 The first item of business this afternoon is portfolio questions. We start with portfolio rule affairs and islands. As ever, if a member wishes to ask a supplementary question, they should press the request-to-speak button or place an RTS in the chat function if they're joining us online during the relevant question. Across both portfolios we've got quite a bit of interest, so the usual plea of succinct questions and succinct answers to match. To ask the Scottish Government what it is doing to reduce the risk of game birds' racist poultry spreading avian flu when they are released from captivity. Game birds may not be released if they're showing signs of disease and they cannot be released in disease control zones around a confirmed infected premises. The Scottish Government, in collaboration with the UK and Welsh Government, has commissioned a risk assessment on the spread of high pathogenicity avian influenza H5N1 to wild birds from released formerly captive game birds in Great Britain. When that's published, we will of course consider the findings and, if any mitigating methods are required, we will assess as necessary. Gillian Mackay. I thank the cabinet secretary for that answer. Pheasants have tested positive frevian flu on many occasions in the UK, but every year 45 million pheasants and over 10 million other game birds are released into the wild, where they continue to be fed and corralled in outside areas in huge densities until they are shot. Is the Scottish Government considering introducing registration of game birds as part of the species licensing review to protect wildlife and help prevent the spread of avian flu and other diseases in the future? My other ministerial colleagues are taking forward that work, so I'd be happy to get back to the member with further detail as to what will be included within that as well. As I said in my initial response, I think that it's also the work that we're taking forward through this risk assessment and, if there's any learnings that we can take from that, that will also be of very important in consideration of that too. As we heard in an extensive evidence session in the Rural Affairs Committee this morning with chief etnw officer Sheila Voas, avian flu is a major concern for poultry farmers in my constituents and elsewhere. So it's crucial that all parties act responsibly to get the CVO's message to the constituents that biosecurity by itself is the single most important thing that people can do. Can I ask the cabinet secretary to reiterate today to the industry that the Scottish Government hears its concerns as live to them and that it will continue to be guided by the science and led by the evidence? I absolutely do hear those concerns and understand why there is such a concern out there as well. But, as the member emphasises, it's the biosecurity here which is really critical and the fact that we do continue to be led by the science and the evidence on this as well. Now, we know that from work that's been done by EFSA that there's a twofold reduction in risk when we see housing introduced, but with excellent biosecurity there's a 44-fold reduction in risk. So I cannot emphasise enough just how important and vital these biosecurity measures are. I thank the Deputy Presiding Officer. Sadly, avian flu was detected at a farm in Huntley in my constituency and 200,000 birds in the north-east, including pantheon tariff, have been at impact in this month alone. The MP David Dugart has contacted the minister, but whilst the UK and Welsh Governments have taken steps to protect farms, the Scottish Government is continuing to ignore NFU Scotland and its recommendation. So can the cabinet secretary clarify what it is going to do about it and how many thousands of birds have to be killed before she will follow the advice of NFU Scotland? I think what is critically important here is that I take the advice of my chief veterinary officer. The member may not have seen the session that took place with the rain committee today, where the chief veterinary officer was there to talk about avian flu, because this isn't a simple decision to make. When it comes to mandatory housing, which I know the member is alluding to in particular, there is a balance of risks here, as well as looking at all the science, looking at the evidence. This isn't a straightforward measure to take, which is why the work that the chief veterinary officer and her team undertake is critically important and why I will continue to listen to that advice. That doesn't mean that the situation won't change, and it is, of course, a situation that we continue to keep under review. Thank you, Deputy Presiding Officer. To ask the Scottish Government whether any further engagement is planned with the UK Government regarding the proposed rural visa pilot scheme. I wrote to the Home Secretary on 27 September, after we published our rural visa pilot proposal, and it gained cross-party support in this chamber. Disappointingly, we have received no response, but I continue to strongly urge the UK Government to accept the recommendation of the Migration Advisory Committee to deliver a migration pilot for rural areas in partnership with Scottish Government, local authorities and employers. While we await a response, ministers have contacted multiple UK Parliament committees and the other devolved Governments to request engagement on the proposal, as we believe it could help address challenges experienced by remote and rural communities right across the UK. I thank the cabinet secretary for that answer. I have significant concerns about the impact of on-going labour shortages on Scotland's rural economy. Does the minister agree with me that rural Scotland has been failed by all four post-Brexit Tory prime ministers? Does she share my concerns that Labour's calls to end immigration dependency will see the continuation of the UK Government's failing Scotland's rural economies? I absolutely share those concerns. We warned about the ending of freedom of movement and the limitations of the current immigration system. I would also draw the chamber's attention to the Highlands and Islands Enterprise Business Panel survey, which was published just a couple of months ago, which reports that 71 per cent of businesses are being impacted by Brexit. Key employers in rural areas are more likely to report risks to their workforces via staffing or skills shortages. Migration is crucial to addressing those challenges. Lack of labour is one of the key issues that I hear about whenever I meet other businesses right across Scotland and on our islands. Migration supports our economic growth, the delivery of public services and community sustainability. We are now clearly seeing the negative impact of UK Government immigration policy, and we continue to call