 The next item of business is a statement by Michael Matheson on planning for winter 2023-24 and ongoing resilience across health and social care. The cabinet secretary will take questions at the end of his statement, therefore there should be no interruptions or interventions. I invite cabinet secretary for around 10 minutes please. Thank you, Presiding Officer. We are in no doubt that this winter will be extremely challenging for our health and social care system. We continue to see change in the demand for health and care services, the population's needs and care packages required are increasingly complex. This sits alongside the rise in the number of patients who see every winter with respiratory illnesses and winter-related injuries from falls and accidents. The winter plan that we are publishing today has been developed jointly with our COSLA partners. It is the articulation of a huge amount of planning and preparatory work already well under way across the whole system. The Scottish Government and COSLA have been supporting the system to be as ready as possible for the pressures it will face since the end of last winter, so that people can continue to have access to health and social care services and the support that they need when they need it most. This winter plan is built around three critical principles. First, the actions that we take must centre around our citizens and the best outcomes for them, so that they can access the right care at the right time and in the right place. Second, we are taking a whole system approach, recognising that pressures in one part of the health and social care system create challenges and pressures elsewhere. Third and finally, we are building on the lessons that we have learned from previous winters and must consistently, with Bairn wavering in our focus, undertake local and national actions that we know that work. There are a number of key differences in our approach to winter planning this year. The planning cycle for this winter started in early spring, earlier than ever before, and recognises that such in demand for health and social care services do not only happen in winter. As on tension that in future years we undertake such planning on an ongoing basis given the sustained pressure, the system is under all year round. We issued a delayed discharge on hospital occupancy action plan to NHS boards and health and social care partnerships in March this year. The actions and best practice this outlined are critical to improving outcomes for patients, flow through the system and capacity in our hospitals. Those fundamentals are reiterated in the winter plan and I would want to urge system leaders to redouble their efforts to adopt and sustain those actions. Additionally, we convened the first NHS and social care winter summit in August. This summit brought together more than 300 leaders from across Scotland's health and social care services to share best practice and local plans for this winter. I was particularly pleased that social care providers, local government leaders and the third sector were all present. We also issued a winter preparedness checklist to local systems in September and have subsequently been taking action on returns from that checklist, ensuring that we have a clear understanding of risk to the system both locally and nationally. We have vastly improved the quality of data and reporting needed to help us and the system to spot issues as they begin to emerge and for us to understand when escalation is appropriate. Let me now turn to our highly skilled and committed workforce, who are the cornerstone of our response every winter, both in health and in social care. In order to meet increased demand and provide the best care possible for our citizens, we are continuing to focus on recruitment and retention of our workforce, ensuring that we support the wellbeing of our staff throughout the challenging period ahead during periods of high demand. We are pursuing a range of different strategies to nurture and grow the workforce in both health and social care over the longer term. Within our health workforce, for example, I am pleased to see that, as a result of significant Scottish Government investment of over £15 million, an additional 1,000 nurses, midwives and allied health professionals from overseas have joined NHS Scotland in the last two years to bolster our existing workforce. In addition, we have already made available £3 million to support the recruitment of up to a further 250 registered personnel. Recruitment is presently on-going and many of the staff will be in post this winter. In social care workforce, we are working with partners and have a number of national social care campaigns in place, in addition to an international recruitment pilot. This investment in our workforce will continue. I am pleased to announce today that £50 million funding boost will be given to the Scottish Ambulance Service this year to help to support with increased demand, particularly ahead of the winter period. Helped in part at this funding, work is presently under way to recruit a further 317 front-line staff to increase capacity for emergency response, as well as additional staff within call centres. That builds on the record number of additional staff that have been recruited to the Scottish Ambulance Service with 1,388 people joining the service in the last three years alone. That investment will help to reduce the need for people to go to hospital by increasing the number of clinicians working in the services integrated clinical hub, improving triage for patients who may not require an emergency response and enable people to receive the right care for them in the right place. Crucially, we are encouraging the system to adopt a home first approach when it is clinically appropriate to do so. Assessing and providing care in a home setting is better for