 The next item of business is a statement by Humza Yousaf on NHS winter pressures. The Cabinet Secretary will take questions at the end of his statement, and so there should be no interventions or interruptions. I call on Humza Yousaf up to 20 minutes, Cabinet Secretary. Thank you, Presiding Officer. I wish to update the Parliament on the extraordinary pressures facing our national health service this winter and the measures that the Scottish Government is taking to address them. Let me begin by stating a simple fact that this is the single most challenging winter that the NHS in Scotland has ever faced. Our NHS, its committed workforce, is facing a perfect storm of intense pressures, which are leading to extreme difficulty disruption and delays right across the service. This especially challenging time for the NHS will continue, we suspect, for the coming weeks. As I have said previously, the full recovery of our NHS is not something that will take weeks nor months, but it will take years. Let me once again take this opportunity to thank our incredible NHS and social care staff for continuing to provide exceptional care under what is the most difficult of circumstances. Our entire health and social care system is facing the continuing impacts of the pandemic, the biggest challenge that our NHS is facing in its 74-year existence. Covid remains a pressure on our health system, with most recent statistics showing that Covid cases are now at their highest levels since the summer. In the week ending 1 January, there were over 1,200 patients in hospital with Covid-19, a 15 per cent increase from the week ending on Christmas day, and double the number of patients from four weeks ago when there were over 600 Covid patients. Recent flu admissions were also around three times higher than emergency admissions due to Covid, and there have been rising cases of Strep A and other respiratory viruses. Challenges around delayed discharge of patients also continues to have an impact in driving up A and E waiting times, and overall pressures on the health system are significant. Last week, latest management information showed that hospital bed occupancy across Scotland was over 95 per cent. Some sense of the intense pressure being felt can also be seen in the almost 100,000 calls to NHS 24 over the two four-day breaks of the festive period, the highest festive period demand for over a decade. Traffic to the NHS Inform website and the symptom checkers in December was at its highest level ever, with 12.7 million page views. The impact on the ambulance service has also been significant. It dealt with over 16,000 emergency incidents last week, 11 per cent more than the average of the previous four weeks. Although that highlights the significant levels of demand that we face, it also profiles the innovative ways that we are seeking to tackle this issue, providing effective triage and supporting hospitals and social care settings. The challenge is significant. Those seasonal pressures come against the backdrop of the UK Government's mishandling of Brexit and the nation's finances, with such dire consequences for Scotland's social care sector in particular. Although fully acknowledging the multiple difficulties that we are facing, this Government is determined to continue taking action to alleviate some of the pressure in our NHS and social care. I am convinced that we should pursue a whole systems approach to tackling these issues and to support from all parts of the Government, the NHS and social care through the critical coming months. Last Friday, the First Minister shared a meeting of the Scottish Government's resilience room score to determine the next steps in addressing the unprecedented pressures across the NHS. As well as ministers, the meeting was attended by senior representatives from COSLA, the NHS, integrated joint boards and the Scottish Ambulance Service. It reviewed the number of measures being taken to alleviate pressures on the system. Those include the use of flow navigation centres as part of the redesign of urgent care, the hospital at home service and ambulance service staff providing treatment where appropriate to help avoid hospital admission. Additional actions will now be rolled out across the health and social care system, and I can today outline a further course of action to unlock additional capacity to alleviate the pressure of delayed discharge on the system. As I have mentioned, delayed discharges and their impacts on patients continue to be a significant issue. It has not only been exacerbated by increases in staff absences due to self-isolation requirements and sickness, but the number of care home places has been impacted by care home closures too. There is no doubting that high inflation and high energy costs have significantly impacted a sector that was already facing multiple challenges. I know that teams across the country are working exceptionally hard to ensure that people are receiving the right care in the right setting. However, the fact is that at present there are more than 1,700 people currently in hospital who do not need to be there for clinical reasons and whose interests are not best served by being there because care packages that would allow them to be discharged home or to a care home are simply not in place. As an additional and exceptional measure, COSLA and the Scottish Government have worked with partners across the care home sector to identify additional interim spaces within care homes to help to provide additional pathways for people to be discharged from hospital in a timely and safe fashion. To support health and social care partnerships, secure the extra provision. We are making funding of £8 million available, so beds can be purchased at an additional 25 per cent above the national care home contract rate. We will work closely with partners across the NHS health and social care partnerships and local authorities to ensure appropriate use of funds and evidence of the impact that this funding has. That is an extremist time-limited measure that is required to help us with the current capacity issues that we face. The additional funding is intended to meet the increased costs of utilising those beds for a short period of time. With partners working collaboratively, we have managed to identify around 300 interim beds that are available. That is in addition to the 600 interim beds that are already helping patients in the system. That support is intended to be used as an additional tool that health and social care partnerships can deploy to support during the current situation and allowing additional flexibility to maximise capacity within our hospitals. We will work with partners to utilise every bed possible. Those interim beds may not be a family's first or second choice for their relative, but I hope that families agree that in the current circumstances this is about making the best possible choice for those in our care. That measure will only be in place for a limited period of time to directly support our hospitals to deal with pressures at the front door. However, it will enable some people to move from an acute setting to a more appropriate community one. It will recognise the risk of prolonged stays in hospitals. In addition to responding to the pressures, a ministerial advisory group has been established for a number of months. The group meets weekly. It brings together cabinet ministers such as the Deputy First Minister and myself, Shona Robison and other ministers—cosla, key stakeholders such as Scottish Care—to advise on pressures within the system and look at possible actions to mitigate them. This week, further guidance has been issued to boards, making it absolutely clear that they can and should take steps to protect critical and life-saving care if that is judged to be necessary. Boards can, of course, ask Government for advice as and when that is required. We believe that local health boards are best placed to judge what reasonable measures should be taken in each local health board area. Those measures could include, among others, opening or procuring additional capacity, moving staff to areas