for the urgent addressing of those failings. I previously said that rural visas could be a way to help reverse depopulation, but they would not be a magic bullet. Powers in this area are held by the UK Government, but the Scottish Government should not use rural visas as cover for inaction on policies that they have competence over, which have proven to help to reverse depopulation, such as infrastructure investment in fixed links and broadband. Will the Scottish Government commit to feasibility studies for tunnels in Shetland to reverse depopulation as the rural visa pilot scheme aims to do? The one element that I would agree with the member is that there is not a single magic bullet that is going to solve the situation that we face in relation to labour shortages or in relation to depopulation, but that is also why, while the rural visa pilot is one element of the work that we would like to take forward, it has the support of local authorities as well as businesses too, and we think that it is a solution that could really work, but it will not automatically solve the problem. That is why the national islands plan and the series of pieces of work that we are taking forward through that are critical all together, because that is about how we challenge and look to tackle the challenges that have been raised by Beatrice Wishart, whether that be transport, infrastructure, fuel poverty and housing. To ask the Scottish Government what action it is taking with relevant stakeholders to support animal welfare over this winter. The Scottish Government is committed to improving and safeguarding animal welfare, and that applies at all times, but even more so now as we face winter and the cost of living crisis. No one wants to see owners having to give up their beloved pets or farmers or crofters struggling to provide adequate provisions for their livestock. The Scottish Government will continue to work with the animal welfare charities and organisations, including the Scottish SPCA, to monitor the situation and ensure that that help is available. As stated previously in this chamber, I would encourage anyone who is experiencing difficulties, who feels that they can't cope or that they can't keep their animal to reach out, ask for help and ask for that support, because there are numerous charities and organisations that are available and who can provide that support for those who are looking after pet animals and livestock too. I thank the cabinet secretary for the answer. The cost of living crisis is indeed impacting many families who are facing the heartbreak of rehoming their pets. Dogs trust found almost half of Scottish dog owners polled would now find it difficult to give their dog all they need. 62 per cent said that the cost of living crisis will likely impact whether they would consider rehoming or purchasing a dog in the next 12 months. Can I ask the cabinet secretary what action the Scottish Government is taking to engage with animal charities to ensure that, especially over Christmas, Scotland's pet owners are getting the best advice and support possible to keep them united with their faithful companions? We are in regular communication with the different charities and organisations that include the Scottish SPCA, the Dogs Trust and Cats Protection, among others. We meet regularly to discuss a range of different welfare issues and, more recently, the cost of living crisis and the impacts on pets as well as livestock. As I said in my initial response, there are a number of charities that offer help and support. For example, there is Edinburgh Dog and Cat Home, and I have previously highlighted to the chamber the Scottish SPCA's pet aid initiative. That supports people and their pets who are struggling. Through pet aid, the organisation supplies pet supplies and food through food banks and community larders. Again, I would just re-emphasise that it is really important that people feel that they need that help or support. Please reach out and ask for it. I would like to point out the Scottish SPCA's helpline number, which is 03999999. People can also visit their website to find out more about that pet aid scheme and the help that is available through that. To ask the Scottish Government what support it is giving to food producers to work towards meeting its right to food commitments. Scottish ministers are taking action to ensure that everyone in Scotland is able to enjoy the internationally recognised right to adequate food. That encompasses a range of support to food producers, including £15 million of funding through the Scotland Food and Drink Recovery Plan over 2020 to 2023, ensuring that they are able to grow, process and get food to market. We are also undertaking work to develop a food security unit with a view to monitoring on-going supply chain vulnerabilities and linking with that future food security work. In addition to that, our good food nation plan will be prepared with regard to the right to adequate food. I thank the minister for that answer. The food and drink industry is still recovering from the pandemic and Brexit and is now facing new pressures from the rising energy costs, which are accounting for more than a quarter of their operational costs. Many people working in the industry earn below the average wage and having to turn to food banks for support. The Government must set out clearly its plans on future energy support for business in order to support businesses to improve pay and conditions for struggling staff. Does the minister set out whether it does indeed have a plan on what it looks like? I think that the member will be aware of where the powers ultimately to tackle some of the biggest problems that businesses are facing right now lie. When it comes to energy, we know the support that is in place at the moment. The energy relief scheme does not go far enough and we need to see that go further. Unfortunately, we do not have the powers to influence that. We have a number of funds that have been available for businesses to apply to, which we will, of course, hope will help with some of the increased challenges and costs that we know that people are facing. We continue to do absolutely everything within our power to ease that burden on businesses, as well as for people right across Scotland at the moment. That is why we brought forward the emergency budget review and have announced £3 billion worth of support to do exactly that. The number of supplementaries would need to be brief, along with the responses. Food producers continue to grapple with the issue of labour shortages. These businesses often acquire access to migrant workers. If producers cannot get the workforce, they cannot make the food available to the public. We cannot continue modifying our food culture and thereby seek to go effect