore, the question is the motion 9246 be agreed. Are we all agreed? The motion is therefore agreed. Before we move to the next item of business, I invite members to join me in welcoming to the gallery the Honourable Mark Monahan, MLA, Speaker of the Legislative Assembly of the Northern Territory. The next item of business is topical questions. At question number one, I call Edward Mountain. To ask the Scottish Government what its position is on whether orthopedic appointments and surgeries when they do not require the use of general anaesthetic should be carried out in community hospitals. Cabinet Secretary, Michael Matheson. Presiding Officer, health boards will always try and offer patients appointments in their local area. However, patients may be offered an appointment at a different location such as a national treatment centre to ensure that they are seen as quickly as possible. Treatment decisions are made by clinicians taking into account the patient's treatment needs and ability to travel. Estate availability and staffing are key considerations for health boards to maximise the number of patients seen. Boards may try to protect theatres for artheoplasty procedures, require anaesthetic or spinal blocks and undertake local anaesthetic cases in community hospitals, treatment rooms and day theatres. Edward Mountain. Thank you, Presiding Officer, and I thank the Cabinet Secretary for that answer. The National Treatment Centre is a great addition to the Highlands, and we all appreciate it up there. However, patients in Cathness welcomed orthopedic surgeons travelling to Cathness General, for example, to carry out lists and minor surgeries and to review cases, which meant that they didn't have to travel all the way to Regmore, which could take two hours. The clinic surgeon could carry out a series of, say, 40 case reviews on his list over a period of two days. Surely that's good use of their time and national health resources? I recognise the concerns that Mr Mountain has raised. As he acknowledges, the National Treatment Centre in the Highlands at Regmore will offer significant additional capacity for elective procedures in the Highlands area. I also recognise the need to try to minimise the need for patients to travel excessive distances within the Highlands, in particular, where they have longer enduring painful conditions or whether they are going through ongoing treatment. I want to encourage NHS Highlands to look at how it can minimise the need for patients to travel to Regmore where possible and if there is scope for further procedures to be undertaken at Cathness General Hospital, including review visits where possible. However, I am also conscious that not all of that work requires orthopedic surgeons. Some of that can be carried out by MSK physiotherapists, by advanced ortho-practitioners that specialise in orthopedics, all of which could contribute to helping to reduce the need for patients to travel to centres such as Regmore. I welcome that answer from the Cabinet Secretary, but my issue is, in relation to patients in remote rural areas, that being able to see an orthopedic surgeon is extremely useful, especially when their case is being reviewed, say, after an operation. My constituents are concerned that, having heard that NHS Highland will have to reduce its budget by £60 million, that this is one of the outcomes of it. Can I ask the Cabinet Secretary to urge NHS Highland to speak more fully with the orthopedic department to make sure that they are taken along with NHS Highlands plans? I would expect the health board to look at how they can maximise the benefits that they get from the existing clinical group that they have within their orthopedic department at the present moment, and how they can utilise their skills to the best of their ability in order to meet the needs of those who require orthopedic procedures within NHS Highland area. Will that be treatment that is being carried out at the national treatment centre at Regmore, or whether it be procedures that can be carried out in district general hospitals? I would certainly want to encourage them to do so, and I will certainly make sure that I raise this issue with the board in order to encourage them to look at what further action they can take in order to address the concerns that have been raised by Mr Mountain. The Government is quick to point to the national treatment centre that opened in Fife back in May, but people are still languishing on orthopedic waiting lists. Does the cabinet secretary accept that his predecessor failed to deliver an end to the two-year orthopedic surgery waiting times, and can he confirm how many orthopedic surgeries have been carried out this year so far and whether the new national treatment centre will meet its target? Mr Sweeney recognises that we have gone through a pandemic, which has a significant impact on capacity within our NHS, which has resulted in many elective procedures having to be cancelled or reduced significantly, which has resulted in a significant backlog. The NHS in Scotland is facing the same challenges as it has faced across the rest of the UK and globally to some extent healthcare systems where we are having to work our way through those significant backlogs. We have made steady progress in reducing those backlogs, particularly those who have had the longest waits. We are seeing capacity increasing across our territorial health boards. We are additionally adding to that capacity through the creation of the national treatment centres, which have already started to open, which are providing additional capability and capacity, and that will help us in helping to reduce the overall waits that people have to wait. I do not want anyone to wait for a procedure longer than they have to, but we also have to acknowledge that a very significant disruption has been to the NHS over the course of the last two years, and it will take some time in order to reduce those backlogs, but we are doing everything that we can to increase capacity and to reduce those waits as much as we can. To ask the Scottish Government what advice and support it can provide to parents and carers who are struggling to afford nappies and infant feeds in light of recent reports regarding nappie needs, difficulties in accessing baby formula at food banks and families with young children being forced to cut back on essentials. Tackling poverty and protecting people from harm is one of the Scottish Government's three critical missions, and the Scottish Government is working closely with national and local partners to understand the scale and nature of infant and maternal food insecurity to support longer-term