 Y First item of business this afternoon is the point of order, Christine Grahame. Deputy Presiding Officer, events over the last week have been unprecedented. UK Government's decision to invoke a section 35 order in response to this Parliament overwhelmingly passing the gender recognition reform bill in December raises serious questions about devolution, which I believe should be a huge concern to every member serving the Scottish people in this institution. Furthermore, the consensus matter has been further amplified in recent days, given the UK Government, namely Alistair Jack and Kimi Bairinoch, refusing three invitations to appear before Scottish Parliament committees to explain the extraordinary use of a section 35 order to block a bill defined within the clear powers and responsibilities of this Parliament. In light of that, under rule 12.4 of standing orders, referencing section 23 of the Scotland Act 1998, I would like to ask you, Presiding Officer, what can be done to ensure that the UK Government respects this Parliament, the devolved powers of it and the legislation that you pass so that Parliament holds the UK Government accountable for blocking the passing of devolved law, as I have said, overwhelmingly supported across parties in the chamber? Thank you, Ms Graham, for an advanced notice of the point of order. I would observe that, in the first instance, I know that the letters have been sent out by the committees and I have noted the responses. In the first instance, it is a matter for the committees themselves to decide how they wish to proceed in eliciting the information that they are looking for. I do not think that there is an awful lot more I can add at this stage. We now need to progress with portfolio questions. The first portfolio this afternoon is rural affairs and islands. I would invite any members wishing to ask a supplementary to press the request to speak buttons during the relevant questions. As ever, there is quite a bit of interest, so the usual plea for brief questions and brief responses wherever possible. I will try to police that as lightly as is necessary. Question 1, Fiona Hyslop. To ask the Scottish Government regarding any impact on Scottish agriculture, what its most recent assessment is of the UK-New Zealand free trade agreement? The UK Government's own economic modelling for the New Zealand deal shows that agriculture and semi-processing sectors will be losing sectors. The former UK Government's Secretary of State for Environment, Food and Rural Affairs shares our view that this and the Australia deals are not very good deals for the UK. Scottish farmers have also been very clear that this trade deal, which provides New Zealand exporters unfettered access to the UK market, despite operating to lower cost and regulatory standards, will undercut domestic agri-food producers and put jobs and the rural economy at risk. The outcome is also in stark contrast to the recently negotiated EU New Zealand trade deal, which better protects their agri-food sector, reinforcing that the best place for Scotland is within the EU. Can I perhaps preface my next question by paying tribute to Scotland's most famous farmer and poet Robert Burns on this 25 January, his birthday? Is the cabinet secretary aware that Conservatives Lord Hannon of Kingslayer and UK Government Minister for International Trade, Lord Johnson of Lanson, both stated during a House of Lords debate that New Zealand lamb was better for the environment than a home-produced lamb? Does she agree that this is not only wrong and an insult to Scotland's farmers who work extremely hard to provide a product of internationally renowned quality and just demonstrates the continuing failure of the Conservative Party to defend and safeguard the interests of Scottish farmers? The member is absolutely right in what she is saying because we know that there have been a catalogue of failures to protect the interests of Scottish farmers. Whether that is from Brexit, we have also seen the abject failure of the UK Government to secure trade deals that actually protect our agri-food sector too. Trade deals, as I said in my initial response, that the former UK Secretary of State, who was in post during the negotiation of those agreements, has now also criticised now that he is no longer in that post. I also couldn't disagree more with the comments that were made during that Lord's debate. Scotch lamb is produced to some of the highest standards anywhere in the world, but even looking beyond the quality itself, when we look to the wider production and supply chain, it supports jobs right throughout our rural communities and economy. By eating Scotch lamb, we are supporting our local producers, rather than consuming a product that has been shipped halfway around the world with the obvious climate impact that that has. To ask the Scottish Government what consideration it has given to how the blue economy vision for Scotland can support developing industries within the blue economy in the drive to net zero. The blue economy vision represents a long-term strategy that serves as an overall framework for marine policies and actions. We have committed to mainstreaming a blue economy approach so that policies and decision makers have that clear alignment with that vision. So, for example, the blue economy vision is at the heart of the marine fund Scotland through which we