of pressure, increased engagement with a third sector or potentially delivering a different model of care for a short period of time. In my role as health secretary, I retain the emergency powers and ability to direct that are set out in the NHS Scotland Act 1978. I am well aware that more severe measures such as blanket pause of elective procedures or key diagnostic tests are not without impact on the health service and, indeed, on patients. I believe that it is important at this time that we ensure that NHS boards have the ability to respond flexibly to local circumstances and to deploy local solutions. Advice has also recently been issued to local leaders that provides clear guidance on the expectations around assessment and discharge practice and around care home oversight arrangements. We are also seeing record numbers of patients delayed under the adults with incapacity legislation. Those are patients who, although clinically ready for discharge, cannot be legally discharged with their court-appointed guardian being in place. Officials have been working with the Scottish Courts and Tribunal Service and the Law Society of Scotland to investigate where improvements can be made to ensure that people are able to be discharged in a timely manner. I have also met the Mental Welfare Commission and the ECHR this winter in regards to matters that are affecting adults with incapacity. While some of the measures that I have just announced are to help in the short term with the immediate pressures that we are facing, we are, of course, also putting in place the long-term steps that are necessary and needed to address social care challenges that we face. We have invested significant additional funding to support social care. That includes, for the current financial year, £124 million to enhance care-at-home capacity, £200 million to increase the hourly rate of pay to £10.50, £20 million to support interim care arrangements and £40 million to enhance multidisciplinary teams. A further £3.6 million of funding has been made available in the 2022-23 budget to support the further development of hospital at home across Scotland. It is clear that our accident and emergency services in Scotland are being impacted severely by the winter pressures. The situation is, of course, not unique to Scotland. Indeed, Scotland's A&E services continue to outperform those in other parts of the UK and they have done for the last seven years. That is, of course, called comfort for those who are waiting far too long for treatment. Scotland already has record numbers of NHS staff and we are recruiting more staff as part of our winter plan. However, it is very clear that far too many people are waiting far too long for care, whether that is for an ambulance response or waiting too long for treatment when they attend our A&E departments. We have taken action to improve A&E rates, including plans to recruit 1,000 new NHS staff and roll out of the £50 million urgent and unscheduled care collaborative to help drive down those rates. Those measures include initiatives such as hospital at home, ensuring that people are directed to the most appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A&E. We have also increased the amount of virtual capacity hospital-level care provided at home to the size of a large teaching hospital. We will also bolster workforce capacity within NHS 24. NHS 24 is an incredibly effective service and, through the expert advice offered, the overwhelming majority of those who call NHS 24 do not need onward transfer to already busy A&E departments. This winter, NHS 24 is taking forward planned recruitment of around 200 new stars before the end of March. As part of this recruitment, the board has appointed over 40 whole-time equivalents, call operators, call handlers and clinical supervisors in the run-up to Christmas. While call wait times for NHS 24 were often longer than usual over the festive period, the vast majority of calls received were dealt with through their initial contact. Despite the pressure that I have outlined, we are seeing progress in some key areas across the system. For example, excluding NHS Lothian, the latest figures show that despite continuing pressures, almost 90,500 operations were performed in November 2022. That was almost 21 per cent higher than November 2021, when more than 16,000 operations took place. This also marks the highest proportion of planned operations performed since the start of the pandemic, with more than 91 per cent of planned operations performed. That is progress in relation to our elective care. We are offering more support outside of hospital settings to assist people seeking help with common winter illnesses. NHS Inform has self-help guides to help to let everybody know when to stay at home and when to seek more care. GPs and pharmacies can also be contacted as a first port of call for non-critical non-emergency care. I would like to add a reminder for all of us that if you have symptoms of a respiratory infection, try to stay home and avoid contact with other people. If you do need to leave home, we strongly recommend that you wear a face covering. I understand that the NHS has built on the people that work in it who have had to work through incredibly challenging circumstances for years. The pressure of the pandemic, almost three years of a pandemic, has been relentless. I will always be available to talk to our committed workforce who provide incredible care for the people of Scotland day in and day out. I am grateful to Unison Unite and other trade union members who have accepted this Government's record pay-off for NHS staff. In fact, the majority of trade unions on-stack, the Agenda for Change Pay Negotiating Committee, have accepted our pay deal. I am actually disappointed that we have not got agreement from every trade union. I am also grateful for the positive engagement with the GMB, the Royal College of Midwives and the Royal College of Nurses that has taken place. I will continue to pursue meaningful dialogue with all trade unions to try to invert industrial action. We sincerely hope that the additional pressure of industrial action can be avoided at this very challenging time for the health service. However, I remain absolutely committed to dialogue and positively engaging with our trade unions. As I have outlined, unprecedented challenges continue to have a real impact on the NHS and on people right across this country. Although we face an extremely difficult period ahead, I remain confident that, with the combined effort of our incredible workforce and the determined will of this Government, these challenges will be met. Not only will they be met, but they will be overcome. Let me end where I started by thanking our outstanding health and social care staff for their herculean efforts during these extremely challenging times. We will continue to honour them, not just with warm words, but through our deeds too. I thank you for the ability and the time to make this statement. Of course, I am happy to take questions from across the chamber. The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 40 minutes for questions after which we will move on to the next item of business. I would be grateful if members wished to ask a question where to press their request to speak buttons now. Under the cabinet secretary's watch, the Scottish NHS is on its knees. A&E waiting times, cancer waiting times and delayed discharge are all at their worst ever level, with no improvement in sight. Whilst record number of patients were waiting over 12,000 A&E, where was the health secretary? We heard nothing from Humza Yousaf over the festive period, only for this hastily cobbled together statement today, before another divisive debate on independence, which is timetabled to last longer than this statement on healthcare. This is a national emergency. People are dying unnecessarily. Our heroic NHS staff are overwhelmed and are burning out. The crisis in our NHS should be a priority for this Parliament, because it is a priority for the people of Scotland, and they will be appalled today. I simply cannot fathom why the