people, better for their families and carers and also frees up workforce capacity, not only in our hostels but also across the social care sector. We are supporting our services to deliver this improvement in care delivery. The Scottish Government is significantly increasing investment in hospital at home, an initiative that provides acute care at home, which provides more personalised care for patients in their own home. This way of delivering care is preferred by the majority of people seeking support with improved levels of patient satisfaction and consistently achieves equivalent or better results. We are already investing an additional £3.6 million this financial year for local systems to expand the service and increase the number of patients treated in this way. I can also announce today additional funding of up to £12 million to further expand our hospital at home service. This funding will be targeted towards the expansion of hospital at home during this financial year, with anticipated delivery of at least 380 more hospital at home beds this winter, significantly increasing capacity in our system. This will have an all-con impact of reducing the need for emergency admissions every single week, and in turn, this will have an impact on reducing pressure on A&E and throughout the system. Of course, it will be better for people who need acute care. This winter plan clearly seeks to address the specific operational pressures experienced across the health and social care system over winter, with actions already under way to improve services. However, we know that longer-term solutions are needed, and we are continuing to engage separately with local government, the NHS, trade unions and other key partners on the wider improvements needed in the development of the national care service. Longer-term, our joint working towards establishing a national care service is a key means to delivering sustained change to respond to the challenge that we know our social care system is facing this winter and beyond. Even with the significant level of effort that has been over the past few months across the whole system, winter remains a concern. If we arrive at a point where measures set out in the winter plan are simply not enough to cope with the surges in demand for health and social care services, we will not hesitate to act to support the system, working closely with our partners in COSLA and beyond. This winter plan is not a starting point for action. It is the articulation of many months of whole system collaboration for this winter. Building on the lessons learned from previous years and partners working together to deliver the best care for the people of Scotland. The Scottish Government and COSLA have been working tirelessly to create the conditions needed for the whole system to deliver, and we are united in our resolve to provide safe and timely access to health and social care services over the winter period. Those, while sobering, will be of little surprise to anyone who had to wait hours to be seen at A&E last winter, to those who were unable to be seen by their GP, and thousands more who were left languishing on NHS waiting lists, despite the heroic efforts of clinical staff. That makes it all the more important that the SNP Government get things right this winter and all year round, so that patients are never again subjected to these kinds of conditions. However, all the signs once again point to another disastrous winter for our NHS under the SNP. John Paul Lowry of the Royal College of Emergency Medicine told the Health, Social Care and Sports Committee that this is no longer a winter problem, this is an NHS in crisis problem and short-term winter reactions is only crisis mitigation. Does the cabinet secretary agree that we need to take a more holistic approach to secondary care rather than simply moving from one crisis to the next? Let me deal with the first point that Mr Gohani raised and that was in relation to the mortality rates. I am sure that he will recognise that there are a variety of reasons as to why there appears to have been an increase in mortality rates, not just here in Scotland but across the UK, which is noted within the actual publication that was issued this morning in itself. I think to try and apply that as though some form of reflection on the present performance of the A&E would be inaccurate. I do not think that it would give people the correct impression as to why there has been an increase in mortality rates. I would also turn to the second point and that is the need for a holistic approach because I acknowledged in my statement the winter plan acknowledges that the system is under pressure throughout the year. It has become particularly acute during the winter months for particular reasons with an increase in respiratory conditions, weather that can have an impact on health, all of those factors that add additional pressures to it. I accept that there is a need to take a holistic approach to it, which is why we have taken a whole systems approach to it this winter, to try to make sure that we do everything that we can, not just on the healthcare side but also on the wider social care side, to help to support the system through what will be a very challenging period for those who work within it and those who will be making use of it during that time. Jackie Baillie I welcome the cabinet secretary's statement and thank him for an advance copy. I also want to thank the many staff in our NHS and social care that support us all year round. I also too want to raise the report from National Records Scotland that revealed that 24,427 people died in Scotland last winter alone. That is a staggering 11 per cent jump on the previous year. This is the highest number of winter deaths in over 30 years and at the same time delayed discharge was the highest it has ever been last winter and this would