are providing £14 million annually in grant funding to a range of sectors who support Scotland's net zero commitments. That protects and creates jobs in Scotland's coastal communities and it supports those local supply chains and industries to adapt, as well as to look to invest for the future. The value of natural capital is referenced across many of the Scottish Government's policies and strategies, including the blue economy vision and Scotland's blue economy approach paper. However, if we have to deliver a good policy that benefits Scotland's natural capital, we must have a complete understanding of what we have. Currently, there is a significant knowledge gap as NatureScot's natural capital asset index does not include marine habitats, citing a lack of available data as a reason for the exclusion. Given how vital good data is to good policy, can the minister explain how the Scottish Government proposes to improve the quality and quantity of their data gathering? I think that this is something that we are always looking to see where we can improve and what other information we can gather. Obviously, when we are taking decisions, we want to base that on the best available science and data that we have. Unfortunately, when it comes to the marine environment, the area is vast, and even with all the resources in our hand, it would be nigh on impossible to be able to map out all the assets that we would want to do, as well as to gather all the science and data that we have. That is why we have also set out a number of policies as to how best we adapt to that, how we develop policy in the absence of science and available data, as well as setting out how we intend to work to improve that where we possibly can. An important element of that is looking towards collaboration. How can we work with our stakeholders, industry and academic institutions, to try to build that science and evidence base? The Blue Economy paper states that it will consult on applying a cap to fishing activity in inshore waters that will limit activity to current levels and set a ceiling from which activities that disrupt the seabed can be reduced in the light of evidence that becomes available. Why are we only using evidence to reduce activity? Why are we not following wherever the evidence takes us, even if that means an increase in inshore fisheries activity? That follows on from Brian Whittle's point, and I think that the point that the member makes is an important one about gathering that data and gathering that evidence. I am not going to prejudge the outcome of any consultation that will be setting out, because, of course, we will be looking to set out more information and have more engagement on those policies in due course, but I would be happy to discuss that further with the member as we look to launch that consultation and as that policy continues to develop. Question 3 is from Sandra Skulhani, who joins us remotely. To ask the Scottish Government whether it will provide an update on avian flu, including any measures that are taking to tackle its spread. Since the start of October 2022, there have been 18 confirmed cases of highly pathogenic avian influenza H5N1 in poultry in captive birds and 81 findings in wild birds in Scotland. The Scottish Government responded to the risk of avian influenza from wild birds through the introduction of an avian influenza prevention zone in October 2022, requiring all birdkeepers to follow strict biosecurity measures and continues to remind keepers of those obligations. Scottish Government and its operational partners have a robust control strategy in place and a proven track record in dealing effectively and rapidly with controlling outbreaks. Sandra Skulhani, I think that we may have lost Dr Gulhani's connection. Thank you. This is an understanding boring time for poultry farmers and all those keeping birds. Scotland continues to be guided by the science, so can I ask the cabinet secretary to reiterate what the CVO has previously said on biosecurity? As a given, the key role has to play, this cannot be repeated enough. I thank the member for raising that point because he is absolutely right. I think that getting those measures out, that message out about biosecurity, we really cannot stress enough just how important those measures are. The scientific opinion that we have from EFSA concludes that housing birds give a twofold reduction in risk, but that is only effective if there are other good biosecurity measures in place. We know that, through adopting that high biosecurity, that gives a predicted 44-fold reduction in cases. Housing of birds that are normally kept in a free range way also has consequences for the welfare of birds, which we also cannot forget about. We also have to remember that, even if birds are housed, that is not a panacea against the disease and the spread of the disease. I invite all members of the chamber to support the chief veterinary officer in sharing those vital biosecurity measures to their constituents. We appear still not to have a connection with Dr Goulhanisaw, a brief supplementary Beatrice Wishart. The spread of avian flu has had a dramatic impact on seabird populations, and Shetland is no exception. Moose and Nature reserve is famous for its population of breeding European storm petrals. The island was closed to the public last August to help to prevent the spread of avian