 Rwy'n credu i chi'n gael eich gwirio cydweithiau oedd yn ei cyflidrach i яw y До mor Llywodraeth i chi'n ymgyrch yn ei gwybod a'u gael eich cydweithiau oedd yn eich gwellio cydweithiau. Yr eich cyflidrach oedd o'r選ffau i chi i chi'n gwirio cydweithiau, oedden nhw'n mynd i chi'n gael eich gwirio cydweithiau. Y rhyf, mae'r cydweithiau i chi'n gael eich gwirio cydweithiau a'r cydweithiau oedd iser health and social care. Can I ask members who wish to request a supplementary question? They should press their request-to-speak buttons or put an R in the chat function if they are joining us remotely during the relevant question. I call question number one, Donald Cameron. To ask the Scottish Government whether it will provide an update on NHS Highland's independent review into allegations of staff bullying in our Garland butte. Many improvement actions have already been delivered in response to the independent review of culture in our Garland butte and that was recommended by John Sturrick, who sees in his review into cultural issues in NHS Highland. NHS Highland has reported that there has been significant discussion at the board and within health and social care partnerships to explore how they may work together to support staff from across both health and social care who have experienced bullying. The leadership team has held a number of staff engagement events to tell staff about the actions taken and listen to staff feedback. The actions include an independent helpline for staff to discuss concerns, an independent review of disciplinary, grievance, bullying and harassment procedures, a wider roll-out of the courageous conversations programme, a monthly assurance panel to review hiring decisions and to build trust. The Scottish Government continues to support NHS Highland as it takes forward actions in response to this report, the report by John Sturrick QC and the recent independent listening and hearing survey. I am very grateful for that update from the cabinet secretary. He may be aware that there were calls in the last session of the Scottish Parliament to hold a debate on the findings in the STIRIC report. The First Minister herself said that she was broadly sympathetic to the issue. Will he commit to holding a debate in Government time on this important issue so that victims of bullying across the NHS, wherever they are in Scotland, feel that they are being listened to and that we do not abandon them? First and foremost, I thank Donald Cameron for raising the issue. I should also mention that Emma Roddick MSP and Edward Mountain MSP have raised those issues, and they are incredibly important issues that the Government takes seriously. I suspect that for all of our political differences, we are united on the fact that there should be a zero-tolerance approach to any bullying and harassment anywhere in the workplace, let alone within our NHS and social care. I would say about a debate that has not been ruled out, but he knows that we are currently in the midst of a global pandemic. He would have heard the priorities from the programme for government yesterday. That will be our immediate focus in terms of parliamentary debates. I would not rule it out in the future. I also note that the Conservative Party might have an opposition debate next week, so it could also bring that debate forward if it so choose to do so. If it did, I would respond on behalf of the Government. To ask the Scottish Government what importance it places on recognising and addressing the societal issues that contribute to poor mental health. Poverty is the single biggest driver of poor mental health, and that is why we continue to urge the UK Government to reverse their decision on cutting the uplift of universal credit. We know that the pandemic has exacerbated pre-existing structural inequality in our society and that the adverse impacts on mental health are felt disproportionately by disadvantaged groups. In our mental health transition and recovery plan, we have committed to making the mental health of those groups a priority. We also know that other social determinants, including employment and debt, can impact on mental health and wellbeing. We are working with employers, trade unions and other organisations, including the money and pension service and Citizens Advice Scotland, to better understand and tackle those issues. Recent summary carried out by the medical and dental defence union of Scotland showed that 47 per cent of Scottish GP members and 58 per cent of dentist members reported higher levels of stress because of the pandemic. Can I ask the minister what measures have been put in place to support the mental health of all NHS staff? Our health recovery plan, published on 25 August, outlines that recovery of staff is intrinsic to our collective ambitions for renewing our NHS. The Government is providing £8 million this financial year to support the mental health and wellbeing of the health and social care workforce. That includes targeted support to the primary care and social care workforces of £2 million. A range of national resources are available to support the mental health and wellbeing of those who are working in health and social care. That includes the national wellbeing hub, which provides self-care and digital resources, the national wellbeing helpline, which provides a 24-7 