have had some effect on the number. Does the cabinet secretary acknowledge that last year the Scottish Government failed to deliver a comprehensive winter plan, resulting in a last minute scramble to roll out additional support in January? Given that delayed discharge was sitting at 1,700 in August, assuming that his plan works, what does he expect the number to be in January? Jackie Baillie Let me turn to the issue of mortality rates. The increase in mortality rates are not peculiar to Scotland. There has been an increase in mortality rates across the whole of the UK, a significant increase. As the report recognises for a variety of reasons, one of the biggest drivers of an increase in mortality rate over the course of last decade has been austerity policy, which is quite literally killing people as a result of the impact that it has directly on services. You only have to look at the report that was published earlier this year from the sense for population health in Glasgow, highlighting the real impact that austerity is now having on our most deprived communities in driving up inequalities and also rates of mortality overall. In relation to the point that the member made about the need to make sure that we have appropriate planning, what I have been keen to do is to try to make sure that the plan that we take for this year is looking at all aspects of the system, the interrelated nature of them, the way in which the health service is dependent on social care and the way social care is dependent on the healthcare system. As the report acknowledges, we have learned lessons from last year and we have tried to implement the actions that we can take to try to address some of the challenges that we faced last year. However, I will not be foolish enough to come here and suggest that this will resolve all the issues, that this winter plan will make sure that we will not have pressures in the system, that everything will go perfectly, that there will be difficulties and challenges in the system. What the winter plan does is to put in place a mechanism to try to deal with those as effectively as we can and the different parts of the system in which to do so. On the final point about delayed discharges, the challenges that we have around delayed discharges are not so much about the figure in themselves. It is because the length of time that patients are now staying in hospital has increased, the level of acuity has increased. As a consequence, pressure is across the whole of the system. Those who are delayed will end up having harm caused them because they cannot get discharged into the community at an early enough stage. That pressure on the system is critical to trying to address that issue. To do that, I believe that the most effective means to do it would be through a national care service. We can get a consistent approach across the country because we can see in different health and social care partnerships performance, which is good and other areas where it is not. That is why we need to move to a service that will allow us to deal with this more effectively across the whole of the country. I will need a bit more brevity with the responses that I now call Christine Grahame to be followed by Tess White. I reference in the cabinet statement the increase in weather-related injuries from falls and accidents. I have read the winter plan and the humble word pavements does not appear. This is not a frivolous observation. Icy pavements are an obvious contributor to winter pressures throughout the health and social care service at all levels due to avoidable falls. Can I therefore ask in discussions with COSLA, for example, on providing self-service sand and salt bins by street, do we have progress? If not, can that be progressed? That sounds like a silly observation, but isn't it silly about it that many people fall on Icy pavements? I do recognise that, historically, there have been challenges during winter months where weather has been adverse and where there has been Icy periods where accident and emergency departments can be busy with individuals who have slipped and fallen, broken wrists, hips, ankles etc. It has been a long-standing issue. I cannot say that the winter plan is to deal with issues within the health and social care system. I need to make sure that local authorities are doing everything they can to help to provide communities with resources to allow them where necessary to be able to distribute salt within their local street or where the council are providing that as well. I certainly want to encourage local authorities to play their part in helping to make sure that we are taking the right actions to try to make sure that pavements are safe during periods of adverse weather. Tess White, to be followed by Kevin Stewart. I would also like to pray tribute to our hardworking NHS staff. Cabinet Secretary, in February this year Aberdeen Royal Infirmary declared a major incident due to a perfect storm of staffing pressures, bed blocking and ambulance stacking. Other hospitals were on the brink of doing the same. The reality is that the health care system is already at breaking point, even before the pressures of winter put greater strain on services and staff who are at rock bottom, rural and at breaking point. How can this SNP Government expect things to be different this time around when the wheels are already off the bus? Some of the challenges and pressures that we face in grampine are similar to the pressures that our NHS across the whole of Scotland is facing. In fact, similar to the pressures that our NHS is facing across the whole of the UK. The member made particular reference to the pressures on accident emergency in grampine, but if we look at the data in Scotland for accident emergency performance, it is for the last eight years that has outperformed all accident emergency provision across the whole of