flu. NatureScot was to carry out a risk assessment review and report back in March 2023. Can the cabinet secretary provide an update on progress with that review? Firstly, it is devastating to see the impact that avian influenza has had on our wild bird populations. The member is right in what she is saying about the work that is being undertaken by NatureScot, but I would be happy to write to her and provide more of an update as to where that work is at the moment. To ask the Scottish Government when it last engaged with the UK Government regarding the reported impact on farmers in Scotland, whose livestock may be exposed to animal diseases as a result of delays to the introduction of post-Brexit border controls for checking meat and other products entering the country. The Scottish Government shares the member's concerns and takes disease prevention and control very seriously. As the UK Government continues to develop its new border controls target operating model, we constantly emphasise that those controls must be based on veterinary and plant health expertise. We regret that we were not consulted when the UK Government took the unilateral decision to postpone the previously planned introduction of import controls last year. We continue to bring in safeguarding measures whenever appropriate to maintain our high bi-security standards. In Scotland's chief veterinary officer is an active participant in the UK-wide animal disease policy group. I will, of course, be stressing this point when I meet the UK minister of state, Lord Benion, on 30 January. Thank you, Minister for that answer. In the view of the NFUS, and I quote, amongst all the chaos of securing a Brexit deal, the mechanics of how border controls would operate were somehow lost, a reference to the UK Government kicking the can down the road last April. While we sit in limbo, the threat of African swine fever has become of particular concern to our pig farmers. Does the cabinet secretary share my dismay at how the Tories and the Brexit that they forced on us have left the agricultural sector exposed in this way? I would agree with the member and the African swine fever in particular that he mentions is a concern and a very real threat. Not only that, right now, we have a situation where our producers and businesses in Scotland have that unlevel playing field. We see importers with the freedom to bring their goods to the UK, but our exporters have had the barriers of checks since day one. Not only is this a competitive disadvantage that we know has impacted and is continuing to impact businesses here, but it does pose that very real risk when it comes to our biosecurity. I raised that with the UK Government in a letter to Lord Frost way back in September 2021, where I stated that the difficulties that have led to this decision are due entirely to the UK Government's reckless approach to exit from the European Union, which is being shown repeatedly to have been done without that responsible planning or co-ordination. The results of that are clear. We have the inconsistency in constant change and delay, incurring unnecessary costs, resource difficulties and delays across the economy and across our communities. To ask the Scottish Government what it will be doing in the coming year to help farmers to mitigate any impact of rising costs in the sector. The Scottish Government has committed to measures worth almost £3 billion this year as a whole to help with the cost crisis. Farmers and crofters will benefit from some of the general measures that we have set out, both as individuals and as a sector. In relation to the sector in particular, we announced in June last year that farm payment dates would be bought forward to as early in the year as was practically possible in order to try and provide that support to businesses with immediate cash flow, which we know was a challenge. We have delivered on this commitment, with more than 17,250 businesses having already benefited from the change, with around £430.5 million paid out to date. I thank the cabinet secretary for that answer. We are in the midst of a cost of living crisis, which in turn is a cost of business crisis, which is a cost of farming crisis. The rising costs of fertiliser and fuel are well documented, but just in the last week it was announced that soy prices—soy being a major constituent of animal feed—have risen to £100 per ton. In addition, we have issues such as new and second-hand tractor prices, which are increasing by around 30 to 40 per cent. I am surprised to find myself raising tractor prices in Parliament. Can I ask the Scottish Government what steps it is taking to monitor those costs and what contingencies it is looking at so that it can step in to prevent farmers from going under from unforeseen rises in the agricultural sector? First of all, we absolutely would not want to see that happen. We have a number of ways in which we monitor this on-going situation, so the member will no doubt be aware that I established a food security and supply task force last year. It was a short-life task force and produced a number of recommendations towards the end of June last year. We agreed to have another further two meetings just to continue in that monitoring capacity to also ensure that we were delivering on those recommendations. We had one meeting towards the end of last year, and we are looking to set up that second