cabinet secretary did not plan for, in his words, the worst ever winter our NHS faces. Covid, flu, cold, accidents all increasing. This is predictable for months we have been calling on Humza Yousaf to rethink his failing NHS recovery plan. Just last month, we published a recovery plan of our own, but our warnings fell on deaf ears, and the Scottish people are now paying the price for the complete lack of preparation. The BMA has said that the Scottish Government have run out of ideas. I was out there seeing patients over the festive periods in different parts of the country, and the problems are similar everywhere. Primary care overwhelmed, secondary care, hospitals overwhelmed, patients scared of going to A&E, we need to see improvements and we need to see them urgently. In terms of the changes that were announced yesterday, I would like to know when we can expect to see real meaningful change in our NHS, improvements to A&E waiting times, delayed discharge numbers, cancer waiting times. Can the cabinet secretary confirm the timescales in which he expects to see significant improvements? For the question, these are issues that are facing every single health service across the UK. Doctor Sandish Gohanne asked me, where was I? I was busy in the festive period talking to our trade union colleagues. If his party did the same, they may not have nurses and ambulance drivers walking out on strike. In terms of his questions about planning, I noticed that the Conservatives published a winter plan. They published it in mid December. That is not particularly helpful nor useful, because the winter planning that we undertook, of course, took place after the last winter had passed. What I would say to Conservative members when it comes to planning, if Doctor Sandish Gohanne was the oracle he claims to be and could have predicted every single one of the pressures that the NHS is facing, he might have wanted to tell his colleagues down south. Those are pressures that are being faced by every single health service, not just in the UK but many across the world. What are we doing about it? There are a number of actions that we have taken, not just the actions that I have announced today, but I have already announced the recruitment of additional staff. In fact, we recruited staff last winter with recurring funding to help with pressures this winter. We have also increased additional funding for the Scottish Ambulance Service. In 2021-22, the Ambulance Service recruited record numbers of ambulance staff. I have a plan backed by £600 million of funding. I have already given details of how that is already helping in relation to social care. We have taken action, but notwithstanding that I have always been upfront, always been honest and publicly stated, even with those mitigations in place, this would be the most difficult winter that our NHS has ever faced. I simply say that I expect, of course, with the action that we have brought forward that we will see improvement in the very short term, but equally let me be upfront and be honest that, as schools will return, as work returns, as people mingle at work, there may well be the possibility that we see a slight increase in some of those viral infections spreading. We expect that the first couple of weeks, a few weeks of January, to be extremely challenging. There will continue to be challenges, but with the action that I have announced both in terms of interim care beds but also the NHS at 24 additional staffing, I hope that we will see in the short term some improvement to those pressures. Jackie Baillie The health secretary is keen to tell us that this winter the NHS is under unprecedented pressure and he cites Covid, flu and strep A. Let me join with him in thanking all NHS staff for everything that they are doing, but they will tell you that this crisis is not unprecedented. It was predicted by clinicians and in fact fewer patients are being seen in A and E now than before the pandemic. What is unprecedented is that the health secretary has been warned about this crisis by clinicians for well over a year and he has failed to listen and to act on solutions. What is unprecedented is that this Government failed to end delayed discharge, something they promised to do in 2015, and eight years on it is at record high levels. Dr Ian Kennedy of the BMA is clear that the current crisis at the front door of A and E is because the back door of social care has not been fixed. What is unprecedented is that this Government has presided over inadequate workforce planning for the last 15 years so that we now have 6,400 nursing vacancies and in some areas 14 per cent of consultant posts lie empty. Let me ask the health secretary about the 1,000 additional staff. How many are actually in post and where are they deployed? Let me also ask him about the extra 300 beds, which will help, I'm sure, but when the latest data reveals a record high of over 1,900 people stuck in hospitals, what impact will that have? Will he give a commitment to removing non-residential care charges and supporting home and family carers as this will directly contrary? Will he give a commitment to helping to end delayed discharge? Finally, why is the First Minister not here giving the statement as she did yesterday and has instead sent along her spare? I do, of course, notice that Jackie Baillie is here and not a sourd leader of the Scottish Labour Party. I'm not going to personally insult Jackie Baillie because at a time of national emergency, the people rightly expect our political leaders to rise above their petty political differences and work together in this nation. Jackie Baillie and her colleagues can shout from a certain position, but I think that it's important that I answer their questions on delayed discharge. Let me say, as I have said to Sandish Gohani, that I expect there to be improvement. Once, of course, we begin to move people from acute sites into these interim beds, so we expect that to be in the short term. I mean, hopefully, as we begin to see the levels of flu and Covid abate and reduce, then hopefully that will begin to see an improvement in our health service and in the performance indicators that she references. We have a very proud record. I'm proud myself to stand on in relation to staffing of the NHS over the course of the last 15 years. We have staffing in the NHS at record levels. Jackie Baillie is right to mention the high levels of vacancies that we are keen to fill. That's why I announced last year additional funding to recruit nurses from overseas. That was 200 nurses that we committed to last year. I can hear Jackie Baillie shouting from a certain position. I'm literally answering your question as you are talking. We promised to recruit 200 nurses last winter. That funding was recurring. We exceeded that. For this winter, we have said that up until April, we will recruit an additional 750 nurses. I believe that there have been 126 from offers with 455 in the pipeline is what boards expect to fulfil. That is all the way up until April. I will give a further update as we get towards the end of this financial year. I will continue to push boards to go further in terms of the recruitment where they possibly can. Her suggestion about non-residential charges is a promise, a programme for government commitment from us to do so in terms of the abolition of non-residential charges. I will continue to work within our portfolio to see when we can do that at the earliest possible opportunity. My question to the cabinet secretary is in relation to the amount of people who are suffering from flu and Covid, not just in our hospitals but in our communities. Will the cabinet secretary what action the Government can take to increase the take-up of the Covid booster and the flu vaccine? Gillian Martin is absolutely right to focus on the issue of vaccination. We know that the vaccination for Covid in particular is a complete game changer. We know that the flu vaccine can also be effective as well. We have taken the decision in Scotland to co-administer both Covid and flu vaccines. The uptake has been very positive, but if I was to give any