service to those who require psychological support and can offer advice, signposting and onward referral to local services where required. We also have coaching for wellbeing, a free-to-access digital coaching service, and we have the workforce specialist service as well. Additional capacity within boards has been put in place to provide psychological therapies and interventions to support staff's mental health. I have a number of supplementaries. I want to take all of them, so I will need brief questions and brief answers. The Cabinet Secretary for Health and Sport conceded yesterday that waiting times for child and adolescent mental health services are, I quote, unacceptable, and he admitted that the targets were being badly missed before the pandemic. We found out this week that camera referral rates are now the highest on record, with one in every 100 children being referred for specialist care. So will the minister now outline what he intends to do to honour its commitment, the Government's commitment, to increase the CAMHS workforce by 320 new staff? First of all, I would outline to Mr Hoy that, since this Government came to power, the CAMHS workforce has risen by some 80 per cent. We will continue to ensure that we do our level best to reduce waiting times and to do what is required to improve services for those in need. What would be helpful in all of this is if we did not have that continued austerity agenda, so we could employ even more staff. What I would say to Mr Hoy and to his Conservative colleagues is that we should try and persuade the UK Government to reverse their austerity policies so that we can invest even more in our public services here in Scotland. The reality is that societal issues such as poverty have a major impact on children and adolescents. The waiting times in Fife for carms are at an unacceptable level and rising. Will the minister agree to meet me so that we can have a discussion on those issues and see what the Scottish Government can do to support Fife NHS by trying to get those waiting times down? As always, I am more than happy to meet Mr Riley to discuss this or any other issues. I recognise that there is a difficulty in Fife. As members will know, I have spoken to a number of health boards about actions that I feel that they need to take to improve services further. We have given some £29 million of additional support to bring CAMHS waiting lists round, but I am more than happy to discuss those issues further with Mr Riley in a constructive manner. The minister listed a lot of contributors to poor mental health, but I did not hear or mention the fact that we have enormous long lists and the contribution that that makes to the worsening mental health in this country. If people have to wait up to two years to get treatment, it is no surprise that their mental health does not improve. Is he going to do something about it at last? We have laid out what we are going to do in terms of our action plans. I am determined, the Government is determined to ensure that the additional resources that we have put in play are used effectively to do the best for the people of this country, particularly the young folk who are waiting on treatment. To ask the Scottish Government what the average waiting time is for cataract surgery. Public Health Scotland published the most recent stage of treatment data on 31 August. It showed that the median weight during the quarter ending 30 June 2021 for ophthalmology treatment was 52 days. Over half 54 per cent of those waiting for ophthalmology treatment had been waiting nine weeks or less. The Scottish Government does not hold subspecialty information, which would cover cataract procedures. We recognise that a backlog of care has emerged during the pandemic as a result of services being paused. However, cataract procedures have still continued during this challenging time. To support that, the Scottish Government has made £1.75 million available to NHS Golden Jubilee to support additional cataract procedures this financial year. I thank the cabinet secretary for that answer. Obviously, all of this is with the pandemic as a backdrop. I have been contacted by a constituent who has been advised by NHS Lanarkshire that she will have to wait at least 70 weeks for cataract surgery unless she pays for private healthcare. My constituent's eyesight is deteriorating rapidly and she is terrified that she will soon be unable to drive or perform her duties as a teacher. Can the cabinet secretary advise what support the Government can provide to NHS Lanarkshire to help to reduce its waiting time for cataract surgery? I share Gillian Mackay's concern. I know that she has corresponded with me, but I would ask Gillian Mackay to provide the details of the constituent. I know that she has corresponded with the general, but if she could give details of the specific constituent that I am more than happy for that case to be investigated. Like her, I would have also nervousness about somebody having to wait 70 weeks for a cataract operation. We are giving additional funding to the Golden Jubilee, their plan on delivering 12,000 cataract surgeries in core sessions this financial year. That is 4,000 more than they delivered the previous year, but we know that there is a significant backlog across all procedures, and that is why we published