meeting shortly, where no doubt we will be going to discuss some of the key issues that the sector is facing at the moment. There is also a monitoring group at UK level 2. We had the interministerial group with the UK Government and the other devolved administrations just at the start of this week, where we were looking at the outcome of that and discussed the importance of collecting and sharing that data between the different administrations. I want to share the member and share those across the chamber that we are continuing to monitor this and to see what support we can provide where that is necessary. Of course, I would again highlight that not all of this falls within the remit of the Scottish Government, but where we can help, we are always striving to do that. There was someone who could have made a really big difference to farmers in terms of mitigating costs, and that was the Chancellor. Instead, the UK Government decided that farming businesses should be classified as non-high-energy businesses. Does the cabinet secretary agree with me that the toys have shown us all what they think of our farmers and have food security by this decision? Just to say that I am, of course, aware that energy costs are a serious issue, and I know that it is causing a great deal of concern right across the sector. Of course, energy pricing itself is reserved, and we have repeatedly called on the UK Government to clarify how businesses, especially SMEs such as our farmers and crofters, are going to be supported through the energy crisis from April, after the energy build relief scheme ends. Unfortunately, we are still waiting on those answers. In addition to the increasing costs on farmers associated with the cost of living crisis in Brexit, farmers also experience attacks on their livestock by out-of-control dogs, which has a financial and emotional impact. Will the cabinet secretary join me in encouraging all dog owners to ensure that they are following the Scottish outdoor access code? Will she agree to meet me to discuss how we can further publicise the Dogs Protection of Livestock Amendment Scotland act, which I took forward in the last session? I just want to thank the member for highlighting the legislation that she brought through the Parliament in the last session, because it is really important. We now have penalties that reflect the seriousness of sheep-waring, because we know that this is a significant issue in rural areas. I would be happy to meet the member to discuss this further and to see what more we can do collectively to build that awareness. To ask the Scottish Government what steps it is taking to curb the recently reported outbreak of squirrelpox. We have had outbreaks of squirrelpox, a virus that affects mainly red squirrels in various parts of Scotland since 2005. I am aware of the local outbreak reported near Lockerbie and through the Saving Scotland's Red Squirrels partnership. Action is being taken to tackle the spread of the virus. That includes targeted grey squirrel control, encouraging the public to report sightings of infected animals and asking them to remove and clean feeders to minimise transmission. Where we have had outbreaks in the past, targeted grey squirrel control has ensured that local red squirrel populations have successfully recovered. Michael Marra, I thank the minister for that response. She will know well the importance of ensuring the diversity of species across the country and across our natural world. My home city of Dundee and neighbouring Angus have a long history in trying to preserve a red squirrel population. I would appreciate any reassurance that the minister can give that she will continue to monitor the situation and report back on any further outbreaks. I thank the member very much for the question and have really encouraged local enthusiasm for red squirrels and for biodiversity in general. Fortunately, the virus has currently only been reported in the south of Scotland, which is one of the Saving Scotland's Red Squirrels partnership's key priority areas. So far, there have not been any case of squirrelpox detected in red squirrels on the Highland line or elsewhere. To make sure that that remains the case, the teams are engaged in strategic squirrelpox sampling of red and grey squirrels when their virus is detected in a grey squirrel in the area that teams deploy a rapid response monitoring and control protocol. The recent reporting of squirrelpox in the borders is indeed a cause for concern. The 2022 Great Scottish Squirrel Survey has shown that concerted efforts in Aberdeen have been very successful, with red squirrels returning and the grey squirrel population significantly decreasing. Will the cabinet secretary join me in commending the efforts of those who have worked to preserve the iconic Scottish species in the north-east? I thank the member both for the promotion and for raising this point. I recognise the hard work and perseverance of those who are working to support the survival of our iconic red squirrel. The dedicated work of those involved in the Saving Scotland's Red Squirrel project, particularly the grey squirrel control officers, has been vital in protecting the Highland line. That has ensured that the red squirrel population in the Highlands remains safe and free of grey squirrels and squirrelpox. I thank them for that and for protecting our native biodiversity. To