encouragement it would be to all those who are eligible who have not come forward. I would say, looking at the statistics, looking at the numbers and the data that we have in front of us, that the uptake levels for health and social care workers are not as high as I would like it to be. If you are a front-line health and social care worker and you have not had the Covid or flu vaccine, please do come forward. It will help to protect you and hopefully protect those that you give exceptional care to as well. I would like to put on record a thanks to the UK Government for the Covid vaccination programme. Cabinet secretary, over the Christmas break I was inundated with correspondence about the crisis in our Scottish NHS and the latest statistics seem to reflect a situation that is now spiralling out of control. Last week, just two in five patients were seen within four hours at the Royal Infirmary of Edinburgh, despite weekly attendance being lower than it was in the same week in 2020 before the pandemic. That should be 2019 before the pandemic. Let me put the current situation in the words of Dr David Caesar, a senior emergency medicine consultant at the Royal Infirmary. Dr Caesar said that dignity feels like a distant luxury and the fatigue among clinicians is bone deep with staff, dejected and in total despair. In your answer, cabinet secretary, perhaps you could speak to Dr Caesar and not me. What is the one practical thing that you will do today that will help him and his colleagues tomorrow? No, Dr David Caesar used to be one of our deputy chief medical officers here in the Government. I am grateful for the work that he has done and I read his piece in the times, but I read his public comments that he has made. What I would say to Sue Webber before I answer her question directly is that she is right. Attendances were lower, but what that masks, of course, is that any clinician on the front line will tell you is that people are presenting with higher acuity. They are presenting sicker and therefore the length of stay is longer, and that is currently the challenge that we are facing, as well as the exit block, the lack of capacity within already very busy hospital sites. What can we do to help the likes of Dr Dave Caesar and every other health and social care worker who is doing an exceptional job? Well, what we can do is reduce that workload pressure. That is why the additional funding for those 300 interim beds that we have identified and will look to utilise as quickly as we possibly can will hopefully begin to reduce that workload pressure. What we can continue to do is make sure that Dr David Caesar and NHS staff are properly rewarded. That is why we have put forward a record pay rise for agenda for change staff, and we will make sure that we do what we can to retain our doctors and other staff as well to make sure that they are appropriately rewarded and remunerated. Emma Harper, to be shalled by Paul O'Kane. I welcome that the Scottish Government's resilience room has been convened or reconvened given the level of pressures our NHS and care services are facing, and I'm pleased that I played a wee part in suggesting it. The First Minister's briefing yesterday, just like the briefings during Covid, were incredibly useful and helpful. Will the Scottish Government continue to keep this Parliament and the public regularly updated of the work being taken forward to help address the pressures on our health and care services? I'm happy to do media briefings in the First Minister and I will reflect on whether to do another media briefing. I'm happy at any point to come to this chamber to answer questions on this issue and keep Parliament updated. I think that there is something important that we should have the ability to speak directly to the public. That public health messaging is incredibly important and she may have seen throughout the festive period. I was reiterating in some of that health messaging the First Minister was, the likes of the national clinical director Jason Leitch doing so. I think that all of us have a role to play to communicate not just with our constituents but with the public more widely. Paul O'Kane, to be followed by Rona Mackay. In relation to the additional beds announced, unpaid carers have raised concerns about the potential of loved ones being parked their words in care homes perhaps against their wishes as they wait for care assessments. There are serious concerns for people's wellbeing. How will the cabinet secretary increase capacity to ensure that people are appropriately assessed and not abandoned in a setting that may be inappropriate and unwelcome, particularly with reports this week that social workers in Scotland miss more than 30,000 workdays due to mental health? Does he accept that all of this comes back to retaining and recruiting more social care staff by valuing them and ensuring that they are offered more than this Government's insulting rise of 40pence? I thank Paul O'Kane for the important questions that he asked. I may disagree with some of the characterisation about it and I'll come to that in a second but there are incredibly important questions. Those are difficult conversations to have but what I would say is that of course our clinicians who have these conversations day in and day out do so compassionately but also collaboratively with families. I was being up front in my statement that an interim placement may not be a family's first or second choice but equally remaining within a hospital when you are clinically safe to be discharged in a hospital that may be at 95, 99 or above 100 per cent capacity, that cannot be good for the individual involved, let alone for the hospital involved. So can we work, always clinicians will try to work with families to ensure that the most suitable care placement is available for them and it may be the case that in some of these placements it may be that people are placed there and the assessment takes place within the interim care placement and then they are moved on to a permanent, either care home place or indeed get the package of care that they require at home. But being in hospital when you are clinically safe to be discharged is not the best choice for an individual because of course we know that prolonged stays in hospital when you are clinically safe to discharge is not best for the patients involved. On social care staff, Paul Cain and I rehearsed this at committee this morning. Obviously a 2324 budget has an uplift of £10.90, that is the third pay rise in the time that I have been Cabinet Secretary for Health from 2020 to 2021. That represents on a full-time wage more than £2,000 of an increase over a year. What I would say to Paul Cain is, and I'll correct this if I'm wrong of course, the £10.90 reliving wage is also the same wage uplift that's being offered by Labour in Wales where they are in charge of the health service too. A recent report by the Nuffield Trust has warned that Britain's departure from the EU has worsened recruitment shortages made accessing essential medicines more difficult and further exacerbated health inequalities. Does the minister share my concerns that the economic hit of a hard Tory Brexit is fuelling the severe challenges that the NHS in Scotland is currently facing? With just no doubt about it, you talk to any social care provider and they will tell you the damage that Brexit has caused. Social care has been hit by a number of real difficult challenges over the year. A hard Tory Brexit is certainly one of them, the pandemic being the other. The most recent concern that social care providers, whether they are care home providers or care at home providers, tell me is the high cost of inflation, which is a direct result of the UK Government's mismanagement of the economy. That has led to care home energy costs being exceptionally high. We know fuel costs being exceptionally high for care at home providers as well. I am in constant dialogue with the care sector here in Scotland, but I also have some regular conversations with other health ministers across the four nations and I will continue to implore the UK Government