to the right of food if fresh produce is left to rot in the fields because no-one can harvest it. In that context, does the cabinet secretary agree with me that labour ought to consider the comments of Keir Starmer, who said that the freedom of movement was a red line and there will not be going back on it? I do not think that those comments were at all helpful because we know that the food and drink sector, like other parts, is one of the areas that has been most impacted. As I said in a previous response, it is probably the number one issue that I hear about when I am speaking to different businesses in the food and drink sector and right across the supply chain. It is access to labour, which is a huge problem, but we know that some of those issues are not new, but they have been exacerbated by the pandemic, as well as, of course, the impact of Brexit. Many EU citizens have left the UK with the resultant loss of skills that we know cannot be quickly or easily replaced, and that makes the situation even more difficult for the sectors that have relied on that EU talent. Keir Starmer appears to be suggesting a policy of British jobs for British workers, but that ultimately fails to recognise that invaluable contribution to our society from overseas workers but also just the economic reality of the on-going need for overseas workers for businesses. With all of Scotland's future population growth projected to come from inward migration, it really is crucial to Scotland's future prosperity. That was neither a brief question nor a brief response. Rachel Hamilton. Thank you, Presiding Officer. A lack of clarity around the new Scottish agricultural bill has been highlighted by protesters outside this building with rural stakeholders from NFUS, Scottish Crofting Federation and the Soil Association. Does the cabinet secretary understand that there is a lack of clarity that is harming the ability of farmers and food producers to make plans for their future seasonal rotations and contributing to meeting the Scottish Government's good food nation commitments? As the member will be aware, I was with her when we had the rally outside Parliament and I understand those calls for greater clarity and detail. That's why I came forward with a statement to Parliament just a few weeks ago to set out some of that timescale, but we will be making more of that detail available in the coming months. To ask the Scottish Government whether it has engaged in discussions or research about the feasibility of vertical farming in Scotland cities. The Scottish Government continues to explore opportunities for vertical farming in Scotland, including in cities. In addition to grant funding towards developing an educational vertical farm at SRUC's Edinburgh campus, we commissioned evidence on the environmental impacts of vertical farming and engaged through the local food strategy consultation. We are supporting vertical farming research to improve production efficiency, enhance plant quality and find ways to improve returns through the strategic research programme for environment, natural resources and agriculture. That is further to £2 million investment in the advanced plant growth centre at the James Houghton Institute via the Tay cities deal. I thank the minister for that answer. Edinburgh Southern is not the most agricultural of constituencies but perhaps with vertical farming it could be. Indeed globally this is important because if we currently use an area the size of South America, we will need to add a land area the size of Brazil if we are going to meet global food requirements. So beyond the research that the minister has outlined, could I also ask what the Government is looking at in terms of skills requirement and supporting infrastructure and also regulatory in particular planning alterations that might be required in order to facilitate vertical farming? Yes, I think that these are important matters that we've got to consider when we look at this because I do think that with vertical farming it's a really exciting technology that we want to be at the forefront of in Scotland, especially when it's Scottish businesses that are really driving that forward and I think it offers huge benefits just in terms of what we're able to do in cities when it comes to food production and growth and I think that's where NPF-4 and what's been brought forward as a result of that should at least enable that kind of development to happen because it's certainly something that we want to see more of. Supplementary Finlay Carson Vertical farming indeed is starting to be adopted across Scotland much thanks to the world-leading institution of the Hutton Institute. Other technologies such as precision farming, smart technology and robots in farmland are being developed by the national robotarium in Heret Watt, but one technology that we are not delivering at the moment is solutions, which would bring benefits to the climate change, whatever, and we heard and committed today from the chief veterinary officer that gene editing could also help in the fight to bring more resistance from our chickens from avian flu. Will the minister clearly set out her future plans on gene editing, which our scientific institutions, farmers and growers are calling for, and best Scottish businesses could be leading the world on? This is not really relevant to vertical farming but, cabinet secretary, if you want to offer a response. I'm happy to respond to this because I know that this is an issue that the member continues to raise in chamber despite the continuing responses that we have given him in relation to this because the member will be aware of the significant issues that exist with the precision breeding bill as it's currently being introduced and a bill that we would only give in 24 hours notice of as well. We think that it's important that we deal with these issues through the common frameworks process, but also that we take the decisions that are best and right for Scotland ultimately. Question 7, Jamie Greene. Thank you, Deputy Presiding Officer. To ask the Scottish Government whether it will provide an update on the carbon neutral islands project. By the end of the year we will publish a progress report for the carbon neutral islands project detailing the work that's been done to date. Jamie Greene. Helpfully short answer. Cumbria in North Ayrshire is one of those islands and I thank all residents for the great efforts they are making, but the reality is on my last visit there I discovered that there's only one electric vehicle charging point, public electric vehicle charging point for the whole island with over 1400 residents in winter and many more thousands in the summer. How on earth can these islands meet their climate change objectives and there's no way on earth there'll