responses. It is crucial to make sure that people get the right help where and when they need it, and I would encourage anyone in need to get advice from a range of services or to speak to their midwives, health visitors or family nurses who can provide appropriate guidance on any money worries and help families with infants to get prompt access to appropriate nutritional support during this cost of living crisis. I would always encourage everyone eligible to apply for the Scottish Government benefits that they may be entitled to, including best start foods, best start grants and, of course, the Scottish Child payment. The Scottish Government recognises the pressure on household budgets, which is why, last year and this year, we have allocated almost £3 billion to support policies that tackle poverty and protect people as far as possible during the on-going cost of living crisis. I thank the Cabinet Secretary for her response, and I know she shares my concerns about some of the heartbreaking findings that were in the Sunday post at the weekend in their special investigation, including the findings of the Joseph Rowntree Foundation survey. There was a lot in that investigation that I want to pick up on this issue of baby formula and the perceived rules around the UNICEF guidelines. Mums have been turned away from food banks. It is not the fault of the food bank volunteers and charities, but mums have been left in tears because of the interpretation of these guidelines. Dr Ruth Bland has warned that the effect of watering down formula to make it last longer will very quickly have a negative impact on babies' health. We know that children are going without the nutrition that they need. What work can Government do to work with a range of partners, including food bank charities, to make sure that those who are asking for baby formula can access it when they need it? I thank Monica Lennon for raising this very important issue, and I also pay tribute to the Sunday post for the very concerning aspects that she highlighted at the weekend. The UNICEF guidance recognises that, in certain circumstances, where there is no immediate alternative, food banks can make use of crisis funding to support families to purchase the right supply. The main point that UNICEF makes, and we agree with it on this, is that food banks and anyone else supporting a family in desperate need should refer them to a local authority or a health professional who can ensure that they are getting holistic support, including financial advice. I would also highlight the work that has been done, for example, on the parent club website, to provide parents with information on how to safely make up baby formula. Monica Lennon is, again, quite right to point to the dangers of watering down formula. The information on the parent club website sets out that all first formula is required to meet the same nutritional standard and makes the point that price does not equate to a better product. We encourage everyone to seek advice from a health visitor, a midwife, a family nurse to ensure that they are getting the widest support possible that they can during these difficult times. The first formula is to feed the UK, which is found by Dr Erin Williams, who is saying that many food banks do not supply baby formula because they wrongly believe that it is illegal to do so, and that is not the case. We need to get that message out. I want to turn to the issue of nappy needs. I recently asked the long-time nappy runs in a small charity in Edinburgh, and they supply thousands of nappies every week for families in need. When I was there, a health visitor had popped in to collect nappies for a young mum and her baby who are in poverty. Toy and Weir, who run into charity, fears that mums and children are becoming socially isolated because they cannot afford all the changes that their baby needs, so they are rationing nappies, words I never thought I would say in 2023. I've asked the Government before, but I'll ask again what work is being done to address this issue of hidden nappy needs and what support is available for charities like nappy runs and nappy libraries to provide support for families who need it. A very important point raised by Monica Lennon and myself and my fellow minister, Ms Minto, who is here with me today, would be happy to ensure that we are doing everything right across government that we can to work both with food banks, food bank networks and others so that there is a shared understanding of the UNICEF guidance and what more we can do on that issue. We need to ensure that we are doing everything that we can to look very carefully at the issue of nappies and nappy rationing. I agree absolutely with Monica Lennon that it does bigger belief that we are talking about that today within Scotland. There is, as I said in my previous answers, a degree of support that has been given both within the health service but also within wider advice services around the issue, but I am always happy to work with Ms Lennon as I hope she knows on this and other issues to see if there is more that can be done and I include my fellow ministers in that as well. Emma Harper There is no doubt that soaring prices of essential products are exacerbating the already challenging circumstances faced by parents as Monica Lennon has just highlighted, particularly those people on low incomes. What additional action is the Scottish Government taking within its limited powers and budget to support people during this cost of living crisis and what more does the cabinet secretary consider that the UK Government should be doing to help as well? I will point to one aspect that the Scottish Government is doing, and that is our five family payments, which include the Scottish child payment, best start foods and the three best start payments, which could be worth up to £10,000 by the time an eligible child turns six. I have recently announced that we will be changing the regulations to remove the income thresholds from best start foods, so around 20,000 additional pregnant mums and children under three will be able to benefit from February 24. I would also highlight information, however, that has come out today that the Scottish Government in 2324 made £83.7 million available to local authorities to spend on discretionary housing payments to mitigate the bedroom tax to ensure that we are protecting families from the other damaging impacts of UK Government welfare cuts, including the low rate of local housing allowance and the benefit cap. That is £83.7 million that we could be using on further anti-poverty measures if we were not mitigating against other aspects of the UK welfare system.