to do what they can in relation to migration, because we know there is more that can be done to help our social care and NHS staff in relation to overseas recruitment, but also to see what more they can do in relation to mitigation against high energy and high inflation costs. There is much interest in this item and I would be grateful for concise questions and responses, and I call Alex Cole-Hamilton. Thank you very much indeed. It is now more than a year since I first asked the cabinet secretary to instruct an urgent government inquiry into unavoidable deaths caused by the crisis in emergency care. We now understand the quantum of that with the Royal College of Emergency Medicine telling us over the Christmas period that as many as 40 people a week may be dying who didn't need to die as a result of this crisis in emergency care. Can I ask him again, will he now instruct that urgent government inquiry into those unavoidable deaths? I am not disputing the Royal College of Emergency Medicine's underlying premise. I do not think that any of us would if patients are waiting excessively long periods for care, then they will come to harm. We would have to say that each individual death would have to be individually examined to understand the true scale of that. I will not instruct a public inquiry into every single death that may have happened as a result of long waits. I will take some time to consider what Alex Cole-Hamilton has said so that we can truly understand the true picture of those who have come to harm due to excessively long waits. John Mason to be followed by Craig Hoy. Can the cabinet secretary confirm that this year in the current year all financial resources are allocated so to put any more resources into part of the NHS or the NHS as a whole there would have to be a balancing cut elsewhere? I do not know if I made this clear, not my statement, but £8 million that we are putting towards the £300 interim care business coming from the health and social care portfolio. Every penny is allocated and there is not additional finance coming from central finance, so we would have to find that money from within the health and social care budget, which John Mason and other members know is extremely challenging given the financial circumstances that we are currently under. Craig Hoy to be followed by Fulton MacGregor. Delayed discharge predates the pandemic, severe workforce pressures predate the pandemic and long A&E waits predate the pandemic. This minister has been warned of these problems for years and he has chosen to ignore those warnings. So now that the First Minister is doing his job, shouldn't he do the decent thing and resign? Again, I will not rise to the pathetic personal petty attacks, but what I would say to Craig Hoy is that when our country is facing a national emergency, when they are facing one of the biggest challenges that I think the NHS has ever faced in its 74-year existence, the best Craig Hoy can come up with is a quip that he has given us. He has practised in the mirror before coming down to this chamber. What I would say to him is that this Government is focused and I am focused on taking action, whether that is the recruitment of additional staff, whether that is the recruitment of additional ambulance staff, whether that is £600 million that we are putting forward to help with this winter and to cope with the winter pressures, that is the action that this Government and I will take. I will leave the flimsy apathetic party politicking from Craig Hoy. I will allow him to do that, while this Government's relentless focus will be to support our NHS, the people that receive care and the wonderful workforce that give that exceptional care. Full to McGregor to be followed by Monica Lennon. Thank you, Presiding Officer. Like I'm sure many others, here my inbox over the last few weeks has been full with constituents concerned about long waiting times at A&E, primarily at Mount Lones for my area, with some reporting waits of up to 10 hours. I've also had many contacts from local NHS staff who I know have been working round the clock and I also want to offer my heartfelt thanks to them. I do welcome the statement from the Cabinet Secretary today and I wonder therefore if I can ask him, in light of the circumstances and pressures faced by at Mount Lones A&E, how the additional support he's outlined today can help NHS Lanarkshire specifically avoid these pressures? Thankful to McGregor for a very important question. He's right. Lanarkshire is one of the health boards that is facing that pressure most acutely. I've been to many sites, as he'd imagined, in Lanarkshire myself and spoken to the new chief executive who has been in place since December about those pressures. I'm personally interacting quite closely, as you'd imagine, with NHS Lanarkshire. In my most recent visit to NHS Lanarkshire, I was in the A&E department and Wishaw was very clear to me that delayed discharge was causing some significant issues. I was talking to one patient who'd been waiting far too long for treatment in A&E precisely because there was not a bed available. Of course, the 300 interim beds—or a portion of them, I should say—will be in both North and South Lanarkshire. I have to commend Lanarkshire. It has a very good collaborative pan-Lanarkshire way of working. When I speak to the chief officers of both North and South Lanarkshire, the chief executives of both North Lanarkshire and South Lanarkshire Council and the health board, it's very clear to me that there's good collaborative working on the ground. I would encourage Lanarkshire to continue to do so. Make no mistake, this is a humanitarian emergency. It is costing lives and it is damaging the wellbeing of NHS and social care workers. NHS Lanarkshire has just been mentioned. That is a crisis within this crisis. The Code Black nightmare, which began in 2021, continues today in 2023. So constituents in Lanarkshire want to know when that will end. I have two short questions for now. One is, again, in Lanarkshire. We need more doctors in and out of hours and across primary care. Can the Cabinet Secretary update on that? As well as the immediate action that we need, we need long-term solutions. Will he agree with the BMA and others to facilitate a national conversation on the future and survival of the NHS? Briefly to Monica Lennon, working out of hours is one of the key areas that NHS Lanarkshire and the new chief executive and I spoke about when we last met. She may have seen from NHS Lanarkshire that GP practices in Lanarkshire will be open additional days on the weekends and that is something that I welcome. I should say that there are standing directions to every single health board to work with their GP practices in their health board area to see what more they can do around extending opening hours. I know that many GP practices are very grateful to our GPs and the staff within the multidisciplinary teams who are working those additional hours, whether it is evenings or whether it is weekends, to help to cope with some of the demand that they are facing. The second question that Monica Lennon asks, I gave an indication over the weekend doing some media interviews that I am open to the idea of a national conversation, a conversation with the public around the health service. That must be grounded, I think that Monica Lennon would agree with this, that must be grounded in the founding principles of the NHS and I think that most members of this Parliament, not every member, but most members in this Parliament would certainly agree with that premise and I think that the idea of a national conversation is a good one. Let's just make sure that we're doing it in such a way and at such a time that it doesn't add pressure and work on a system that is already facing significant pressure and are happy to keep Monica Lennon updated on those conversations. Jackie Dunbar, to be followed by Gillian Mackay. Can I ask the cabinet secretary what actions are being taken to ensure that health boards retain the ability to respond to local circumstances and alleviate some of the unique pressures that they may be