be carbon neutral if the Government doesn't invest in much needed infrastructure? How many charging points does the island actually need to become carbon neutral? And how many are going to be installed by the Government in the next 12 months? I think that in those particular points those of course would be more relevant for the transport minister and I'd be happy to follow up on that and get that information to the member in relation to that too. As I said in my initial response as well, we'll be setting out the work that's been undertaken today and how we intend to develop that project going forward because I do see this as a really exciting prospect not just for the islands that are part of this programme but also the wider learning that we can take from that too because we know our islands are at the forefront of some of the innovations and in relation to some of the technology that we see as well. And what's also important about this project and how we're taking it forward is that we really want to develop this with communities and we do that work with communities, it's not a top-down approach, very much bottom-up and hopefully I think it is really exciting and something that will ultimately deliver for communities in our island. Thank you, Presiding Officer. The Carbon Neutral Islands project will create jobs and put islands at the centre of Scotland's journey to net zero. Jobs are key to securing populations on our islands and are often linked to tourism. Does the cabinet secretary agree with me that if the opposition parties are concerned about how we invest in carbon neutral islands and reduce island depopulation, they should promote what makes islands wonderful, unique communities with so much to offer rather than focusing on the challenges that they face? We must acknowledge that our island communities do face some unique challenges. We must also acknowledge that the Scottish Government is absolutely committed to supporting our island communities and that's evidence that I talked earlier about our national islands plan, it's evidence through that. The historic islands act that we have as well as the investment that we're taking forward through the islands programme. However, I would also agree that language does play an integral part in how we perceive islands because I think it's the negative language associated with solely focusing on the challenges, harms our communities, but so does the use of language such as remote when describing our islands too. We all should be cognisant of that when we're discussing our islands. Remember that, of course, just as the member said in her question that there are places full of life innovation and of huge cultural significance to Scotland. It would help if some of the islands had ferries that ran on time, but, nevertheless, I think it's important that we add value for the climate with policies that add substantial change. On carbon neutral islands, can the minister assure us that it isn't simply badging changes that we're already in train? Yes, I can assure the member of that, but I'd be happy to absolutely welcome his feedback in relation to the update on the project when we publish that towards the end of the year. Question 8, Graham Day. Thank you, Presiding Officer. To ask the Scottish Government what action it's taking to support local food and drink producers to access public sector procurement contracts. We provided funding of up to £150,000 in 2022-23 to the supplier development programme, which delivers free training and guidance on how to submit and when public procurement bids. We're also updating our catering for change guidance and advice for sustainable procurement of food and catering services in the public sector. In addition to that, we provide broad support measures to ensure that local producers have the capabilities to access public sector contracts. That includes £15 million of funding towards the Scotland Food and Drink Recovery Plan over 2020-23 and £17.5 million to businesses through the food processing, marketing and co-operation grant scheme, and continued support for the Food for Life programme. I'm sure that she'll be aware of a joint Tayside contracts NFUS initiative that aims at improving access for local suppliers to the output of Tayside's largest catering organisation. I wonder if she agrees with me that increasing the locally grown and produced element with the meals being served to 30,000 people daily by Tayside contracts is an absolute must, both from a sustainability perspective and generating much-needed revenue for those producers. Would she join me in encouraging Tayside contracts and other such bodies to maximise their efforts in that regard? I absolutely would, and I couldn't agree more. I think that it's been a fantastic initiative that's been brought forward, particularly in the region that we're both fortunate enough to represent. I think that it offers some huge opportunities there. We know that SMEs and micro-businesses are critical to the social, economic and environmental health of Scotland, and that's why we're committed to leveraging the full procurement rules to make it as easy as possible for SMEs to bid for and win public procurement contracts and to participate in local supply chains. We've demonstrated our commitment to local food in the public sector through our local food strategy, our food for life programme and through the supplier development programme, which delivers that free training and guidance on how to submit and win public procurement bids. I really would encourage producers within Scotland to explore the opportunities that provision into the public sector offers. I'm very brief supplementary, Brian Whittle. Thank you, Deputy Presiding Officer. The minister was aware that East Asia as an exemplar comes to public procurement with some 75 per cent of food making on our pupils' tables coming from local. Why is it the XL contract remains so difficult to access and so little of the food within the XL contract comes from Scotland? I'm briefly as possible, cabinet secretary. I agree with the member and that East Asia is an exemplar. I think that's why we would encourage all local authorities to sign up to the food for life programme. We have got over half of local authorities who are already taking place through that as well. Of course, we're always looking to strengthen that and make improvements wherever we can and make it as easy as possible for suppliers to enter into those contracts and bid for that through the public procurement process. Of course, I'd be happy to look at that further and see what more we can do in relation to that. That will form part of the work that I hope we will take forward through the Good Food Nation plans to. Thank you very much, cabinet secretary. That concludes portfolio questions