the UK. I know that for those who go to accident emergency and do not receive the service that they would wish to, that is called comfort to them. However, if we look at the performance relative to England, we are almost 9 per cent ahead of performance in England in A&E when it comes to four-hour waits. We are almost 10 per cent ahead of Wales and we are significantly above that for Northern Ireland. We are putting resources in to try to help to support these key services to support them where we can. Today I have announced £50 million of investment into our ambulance service, another £12 million that we have £15.6 million this year alone into hospital at home. That is the equivalent of another Aberdeen royal infirmary alone that we are providing funding for to help to support our NHS to take demand away from the front end of our hospitals, to support people in their communities, to make sure that we are seeing people seeing treatment through the ambulance service, diverter them to primary care where that is appropriate, to minor injury units where that is appropriate. We will keep taking action that is necessary to support the first-class staff that we have within our NHS and the funding and the approach that we are taking. I believe that it demonstrates that and our record over the course of the last 16 years demonstrates our commitment to making sure that we provide the best possible healthcare we can where possible. Aberdeen City Health and Social Care Partnership had intended to expand its hospital-at-home service from 37 beds to 55 beds by the end of March 2024, ensuring maximum efficient use of the current capacity, helping to provide acute care closer to home, supporting early discharge from hospital and providing alternatives to admission. I welcome the hospital-at-home announcement in the statement today. Does the cabinet secretary envisage that with this additional £12 million that expanding hospital-at-home and Aberdeen and in other places can now go further and faster for the benefit of our people? From the funding that we provided earlier on this year to partners, I know that, as Kevin Stewart mentioned, Grampian, the Elder Social Care Partnership and Aberdeen have been able to expand hospital-at-home. With this additional funding, they will be able to do further expansion of that service over the course of this winter period, providing support and care to patients at home when they require acute care in an appropriate way where it is clinically appropriate to do so. I should just point out to the member that this hospital-at-home service is larger for older people. However, there have been services in different parts of the country that have expanded into providing support to younger people and to those who have respiratory conditions as well. However, the expansion of hospital-at-home that I have announced today will allow us to provide at least an extra three hundred and eighty beds in the community, which, as I mentioned earlier on, alongside what we have already provided, is a 50 per cent increase in capacity at the present moment, which will make a significant difference to help to manage some of the challenges. Thank you, Cabinet Secretary. We are going to have to have brief responses as well as brief questions. Paul Sweeney to be followed by Evelyn Tweet. Thank you, Deputy Secretary of State. The Cabinet Secretary of State referenced the recruitment of 1,000 nurses, midwives and allied health professionals of the last two years, which is welcome. However, 7,000 vacancies in our NHS remain unfilled. Recruitment means little without a long-term retention strategy. Is he planned to ensure that those new NHS workers will stay in post, and how does the Government plan to fill the other 7,000 vacancies? I recognise the need to make sure that we not only recruit, but we also retain staff within our NHS, which is why we have the nursing and midwifery task force, which I chair, which has very specific actions on looking at how we can tackle both of those issues. We also recruit more people into our NHS, but we also help to retain staff within the NHS and work in that task force has already been taken forward, which will help to address those issues, which has partners from trade unions, educational and NHS services all across the task force, helping to support that work in order to make sure that we have a long-term plan to help to support both retention and recruitment into the NHS. Rural areas face additional challenges in winter, longer journeys and greater disruption due to poor weather. How will the Scottish Government ensure that those are accounted for? I recognise that there can be specific challenges within rural areas. Hospital at home is a very good example of a service that can be deployed within rural communities to help to support people to remain within their own home environment. The expansion of services that we have through things such as pharmacy first is a service that can be deployed within rural areas. The expansion that we have had of NHS 24 in the range of services that it is able to provide to individuals over the phone, including direct clinical support to individuals at home, can help to support people within rural communities such as everyone tweets during the winter months and throughout the course of the year. The warnings from NHS workers are as bad as they have ever been. They are being put in a situation by the Scottish Government that is as desperate as it is dangerous. The BMA says already exhausted staff find it, and I quote, demoralising and incredibly insulting to listen to Government assurances on staffing. The latest statistics bear that out, with 5,600 vacancies in nursing and midwifery and consultant vacancies also sky-high. Any plan to recover NHS to tackle horrendous waiting lists to get people treatment will fall flat without enough staff. Does the cabinet