our NHS recovery plan at the end of last month. I was trying to go too fast, but I tripped up. Across my health board with her heroic front-line staff under unprecedented pressure, we are seeing cancellations of elective surgery appointments, leaving thousands to wait and pain before they can get the surgery that they need. That is having a brutal knock-on effect on A and E being the fourth week in a row where waiting times have hit the worst level on record. Can I ask the cabinet secretary what reassurances can be given to staff and when will our winter preparedness plan be published? I did not catch the very end of that question, but what I would say to Annie Wells is that we take that significant challenge extremely seriously. As the Secretary of State in England and as health ministers do in Wales and Northern Ireland, we are facing this collective challenge that has been exacerbated, extremely significantly exacerbated, by the effects of the pandemic. Our recovery plan, which is backed by £1 billion worth of investment, goes into significant detail about how we will increase in-patient activity by 20 per cent of the lifetime of this Parliament, outpatient by 10 per cent, and diagnostics significantly by more than 70,000 by 2022-23 in its detail. I am more than happy to meet the member to discuss that in more detail. Those are challenging decisions that health boards are making, and we will continue to fund them and give them the investment that they need, but we will also take care of our staff's mental and physical wellbeing, because they are crucial to helping us to meet those targets in our recovery plan. I note that we have supplementaries for most of the rest of the questions, so I want to get those supplementaries in, so I would appreciate brief questions and ministerial cabinet secretary's brief answers. To ask the Scottish Government when it last met with the National Autistic Society, in light of its reported concerns regarding support for families during the Covid-19 pandemic. I fully recognise the incredible pressure that the pandemic has had on autistic children, their families and carers. The Scottish Government meets with the National Autistic Society regularly. Officials last met with the National Autistic Society on 23 August, and I will meet with the director of the National Autistic Society shortly. The Scottish Government has provided significant additional funding to help to meet those pressures, including £170,000 to national autism charities, £28.5 million for local carer support and a further £1.1 million last year to the voluntary sector short break funds. We also published our towards transformation plan in March. The director of the National Autistic Society Scotland has warned that the pandemic has removed critical support for families that have left carers and young people struggling. Homeschooling was difficult for children with autism to adjust to, with statistics showing that 63 per cent of autistic young people missed attending school. In addition, figures from the Autism Centre for Education also revealed uncertainty around education, which caused high levels of stress and anxiety. What progress has been made on the Learning Disability, Autism and Neurodiversity Bill? When will families and people with autism receive the help and support that they deserve? Families will continue to receive the support, some of which have already outlined. As I say, I am sure that some of that will form part of the discussion that I have with the director of NAS when we meet shortly. I should say that the Scottish Government, in terms of the Bill and the Learning Disability and Autism Commissioner, will carry out the scoping work for all that, the remit and powers, very soon within this parliamentary year. Following the successful passage of the Learning Disability, Autism and Neurodiversity Bill, a commissioner will be appointed as soon as possible. I know that there are some very diverse views around how we should move this forward. I aim to talk to as many stakeholders as possible about that so that we get the scoping work and remit and powers right. What action is being taken to support young children who are effective in masking or hiding their autism, causing delays in receiving a timely diagnosis in their early years of education? Specifically, what action is being taken to support young girls who are more likely to mask their symptoms and how will they adapt pre-pandemic plans to do more to work with the affected families to focus on identifying and supporting those children? I thank you. I will start by saying to Ms Hyslop that I will write to her because there is a lot of work going on here, but very briefly, new guidance commissioned by the Scottish Government and published by the National Autism Implementation Team in May this year supports areas to develop local children's neurodevelopmental pathways. We know that there are challenges and diagnosis, particularly with young females who are able to mask the condition. We will do more in terms of developing the guidance to get this absolutely right. As I say, this is a complex area, and I will write to Ms Hyslop in some depth and any other member who requires that information. To ask the Scottish Government what support is available to dental practices to alleviate pressures specifically related