on rural and islands. We now move to the second portfolio, which is health and social care. Again, if a member wishes to ask a supplementary question, they should press the request-to-speak buttons or put an RTS in the chat function if they're joining us online during the relevant question. To ask the Scottish Government whether it will provide an update on its work to provide mental health and suicide prevention support to refugees. The Scottish Government works with partners such as Heads of Psychology Scotland and local mental health and psychological therapy services to provide access to mental health and psychological support, along with a range of practical supports. The best first-line treatment to support refugees is psychological first aid, as not all those who need support require to be seen by a specialist mental health professional. If more specialist help is needed, anyone in Scotland, regardless of their nationality, residence status or length of time they will be in the country, is already entitled to receive mental health, psychological or emergency treatment and can register with a GP practice to receive general medical services at no charge. Support can also be provided through NHS 24. Together with COSLA, we recently published our new suicide prevention strategy and action plan. That will address the inequalities that can contribute to suicide and will also ensure that we take every opportunity to prevent suicide supporting people as early as we can. Specifically, we will explore how to further support people with no recourse to public funds, including people seeking asylum and people at risk of or experiencing destitution to access the services that they need to support their mental health, including where there is a risk of suicide. I know that the answers are attempting to be helpful, but we are going to have to have shorter answers if we are going to get in all the questions, including supplementaries. Thank you. I thank the minister for that response and the recognition that mental health in Scotland is our responsibility, while refugee and asylum systems belong with the UK Home Office. Is the minister aware of the asylum seeker memorial project by Liberty investigates that seeks to name and remember those in the system who have died, either by completing suicide in despair or by the actions of others also severely traumatised? Does he agree that ensuring asylum seekers and refugees have equity of access to mental health services, including specialist provision, is absolutely essential to prevent mental health crises in our communities in the future? I am aware of Liberty investigates project, and the Scottish Government is very clear, Presiding Officer, that all refugees and people seeking asylum living here can access health services. They are entitled to receive emergency treatment and can register with a GP practice to receive general medical services, including referral to mental health services and treatment for specific conditions. I know that Maggie Chapman has taken a keen interest in Baroness Kennedy's asylum inquiry, and one of the recommendations there was that there should be £5 million of annual funding that the Home Office should provide. I completely agree with Baroness Kennedy on that front. The UK Government needs to recognise the true cost of the asylum system to our individuals, communities and public services, and the Home Office also needs to take its responsibility to safeguard people in its care seriously. It must have systems in place to recognise when someone needs support and processes to enable people to access appropriate services. The answers and some of the questions are going to have to be shorted. As dispersal areas for asylum seekers expand to all council areas in Scotland, and given that we know the truly terrible impact that hotel accommodation has had on mental health of asylum seekers, will the minister, hopefully in conjunction with the cabinet secretary for housing, explore the community sponsorship scheme that is run by Reset UK as a means to assume greater control over housing of asylum seekers and their support for improved mental health and well-being, giving us the link between housing and well-being? I think that the situation that the Home Office has allowed in putting people into hotel accommodation, which is often very unsuitable, is not the right thing to do. The member can be assured that there will be co-operation right across the Government to try and do our level best for those folks. However, the key thing in all of this is that we should be in charge of immigration and asylum policy here in order that we can get that right for people right at the very start. To ask the Scottish Government how many pharmacists have been recruited into primary care since 2018. The most recent data provided by health boards indicated that, since 2018, 610 whole-time equivalent pharmacists have been recruited into GP practices through the primary care fund. That figure shows primary care funded posts only. Health boards will also have pharmacists who have been recruited to GP practices that were funded by other funding streams, and that data would only be available directly from the boards. In Ayrshire and Arran, there is a real problem with pharmacy staff shortages. Planned pharmacy closures in reduced opening hours are becoming the norm, and that was never heard of before. That can make it more difficult for vulnerable people to pick up prescriptions. It can impact people who work irregular hours, and it puts more strain on other health services that are open. From speaking to pharmacists, they say that this is the result of the Government increasing their workload and leaving staff to work elsewhere. What workforce planning has the Government done to increase the number of pharmacists and has the number of pharmacy places at Scottish universities increased? One thing that I must say in agreement with the member is that, as a pharmacist myself, I think that the pandemic has shone a light on just how significant community pharmacy is to the healthcare of the nation. They have stepped up during the course of the pandemic, and they are providing more services than ever before, and they are a very valued part of our primary care system. There are a number of reasons why there are scheduled and unscheduled closures across community pharmacy network. Those have usually been shortened in nature and localised, not least because Covid is still causing staff absences and making it challenging for people to maintain community pharmacy services. In terms of workforce planning, the Scottish Government does have a health and social care integrated workforce plan that commits to increasing pharmacy pre-registration training places by 120 until 24, 25, and we have increased