secretary recognise that there simply aren't enough staff to meet the challenge of the winter ahead? I recognise that we have staffing challenges within NHS here in Scotland, as is the case across the whole of the UK. He will be aware of that, but there are a variety of reasons as to why that is the case. What are we doing to try to address those things? We have increased our training provision in order to help to recruit more people into NHS staff training programmes, whether it be in HPEs or whether it be in nursing or whether it be in medical courses, in order to help to ensure that we have a sufficient throughput of training places to support the NHS going forward, and we will continue to work with the professional groups to make sure that we get that training balance right in order to try to recruit as many as we can into the NHS and to support our staff as well. I will finish on this point. One of the things that I think underscores the difference in the approach that we have taken here in Scotland around retention and recruitment of staff is through pay. NHS staff in Scotland are paid higher than any other part of the UK. We have avoided industrial action because of that. Our direct interaction with trade unions in order to pay our staff the right wages that they deserve in order to make sure that they can continue to provide the first class services that they do right across the country. We have four members wishing to ask a question. Four minutes to go. I am intending to get everybody in, but they will need to be brief. Following the First Minister's recent announcement of additional investment to tackle waiting lists, can the cabinet secretary outline how this £100 million annual package will improve services in East Kilbride and across Scotland while benefiting patients and staff and helping to ensure the NHS' resilience over the often challenging winter period? I recognise that there are patients who are waiting too long for the treatment that they require, which is why the additional £100 million and the £300 million over the next three years will be new investment that will tackle the issues that we have around waiting lists. That will allow us to treat an additional 100,000 patients through over the course of the next three years. It is a demonstration of this Government's determination to make sure that people receive the treatment that they require at the earliest possible point in the appropriate setting. Gillian Mackay, to be followed by Sue Webber. NHS Forth Valley in my region has faced extreme pressure on their A&A department in previous winters, affecting patients and staff alike. What action can the Government take to provide targeted support to those health boards that are facing particularly acute pressures? For those health board or health and social care partnerships where there are particular challenges, we work in partnership, directly in partnership with the health and social care partnership to make sure that they are taking forward a range of actions in order to address the pressures and the challenges that they are facing. I mentioned in my statement the winter preparedness checklist that has been issued. That has allowed us to draw in a lot of information on preparations that are in place in areas such as Forth Valley that cover my own constituency to look at the state of preparation and to then address areas where further actions need to be taken. That is the type of action that we are taking with health boards such as NHS Forth Valley and its partners to try to make sure that they are doing everything they can to be prepared for the winter pressures that they will face. Cabinet Secretary, substantial and sustained improvement on delayed discharge depends significantly on addressing social work and social care workforce issues. In response to the winter planning 2324 Scottish Parliament inquiry, Social Work Scotland highlighted the issue with non-recurring funding and the detrimental impact that it has on recruitment and retention of staff. There is difficulty filling posts due to short-term nature of the contract, leading to unintended consequences of gender of greater insecurity in the sector. What action will the cabinet secretary take to stop the ongoing deterioration of this workforce situation? We have gathered a range of work that we are taking forward in order to help to improve social work services, including additional funding that we have made available in order to increase recruitment of social workers. Alongside that, the work that we are taking forward in order to help to encourage people into the social care setting to make it an attractive place for people to pursue their caring career. That is a piece of work that will take time, but it is already work that is in action in order to help to try to address the challenges that we face within the social care setting. The additional funding for the Scottish Ambulance Service this year to support increased demand is very welcome. Can the cabinet secretary say some more about how this investment will be directed to improve things for patients and to reduce winter pressures on our health services? A key part of the £50 million investment that we are putting into the Scottish Ambulance Service is to allow them to recruit an extra 317 front-line staff to help to increase emergency response capacity. Alongside that, to provide 18 additional clinicians who work in their call centre hubs who will be able to provide additional triage services and to help to provide patients with advice and information where it is not time critical and where it does not require emergency response. What actions can they take in order to make sure that they deal with their condition or circumstances appropriately? That concludes the item of business. There will be a brief pause while the front bench changes and we move on to the next item of business.