to Covid-19. Minister Marie Todd joins us remotely. The Scottish Government is fully committed to supporting the NHS dental sector, which is why, from the beginning of the pandemic, we have put in place emergency support payments for NHS practices and dentists, which includes £33 million of additional funding per year. We have also recently announced £7.5 million of funding for dentists to buy new equipment to help to reduce the impact of UK-wide Covid restrictions. That builds on the £5 million that we have already provided to the sector for ventilation improvements. National procurement continues to provide around £1.5 million of PPE per week free of charge to dental contractors providing NHS care. We expect those measures to increase the productivity of practices, enabling them to see more patients within the current infection prevention and control constraints. I thank the minister for that. In my constituency, plain street dental practice has the responsibility for 6,000 patients, yet due to funding structures in place for Covid support, when one dentist left during the pandemic, the practice lost 25% funding, despite patient numbers remaining the same. Balancing reduced staff and physical distancing while ensuring dental care for thousands of patients places increasing demand on practices. Will the Scottish Government agree that the anomaly is unfair on practices in such situations? Will the Government commit to evaluating how that policy can be adapted to ensure proportionate funding is maintained? I thank the member for that question. We are certainly interested in working with dental practices to ensure that they are financially sustainable. Our commitment in programme for government to providing free dental care shows absolutely the priority that we give to dental care for the population. We have provided significant funding for contractors to provide NHS dental services. Dentists have received a top-up payment of 80 per cent of their average monthly earnings from 2019 to 2020, and from November 2020 we increased that to 85 per cent. That remains in place. I am more than happy to hear more details of the situation in the that the member raises in his constituency. If he could write to me, I can certainly look into that particular situation and give him a fuller, more individual response. With dental practices across Scotland currently operating at restrictive capacity in line with those Covid restrictions, there have been worrying reports that, while NHS patients are having to wait months to see a dentist, those who can afford to go private are being seen within days. Is the minister not concerned that we are seeing the development of a two-tier dental system in Scotland? What steps will be taken to ensure that NHS patients who cannot afford private dental care still receive timely treatment that they need and are entitled to? I thank the member for that question. We are absolutely committed to NHS dental care and we are absolutely committed to supporting and protecting NHS dental care for all patients in Scotland. By the end of this term of Parliament, everyone in Scotland will be able to access free NHS dental care. There are particular challenges for the dental sector because of Covid, because the majority of procedures involve aerosol generating procedures. We have put in place funding to support enhanced ventilation in NHS practices, and we have also put in funding to support different types of hand-held instruments that are less likely to generate aerosols. We are doing what we can within the constraints of the pandemic to increase capacity for NHS dental care. Our commitment to NHS dental care is absolutely, fundamentally strong. To ask the Scottish Government what action it is taking to address the reported backlog of the NHS operations. We published our NHS recovery plan on 25 August that outlines our ambitions of increasing NHS capacity by at least 10 per cent as quickly as possible in order to address the backlog and meet the on-going healthcare needs for people across the country. That is, of course, backed by £1 billion of additional Scottish Government investment. For this year alone, we have made more than £80 million available to support health boards, specifically to target the backlog of treatment and care. However, we need to remember that the pandemic is not over and that Covid-19 and other pressures will impact on the NHS for some time to come. Health boards' elective activity is being monitored through daily and weekly returns to the Scottish Government and support provided where required. I thank the cabinet secretary for the answer. We have ambulances queuing out the door of A&Es, record waiting times, all of which putting patients' lives at risk. In my own region, I have constituents reported a stroke, a heart attack. In one example, an ambulance— We need a question, Ms Gosum. One ambulance was called at 2.30am and came at 4.45am next morning. I contacted you about this, cabinet minister, and I am still waiting for a response, and that has been over a month. Can I therefore ask the cabinet secretary how he can help patients like my constituents to get the help and support that they need from the paramedics who are desperate to deliver it? I first start by thanking the ambulance service for the incredible work that they are doing when they