pharmacy technician training places by 108 for the current academic years. We certainly are putting in place programmes to increase the number of pharmacists available. The answer is to encourage more people to take up pharmacy fantastic career, and I declare an interest. The most recent figures for pharmacy in Scotland published in March show an increase of pharmacists working in primary care in Scotland, and an increase overall in the number of registered pharmacists taking the total to 5,284. Does the minister agree that those figures contradict community pharmacy Scotland's claim that the recent wave of branch closures has been caused by the primary care sector poaching pharmacists from community pharmacies? Furthermore, does the minister agree that the on-going and widespread closures of branches affecting the large pharmacy chains is not, in fact, caused by a shortage of pharmacies? Let me say that there are, undoubtedly, shortages in certain areas. Although pharmacy is a profession where you do a generalised undergraduate degree and a postgraduate year, there are opportunities to specialise in various different branches, industry, hospital, community and, most recently, primary care has developed. Obviously, we need to be very careful about balancing that workforce and ensuring that every career stream is attractive and that there are opportunities for every pharmacist to flourish whichever branch of the profession they go into. There are, I hear, and we work very closely with community pharmacy Scotland. There are concerns, undoubtedly, about people being attracted from community pharmacy into primary care posts. The solution is A, to train more pharmacists, but B, to also ensure that the career in community pharmacy is as satisfying and as worthwhile as people can make it. The conditions are as important as the salary in this point. We are going to have to pick up the pace a wee bit if we are going to get through all the questions, including supplementaries. Question number three, Kenneth Gibson. Thank you, Presiding Officer. To ask the Scottish Government whether it plans to integrate gender identity and mental health services. We remain committed to improving access to and delivery of NHS gender identity services. That is why we published a framework in December 2021 with a range of actions for that purpose. Many of those actions are well under way. That is why we are also allocating funding to health boards to directly support these clinical services. The services will be ready. I am already able to connect patients into local mental health services if required following clinical assessment. Finally, we are working to create a mental health system that responds to everyone's needs. That means that mental health services and support are being person-centred. That includes supporting transgender and non-binary people with a whole range of issues, including gender identity, which might impact on their mental health. Kenneth Gibson. I thank the minister for that reply. Does she agree that many young people who present at gender clinics have concomitant complex psychological and mental health needs when someone is identified as having gender-related distress? Other important health issues can be overlooked in favour of an unquestioning, affirmative approach to transition. What support is available for people seeking to de-transition? Can she share with the chamber the protocol for dealing with his vulnerable patient group? Following clinical assessment, health services are able, as I said, to connect patients into local mental health services if required. I can assure the member that the young people's gender service delivered by NHS Greater Glasgow and Clyde works closely with a range of other services, including local, child and adolescent mental health services. Public discussion about this type of health care can unfortunately be polarised, leading to misconceptions about how it is delivered. In NHS Scotland, best practice is expected to be grounded in the principles of realistic medicine. The framework supports patients and registered medical practitioners to have honest and open conversations about health care. It promotes shared decision making and a personalised approach to care. De-transitioning can generally be understood to be the process of reversing social, medical or other steps towards transitioning and returning living to one's sex at birth. In cases where an individual might decide to halt or reverse aspects of a medical transition, they would be appropriately supported by their clinical team to do so. Health professionals will, of course, understand that the reasons behind any decision to de-transition will be varied and incredibly personal, and they will respond appropriately. The Scottish Government has described the current process for obtaining a gender recognition certificate as overly medicalised and is proposing to remove the requirement for medical evidence to change one's legal gender through the Gender Recognition Reform Bill. The Sandofford Gender Identity Clinic in Glasgow is currently offering initial appointments to patients that registered three to four years ago. Do you agree that the real problem facing trans people is a lack of timely medical care and support, and what does the Scottish Government plan to do about the sky-high waiting times for patients experiencing gender dysphoria? Let me agree that there is undoubtedly a real challenge in delivering gender identity services. The waiting lists are far too long, and people are waiting far too long for the care that they require from NHS Scotland. We have a great deal of work going on in that front. I think that if the member would care to look in the interests of time at the letter that the Cabinet Secretary has provided to the committee inquiring into that particular piece of legislation, at the moment you will find the answers to all the questions that you have asked in terms of the range of work that is going on to improve the services on the ground. To ask the Scottish Government what assessment it has made of hospital coverage for remote and rural areas in the Highlands and Islands. It is primarily a responsibility of individual territorial NHS boards to plan and provide services, including hospital provision, which meet the needs of local people and are consistent with our national policies and frameworks. Indeed, I had the pleasure of formally opening two new NHS Highlands at community hospitals earlier this year. The hospital is now in Skyn, Badnig and Strasby community hospitals, with both facilities delivering healthcare right across the communities that they serve, bringing benefits to the people of Highlands. The cabinet secretary will be aware that in the sky there is no urgent care available at Port Tree hospital, and