currently facing? I hope that I gave an indication of that in my statement. There has been some calls for, for example, the Government to declare a national major incident but I think that it is right that local health boards retain that decision making at a local level and determine how to best flex their services in order to cope with that demand that they are facing. So I'll continue to give that flexibility to local health boards but the Government at a national level, whether it's myself, whether it's the chief executive of the NHS, Caroline Lamb, the chief operating officer John Burns, we will always remain close to our NHS boards to offer advice and support where appropriate. Gillian Mackay, to be followed by Co-Cab Stewart. Thank you, Presiding Officer. The cabinet secretary will be aware of my keen interest in staff welfare. Time away from wards is the biggest barrier cited for staff to access breaks. For them to be able to do this, we need more staff and Brexit has undoubtedly benefactor. I welcome everything the cabinet secretary has said so far about recruitment. Further to the answer to Rona Mackay's question, what conversations has the cabinet secretary had with the Home Office and UK Government ministers about fast-track visas for those coming to work in the Scottish NHS? If those conversations have not yet taken place, will he ask for a meeting as a matter of urgency on this? I have raised it previously with the UK Government on Inferness. It wasn't just raised by myself, it was raised by the Welsh Health Secretary at the time as well. She is very supportive of continuing those discussions with the UK Government to try to get them to see sense when it comes to the very prohibitive and restrictive immigration rules that we currently have. I genuinely don't understand it because I know that there are many NHS trusts in England who are facing the same challenges from a social care perspective as well as an NHS perspective too. I think that Jeremy Mackay makes a good suggestion in my next four nations meeting. I will ask that the issue of immigration and immigration rules in particular are back on the agenda. Given the additional pressure that Covid and seasonal flu are responsible for in both primary and acute care sectors, can the cabinet secretary confirm whether medical opinion indicates that it would be a valuable step to extend eligibility for the vaccination booster programme from all adults aged 50 years and over to include adults under 50 years old? I think that it is a very good question from cocaps juror. What I would say to cocaps juror is that the eligibility for any Covid booster programme, any future Covid vaccination programme is always led by or informed by advice from JCVI. We haven't departed from that JCVI advice in any significant way previously, so we will continue those discussions with the JCVI, but it is important that we take that informed expert advice from the Joint Council for Vaccination and Immunisation and then come to a decision based on the circumstances at the time. One in 10 patients arriving at hospitals by ambulance in the final week of December waited over three hours to be offloaded into A&E departments. I also had one constituent who called 999 and waited for 12.5 hours for an ambulance crew to arrive. What steps is the cabinet secretary taking to ensure that ambulances can get back onto the road as soon as possible? And what steps is he taking to ensure that call handlers have the training they need and are able to prioritise calls as they come in? That's a very important question from Sharon Dowie. She's right that ambulance turnaround times have been far too long in far too many acute sites. Particularly, I think, Sharon Dowie has an interest in air hospital and cross-house hospitals and in those two sites in particular, a hospital turnaround times have been far too long. We're working closely with the board in Ayrshire and Arn as she would expect us to do in order to try to improve the situation. I think that she's very well aware that the entire system is connected and that's why I said in my statement that we're taking a whole systems approach. So, if we can create some capacity by safely discharging 300 people within the current system who are clinically safe to discharge, get them out of busy acute sites, that helps with the flow in our hospitals. That will allow ambulances to be able to convey to the acute site much quicker and get back out into the road. That shortens the response times because I agree with her the type of response times that she's just referenced and not the standard of care that we'd expect. So, the measures that I've announced today directly will help to impact those turnaround times. We're also working with the sites and health boards such as Ayrshire and Arn where those turnaround times are far too high to see if there's other conveyancing areas that can be created, accepting that there's limited capacity within acute sites. Is there any additional space that can be found to convey and then allowing hospitals to quickly turn around and get back out into the road? I was contacted by a constituent regarding a recent call to NHS 24 which went unanswered and they were cut off after a two hour wait. I'm sure the cabinet secretary agrees that this should not happen. In such circumstances, patients are likely to attend A&E for instance, although it might not always be required to put additional pressures on service. Can I therefore ask, as a route of recent increased demand to NHS 24, what provisions are being put in place for future surge capacity to adequately handle calls to ensure people can make use of the service instead of accessing other parts of the NHS including hospitals? I should say that I was at NHS 24, I went to speak to staff and meet with staff on Christmas Eve so I was there when pressure was at one of its highest possible times and moments. In fact, I went at 10 in the morning if memory serves me correct and there was already 900 people waiting for the call to be answered. I hope that Bob Doris understands and appreciates—I think that he does—the exceptional pressure over the festive period. In fact, I made reference to the almost 100,000 calls that NHS 24 received over the 2,4D weekends or holiday periods and that is just a demonstration of a high level of demand. NHS 24 did expect high levels of demand that they increased their staff. I referenced some of that increase of staffing between October and December. Even with that in place, there are still challenges for some people getting through. That is why I have made reference to the additional staff 200 over the course of the winter that NHS 24 will recruit and that will help with call answering times. What I would also say to Bob Doris and to anybody listening is that there is the NHS 24 app. It is a minimal viable product. It has the kind of self-help guides on it. It has information about your local GP practice, your local pharmacy and so on. We will keep building on that app so that it is a full digital offer in the weeks, months and years to come. We would also point people towards NHS Inform as well. Foisal Chowdry, to be followed by Murdo Fraser. Thank you, Presiding Officer. Constituents in Lothian region have struggled to get through to a call handler on NHS 24, causing distress and anxiety to those who are ill and don't know where to turn. As a result, constituents may be more likely to unnecessarily attend A&E to get medical attention, thereby increasing pressure on NHS service, which are already at breaking points this winter. Can the cabinet secretary advise what support will be given to Constituent desperately trying to get help from NHS 24 before the recruitment of new starts is completed by March? Over 100 train staff are being let go from the Covid national contact centre. Could this worker be resigned to assist? Thank you, Foisal Chowdry, for his suggestion. Obviously, as we have begun to reduce the numbers working in the national contact centre, we have looked to deploy as many as we possibly can back into the health service and some into social care as well. What I would say