are facing such significant pressures—pandemic pressures—that have built up the demand that Pam Gosall and all of us are seeing in the constituencies and regions that we represent. For the ambulance service specifically, we have given an additional £20 million that was already invested, and now we are starting to see recruitment come on board. In fact, last week, additional recruitment of 60 odd paramedics and ambulance staff into the north and northeast of the country. We will back that by £1 billion of additional investment. That will help to increase our capacity. However, what we will not do is when it comes to that additional £1 billion to aid our recovery, which is, by the way, £400 million more than the Conservatives are looking to spend, we will not hammer the lowest paid in order to pay for that recovery. We will make sure that that recovery, that additional investment that we bring forward, does not hit those who have already been hit hardest by the pandemic. To ask the Scottish Government what plans it has to support rural health services following the end of Covid-19 pandemic. Our NHS recovery plan sets out key ambitions and actions to be developed and delivered now and over the next five years, and that includes in rural areas. The recovery plan, as I say, has been backed by £1 billion of targeted investment. Scottish Government remains committed to the recommendations set out Sir Lewis Ritchie's shaping the future together, remote and rural general practice working group report, which aims to enhance primary care across remote, rural and island communities by ensuring stability for rural GP incomes alongside other measures that support innovative approaches to the use of IT and physical infrastructure, as well as supporting recruitment and retention practices in rural areas. Following the 2021 Scottish parliamentary elections, the recommendation to create a centre for excellence for rural and remote medicine is now a Scottish Government manifesto commitment that we will deliver in this parliamentary session. Yesterday it was revealed that more than 1,600 children have been waiting over a year for mental health support. Alarmingly, in my constituency, nearly two thirds of young people seeking help have not been seen within the 18-week NHS target time. That is absolutely shameful, I am sure that the cabinet secretary will agree with me. It is a lost generation of vulnerable children and young people, particularly in the wake of the pandemic. Despite promises from the Scottish Government, services still remain under the doors. Can I ask when the Government will finally act and provide adequate and timely support from my constituents? We are acting, as my colleague Kevin Stewart outlined in a previous question. An 80 per cent increase in CAMHS staff under this Government increased spending on mental health, promised by this Government—a billion pounds of additional spending on the recovery plan by this Government—a 320 increase in CAMHS staff. Where there are specific issues in rural areas, as I am happy to work with the member to help to address those, I would give him an absolute and categorical assurance that the mental health, particularly of our children and young people, is a Government priority. Before inviting question 8, earlier in this session I asked members to be brief in their questions and ministers to be equally brief in their responses. I think that we have not seen any evidence of that this afternoon and so forth. I am going to have to consider how we go about trying to trim this back. We have three supplementaries on this question alone, none of which we will be able to take. Question 8, Mercedes Villalva, please. To ask the Scottish Government what steps it is taking to ensure that patients and staff at Old Aberdeen medical practice are consulted on the future provision of its GP services. Patient safety is absolute paramount in any changes to service provision. Integration authorities are legally required to engage and consult with staff, but it is also crucially patient to ensure the best outcomes for local communities. Aberdeen City partnership has extensively engaged with staff in the proposed changes and communicated their plans to patients, assuring them that they will continue to receive medical care at the practice. Mercedes Villalva. I thank the minister for his response. Until recently, Old Aberdeen medical practice was publicly run and it served the community well. I have met campaigners who are angry about the way in which it has been put out to tender and the previous minister ignored requests to intervene. Will the cabinet secretary agree to meet with the campaigners to hear their concerns? Of course, I absolutely consider that request. I would say that it is often from the Labour benches that we are told that government interferes and intervenes too much when it comes to local decision making. Those are local decisions to be made by local integration authorities. Now you are asking for central government to now intervene and interfere in that decision making against the best judgment of the integration authority. However, if Ms Villalva writes to me, I will consider meeting her and indeed campaigners about what I know is an important local issue. Thank you. There will be a brief interlude before we move to the next item of business.