the number of beds have been cut in half. In Shetland, there are concerns of when the proposed replacement for the Gilbert Bayne hospital will be delivered and no confirmed timetable is yet. In Fort William, the new Bedford hospital was originally supposed to be delivered this year, but that date has now moved to 2028 at the earliest. Can the cabinet secretary give assurances to my constituents in the north of Skye that services in Port Tree will face no further cuts and that urgent care will be restored? Will he confirm from my constituents in Shetland that plans for the new hospital are progressing and that a clearer timetable for completion will be available soon? Will he give a commitment to my constituents in Lekaba that the delayed new Bedford hospital will be delivered by the now extended date? I am conscious that I have a three-part question. In the interests of brevity, what I could do is write to Jamie Halcro Johnston with each of the projects that he has listed. I have also written to community members most recently in Fort William about the Lekaba project, so I am happy to give him updates in that respect. We, of course, have a limited finite budget. We have to make prioritisation within that budget given the constraints of it. What does not help, of course, is having £650 million ripped out of that budget because of sky-high inflation costs, but what I will do is write to the member with full details of the projects that he has raised. Gilbert Bain hospital in Llerwick opened in 1961 and the current building footprint does not allow for modifications to meet and deliver modern hospital requirements. The case for a new building has been used in the making, so when will Shetland get a new hospital? I have been to the Gilbert Bain hospital and she is right, of course. It requires investment, she will say replacement, and I do not disagree with her in that regard, but I have just outlined the fact that we have a capital investment project for health that is incredibly ambitious. I will give her an update when we are able to make further progress on that particular site. To ask the Scottish Government whether it still plans to launch a launching national care service in the current parliamentary session. I thank the minister for his optimism. I am not sure that I share it. Following criticism from stakeholders and members of committees of this Parliament, the minister is well aware of the huge practical and financial risks involved in the massive reorganisation of staff across care services, including the potential transfer of 75,000 local government employees to his centralised service. Is the minister able to say whether the financial memorandum to the bill fully includes the cost of asset transfers, the full cost of two-pay transfer of staff, any resulting costs associated with pay terms, conditions and pensions, and the impact of the application of VAT? That was a five-part question there, Presiding Officer. What I would say is that any spending decisions on the national care service will be backed by rigorous evidence-based decisions. The costs in the financial memorandum largely represent investment in service improvements and terms and conditions for front-line care staff. Any insinuation suggestion that the figures relate exclusively to admin costs are totally false. Beyond that, our 2022-23 budget confirm more than £1.6 billion for social care and integration to lay the groundwork for the national care service. Brief supplementaries, and that means our question. Evelyn Tweed first. Around one person in 25 receives social care, social work and occupational health support in Scotland and demand is forecast to grow. To what extent is establishing the national care service a precondition to ensuring that we meet those future needs while delivering the consistent and high standards needed? We have been clear that we must design a national care service that is sustainable and future-proof, taking account of the changing needs of Scotland's population. We have also been clear about the benefits of framework legislation in that respect. Legislating for the detail on a national care service in secondary legislation will allow our laws to keep up with the pace of population change and help to close the implementation gaps that many of those folks who receive care and support say that we need to close. Trade unions, local government, professional associations, care providers in all sectors, carers and frontline workers are calling for a pause to legislation, but they are also concerned that the legislation will not meet the aspirations of the Feeley review into social care. Can the minister explain why he has failed to introduce key recommendations of the Feeley report right now, such as ending non-residential care charges, which was incidentally an SNP manifesto pledge? When will he listen to the stakeholders that we have seen? Mr O'Kane missed out on one key group that definitely wants change, and that is people. People who are in receipt of care and support, their carers and others are in favour of that, and that was shown in the consultation. I have to say to Mr O'Kane that the Government would like to do much, much more in terms of changing our social care system and providing greater investment, but that is not possible in the current financial climate. It is a bit grim the fact that Labour continues to support rule from Westminster, where Tory chancellors keep a firm grip on the purse strings and do not allow investment in our public services. To ask the Scottish Government what steps it is taking to ensure that NHS staffing levels are maintained at appropriate levels. We have a strong track record of recruitment and staffing within the NHS, especially in comparison to other parts of the UK. The Scottish Government continues to take a number of steps to ensure that NHS staffing levels are at appropriate levels, including as part of our £600 million winter package of measures that we are providing funding to health boards to support the recruitment of 1,000 additional staff and measures to make it easier to retain andre higher-experienced staff. All that said, Deputy Presiding Officer, I am under no illusion whatsoever at just how pressure the system currently is and the impact that that will be having on staff to patient ratios. I thank the cabinet secretary for that answer. The cabinet secretary will be aware of Labour's plan to end non-domicile tax status across the UK and use £3 billion in extra revenues to boost NHS staff numbers, including more newly-qualified nurses, more doctors, more midwives and more health visitors. That will represent the biggest medical training expansion in NHS history. With our NHS facing so many challenges, including unacceptable A&E waiting times, does the Scottish Government agree