to Foisal Chowdry is that the 200 additional staff for NHS 24 that I have referenced, the recruitment began in October to help with the festive period as well. We will continue to recruit, which will help with constituents who are struggling to get through to NHS 24. I have seen the latest data and we are seeing reduction in the amount of time people are waiting for the call to be answered. That is hopefully a positive sign for things to come. I would also say to people that, as well as NHS 24, we have the app that I have mentioned, we have NHS Inform, which has a symptom checker, which has been checked millions of times over the course of the festive, over the course of the last few months. We also have Pharmacy First and your GP, so there are many avenues that you can go to before going to A&E, and I would encourage everybody to make sure that they get the right care in the right place in the right time. Thank you, Presiding Officer. Both Bob Doris and Foisal Chowdry have just raised the really important issue of the time it takes people to get through on NHS 24. Sometimes I have had examples of people waiting two hours or more to try to get the phone answered, which leads to additional problems. Of course, people still have other problems trying to access GP services for exactly the same reason, making call after call day after day trying to get an appointment and not able to do that, and that just builds up problems for the future. So what specific action will the Government take to increase the availability of GP appointments to try to avoid warranted unnecessary presentations at A&E? That is a really important question from Murdo Fraser, and it is a really important issue that he raises. I think that, first of all, it is worsening. I think that Murdo Fraser would agree with us that our GP staff are doing an incredible job in really difficult circumstances, and the workload pressure that is upon them is unprecedented as well. At the same time, I recognise the situation that he articulates. Many members across the chamber from all the political parties have written to me to tell me over the weeks and months that they have constituents who have struggled to get GP appointments. That is why I announced a couple of measures, or few measures. One is funding for telephony services, where GP practices can improve their telephony services to help with access issues. We have provided some funding. I have written to every GP practice to say that my expectation is that every GP practice should offer pre-bookable appointments because we have the situation in still far too many GP practices where you have to phone up at 8 in the morning. You might not get through. You will be 25th in the queue and people will hang up and end up at A&E, as Murdo Fraser has said. Pre-bookable appointments could help with that. The last thing that I would say in this particular issue is that I have instructed a GP access group to be set up, which will have GP's on it but also a patient representative to unblock any of those GP access issues that currently exist. I am in regular dialogue with the BMA. He will know Dr Andrew Bews, I suspect fairly well. I am in constant regular dialogue with the BMA about what more we can do to work collaboratively together to improve access to the GP practices. Let me make it clear. Let me end that question where I started that I understand just how hard our GP practice staff are working under unprecedented pressure. Paul MacLennan, to be followed by Brian Whittle. Thank you, Gennac Henry. I provide an update on the measures previously put in place. Sorry, Mr MacLennan. I am taking a point of order from Mr Kerr. I am mindful that you had allocated 40 minutes. We are now at 39 minutes and a number of colleagues, I am sure, still want to ask questions, including people on these benches. Would you be minded with the president of the Dr Gray's statement of last year understanding order 8.14.3 to extend the time until all colleagues who have issues to raise with the cabinet secretary have the opportunity to do so? I thank Mr Kerr for his point of order. While I am not minded to accept such a motion, I am determined that those who have pressed will have their questions taken. I go to Mr Paul MacLennan. Can the cabinet secretary provide an update on the measures previously put in place to recruit additional staff from outwith Scotland and what progress has been made towards this? Let's just say before I answer that question, I'm happy to stay in the chamber for as long as necessary to answer these important questions. In terms of recruitment outwith Scotland, I've already referenced in some of my answers the efforts towards international recruitment. We made those efforts in terms of international overseas nurses last winter, with a recurring funding to help with this winter. We exceeded our target of 200 nurses and we've given further funding, as the member probably knows, that I announced in October around £8 million to support the recruitment of up to 750 nurses, midwives and the HPs. As a reference in an answer to Jackie Baillie, around 126 firm offers have been accepted and we expect many more in the pipeline towards April. We are also continuing to ensure that we proactively encourage Scotland as a destination for particularly GPs from across the rest of the UK. I think that Scotland is a very attractive place to work, particularly a remote rural and island community, so we have a proactive campaign underway to see if we can attract GPs from the rest of the UK to work here too. I've just got a text from my GP surgery saying that they will only be providing emergency appointments. That is a similar text that I've been receiving since June 13, since I've been trying to access more GP surgery, so we are in a real crisis. However, what I wanted to ask the cabinet secretary was, and I've said many times in this place, that the trajectory that the Scottish Government is taking the healthcare in Scotland is unsustainable, and that the Scottish Government is just managing the decline of our health service and Covid has just accelerated that decline. Isn't it about time that the long-term sustainability of the Scottish national health service was mapped out? I will look at the preventable health agenda, where we tackle Scotland's poor health record, where we are still the unhealthiest nation in Europe, and shouldn't we be looking to prevent the need to seek healthcare in the first place, or at the very least treat patients at an earlier stage before they become acute and require more intensive care? Cabinet secretary, surely that is a significant way to reduce the pressure on our health service. I agree with everything that Brian Whittle has said in relation to the importance of the preventative agenda. I spoke at length about this in committee when I appeared this morning, so a 23-24 budget continues that focus, that investment and funding towards the preventative agenda. I think that he's right that we will avoid this temptation, but there can be a temptation when you're dealing with unprecedented emergency situation in front of you to lose focus of the preventative. We won't do that. We'll continue to focus on smoking cessation, on our work around alcohol and drugs treatment in relation to obesity and healthy and active lifestyle, something that I know is very important to Brian Whittle. I can give him a very firm commitment that will continue our focus on the preventative while also dealing with the unprecedented pressures that we're currently facing. The cabinet secretary will be aware that AHPs have unique skills that help with discharge from hospital. They're essential to make this happen and return people home safely. This undoubtedly helps with pressures on acute beds. AHP services are currently under pressure with vacancies across the country. What discussions has the Government had to ensure that this increase in bed capacity also gives patients access to this essential group of staff? I can agree more with Karen Morgan about the importance of AHPs. A multidisciplinary approach has needed to be taken to provide people with holistic