with me that Labour is right to end non-domicile tax status and will the cabinet secretary pledge to prioritise increasing NHS staffing with the Barnett consequentials from that policy? I would rather talk about the powers that we have in our hands. Of course, any powers that are held by Westminster—oh, they do not like that. One minute, they are castigating us, Presiding Officer, for even mentioning Westminster in the next minute when I am saying that we should be focused on the powers that we have in our hands. If there is anything that Neil Bibby wants to suggest that we can do, that is with our gift, I would welcome that suggestion. Anything that takes financial controls and leaves us away from the Conservative Party, who have already slashed our budget by £650 million just due to the financial incompetence, I welcome any of that. What will not help staffing in the NHS is Keir Starmer's insistence of talking down our overseas workers in the NHS, who make a fantastic contribution to the NHS here in Scotland. I think that somebody in Scottish Labour should stand up and apologise for Keir Starmer's continued anti-immigration rhetoric. I am not now able to take any further supplementaries if we are going to get through the questions on the order paper, which is highly regrettable. I call question number seven, Fergus Ewing. To ask the Scottish Government what action it can take to support the GP-led Covid-19 and flu vaccination programme in NHS Highland in light of reports that it would cost several million pounds less than the model proposed by the NHS Highland board. The Scottish Government will continue to support NHS Highland to determine whatever delivery mechanisms it considers best for delivery of the winter programme and has not and will not veto the use of primary care. Within that, let me give the member an absolute assurance on that. For the other vaccination programmes that I understand the proposed NHS Highland model concerns, GPs have a key role in forming the local primary care improvement plans, which set out how the vaccine transformation programme and other elements of the GP contract are delivered in each and every area. I would expect NHS Highland to benefit from the experience of its GPs in designing vaccination services that are cost effective and allow the greatest use of all funds and work towards the best experience possible for our patients. GPs provided the service for £1.5 million a year. The NHS Highland model is up to £9 million a year. Will the cabinet secretary ask his officials to engage directly with the GP practice in there and others representing GPs in the Highlands to devise a system of provision of vaccination services that is safest, most efficient, community-based and led by GPs, and which, on the evidence available, would be likely to save several million pounds for the taxpayer when compared to the health board proposals? I will ask my officials to engage directly. I will go on further and I will engage directly with NHS Highland on the issues that the member has raised. He is right that those things have to be balanced. Of course, at the time of severe financial constraints, we should be looking to get the best value for money, but also ensuring that people have the access that they need for vaccinations. The winter Covid and flu vaccination programme is nearing its end, but it is certainly in advance of any potential future booster campaign. I will engage with NHS Highland very much on the matters that Fergus Ewing is talking about. I would like to ask the Scottish Government what steps it is taking to improve access to treatment for people with Crohn's disease. The Scottish Government is committed to ensuring that everyone living with Crohn's disease can access the best possible care and support and benefit from safe, effective and personal-centred healthcare services. The Scottish Government-funded modernising patient pathways programme, Triple P, has a specific work stream in inflammatory bowel disease. That work stream is driving improvements that will support a standardised and equitable service across Scotland. The Scottish Government also funds NHS Research Scotland, and that includes a gastroenterology specialty group that leads on research into Crohn's disease, focusing on a range of areas, including early diagnosis and new treatments. I have received emails from multiple constituents on the detailing incidents where they are dissatisfied with the treatment of Crohn's disease in the NHS Tayside region. They express concerns about lack of communication over their care, time taken between testing and diagnosis, and inadequate availability of certain treatments. What can the minister do to assure my constituents that there will be an all-round improvement in the care and treatment in the NHS Tayside region? I am well aware that the diagnosis of Crohn's disease can be difficult, and that the service at NHS Tayside is supported by a robust multidisciplinary team structure to ensure that appropriate diagnosis and treatments provided by the board are consistent with national guidelines for the management of inflammatory bowel disease and are discussed by the multidisciplinary team when changes are required. Another specialist consultant has recently been appointed to the inflammatory bowel disease team in the NHS Tayside region, which will increase the total number of specialist consultants to six, working alongside the specialised nursing team. The board also offers multiple support services to patients, including the hot clinic and the IBD hotline specialist monitoring clinics for different treatments and nurse-led review clinics. In addition, one of the consultants sits in the cross-party group for IBD, and the team is fully engaged with the work of Crohn's and Colitis UK in order to hear and respond to the needs of patients with these and other IBD conditions. Improvement work for Crohn's and Colitis services is under way at the national level through the MCCP gastroenterology programme, as I mentioned, with work focused on the redesign of pathways and intervention inventions to provide timely and effective care for patients. That concludes portfolio questions. We got through all the questions on the paper, but I am conscious that members from all parties were not able to be called during supplementaries, which is, as I say, highly regrettable. It is not helped by members asking questions that have multiple sub-questions built into them, but equally it is not helpful when ministers give responses that last as long as they have during this session, both in terms of the initial questions and in response to the supplementaries. I would hope that that we take an into account for future portfolio questions, and with that we pause before moving on to the next item of business.