healthcare. That's why we've recruited over 3,220 members of those multidisciplinary teams. Many of them are working in general practice right up and down the country. Of course, we're investing in AHPs in our hospitals and our frailty teams, for example, to help to reduce the length of time, particularly elderly people who have a fall come into hospital. We'll certainly continue to work with all the relevant bodies in relation to AHPs, but I want to place on record my thanks for the incredible work that they do and the holistic care that they provide up and down the country. We'll continue to work with more warriors of healthy health brave science now. We won't be listening to BCLs processed at this meeting as much as can be done in the future. This work has to follow the NHS services the health service works, because there has never been a blockage on local health boards being able to take local decisions. In fact, she's just given the example of how a local health board took a decision to meet local demand. That has happened up and down the country far before I was health secretary. It's happened for many, many years and is the foundation principle of our national health service that local health boards have the ability to locally flex the care that they provide. What I simply did in my letter was to make sure that there was further guidance, particularly in these emergency type situations, should health boards require it. However, as Rachael Hamilton referenced in our question, this is already being done and I'm very grateful to local health boards for taking really difficult decisions in a time of great emergency. The villages and communities of Port William and Whitton and Wigtonshire have been without adequate GP coverage for many months. With the closest A&E and hours drive away and with four hour waits on NHS 24, there is massive pressure on the community pharmacy who are going above and beyond to look after the health concerns of locals. The pharmacist in Whitton is looking at an average of 83 pharmacy first a week of those 28 pharmacy first plus. This is over and above the normal day job and over the last few weeks it's been dramatically worse. This is far more than an average pharmacy would see over a month. This is undeniably a crisis that is putting people's lives at risk. Will the cabinet secretary consider intervening and deploying, as a matter of urgency, GP's to those two rural communities which are undeniably areas with the greatest pressure, greatest needs and greatest risk? I have regular conversations with our health boards, including Dumfries and Galloway and also NHS Borders, where we tend to see some pretty significant and grampian pressures in relation to general practice and in relation to community pharmacy. I will continue to ask the chief medical officer and the chief pharmaceutical officer to see what more can be done, particularly around general practice cover, in the areas that Family Carson references. I am interested in patient rights with regard to the interim beds. Can patients refuse to go to the interim beds in the care homes because they want to go home but there is not a care package for them to be able to go home? Will there be part for weeks within those beds? Is the cabinet secretary confident that he can move them on quickly? Will he guarantee that those people won't be required to pay the fees for the care homes if they are self-funders? Cabinet secretary. Can I say these are very important questions that Willie Rennie asks? The choice guidelines are still in place. We have not suspended the choice guidelines, so the choice guidelines are still there, they exist, clinicians are very mindful of them, they have these conversations that I mentioned in a previous answer day in and day out. We are not going to be forcing people out. I simply said in my comments and I hope that Willie Rennie takes them in the spirit that they have intended that an interim place might not be the first choice, might not be even the second choice, but ultimately being in a hospital that is over-occupied, facing the pressure that it is under when you are clinically safe to be discharged, and that is crucial. Those people are clinically safe to be discharged. It is not best for the patient, it is not best that they are there. Can they be in an interim place in an environment? To answer the question directly, the choice guidelines are still in place and have not been suspended. I do not like the phrase that anybody is going to be parked. Whether it is an interim care home place or a permanent care home place, people working in social care, I think that Willie Rennie agrees, provide exceptional care, so their care needs will be tended to as best as we possibly can. We are looking for this measure to be a very short-term interim measure, weeks, not months. We do not want people in those interim placements for months and months, we want them to be there for weeks. I have got every confidence that chief officers who are excellent at their job, whether it is in Fife or whether it is in any other parts of the country, to do a phenomenal job of getting people the permanent care package that they require. On his very last question, there will be no cost to the individuals that are involved in relation to their interim care placements. Stephen Kerr. The cabinet secretary will be well aware of why I might be concerned about the situation in Forth Valley Royal hospital in the context of the measures that have been taken to reinforce the management and work practices at Forth Valley health board. With that in mind, not having had a view of the statement in advance or having a chance to read it, I have listened carefully to see whether there was something that was going to happen right here and now that was going to meet the need that has been identified by the chair of the BMA Scotland, who said, if I might, that the NHS is hemorrhaging crucial staff, staff whom we urgently need now more than ever before and the Government must step up to stop it. They can talk all as much as they want about recruitment of staff, of investment in systems or plans for improvement, but every single one will fall flat on its face unless there is laser-like focus on keeping the staff we have. That is what he said. Would the cabinet secretary please underline the one thing that is going to happen now that will reinforce the retention of the very valuable NHS workers? I can give him more than one in just a second what I will say about Forth Valley Royal hospital. I am more than happy to have conversations with members who are interested. He will know that that improvement plan is in place, and I have committed to come back to this chamber to give an update on how that improvement plan is being enacted. I commit to absolutely doing that. One of the actions that doctors have asked us about is the reintroduction of a rec scheme or recycling of employers' contribution scheme. We have done that or given that ability to health boards, and that has gone live in many health boards up and down the country at the end of last year. That will help directly with retention. That was an ask from the BMA directly to me. The other ask, of course, is on other pension issues. There has been some movement from the UK Government, but the BMA is not enough, so we will continue to lobby the UK Government in that respect. We will also pay our workforce. That is really important. We will make sure that when we pay them adequately and fairly, we will continue to engage with them. We have done that in the Scottish Government. We have put a record pay deal on offer for a gender for change staff, and we will continue to work with the medical workforce as well to listen to them, particularly junior doctors who are feeling particularly aggrieved and understandably so, given the pressure they are under, and given the pay differentials that exist between junior doctors and senior medical staff. We will continue to engage on pay. That will also help with retention as well. That concludes the ministerial statement on NHS winter pressures. There will be a brief pause before we move on to the next statement.