ask the Scottish Government whether it will provide an update on the aquaculture regulatory framework. I welcomed the independent regulatory review of aquaculture consenting last year, announcing an immediate change to the validity period of new marine licenses for shellfish and fish farms from six to 25 years. I established and chaired the Scottish Aquaculture Council to ensure progress across all of our commitments, which includes progress of the regulatory review in addition to delivery of the actions set out in our response to the salmon interactions working group report and a new vision for sustainable aquaculture. I am pleased to inform you that members can keep up to date with developments at the Scottish Aquaculture Council on the Scottish Government's website. Recent activities include establishing a dedicated consenting task group to explore and pilot new ways of working in the consenting process. The Scottish Science Advisory Council is currently considering the use and communication of science in the fish farm consenting process and I look forward to receiving the conclusions of that project this spring. I thank the cabinet secretary for her answer and the cabinet secretary will be aware of the importance of the salmon industry to my constituency with 600 jobs based at Maui in Rhesaith. So could I ask the cabinet secretary therefore to advise as to how much more time is to elaps before the full implementation of the Greg's report and what the reason is for the near one-year delay in doing so and whether SIPA has in fact been supportive of this process or otherwise? Firstly, I would just want to recognise and the Scottish Government recognises the importance of aquaculture to the member's constituency and of course a number of constituencies right across Scotland. It is an important sector to our economy and we remain committed to the sustainable development of it and that applies not just to our farms located but also to that wider supply chain and the jobs that the sector supports including the jobs in the member's constituency. I would want to emphasise though that there hasn't been a year long delay and I would hope from my initial answer the member would recognise that a number of pieces of work have been initiated and are currently under way. We always knew the timescales that had been put forward in the Greg's review. We are going to be really challenging to meet but of course we wanted to make sure that we hit the ground running and we got started. We have made significant progress since that report was published again with the establishment of the Scottish Aquaculture Council, the consenting task force and I would just want to assure the member and of course other members across the chamber that SIPA is of course fully engaged with us on this journey and is a positive and active member of both groups and we really want to and we will continue with this momentum to ensure that we deliver a fit for purpose consenting system for aquaculture as soon as possible. Two supplementaries that would be good if they were brief and likewise the responses for us Edward Mountain. Thank you Presiding Officer and I refer members to my register of interest in a world salmon fishery. In 2018 the former rec committee published its salmon farming report. There were 65 recommendations and it's clear the industry is not improving. Fish farm mortalities increased to a high of 29,000 tonnes last year. If you were to put them all in lorries you'd have a nose to tail cue from here to Edinburgh airport and beyond of rotting fish. Mortalities are unexciting. Does the cabinet secretary agree on what she's going to do about it? I would say the action that we're taking right across the piece on the back of the Greg's review and a number of recommendations from that that we're making progress on and I would also outline that we have made significant progress since the publication of those reviews that have been done as well but I'd be happy to write to the member with more detail on that and to outline all the progress that's been made in that time. Thank you. Instead of dredging for kelp there is now growing interest in sustainable cultivation but the sector would benefit from a robust independent regulatory framework as was recommended in the aquaculture process review. So can I ask cabinet secretary what progress has been made in establishing this framework for a kelp farming industry? Yes well of course one of the first steps we said that we would do is publish our vision for aquaculture and that industry I think it is a really exciting and burgeoning industry and we obviously want to make sure that we see the sustainable development of that and that we get the regulation for that right. So what I would say that the first step will be the publication of that vision and it will take forward further work from there. Thank you cabinet secretary. That concludes portfolio questions on rural affairs and islands. I'll allow a brief pause while front bench is changed. And the next portfolio is health and social care. Again if members wish to ask a supplementary question I'd invite them to press the request and speak buttons during the relevant question. Again quite a bit of interest so I'd appreciate brief questions and as brief responses as possible from the ministerial team. Question number one is from Evelyn Tweed. Thank you Deputy Presiding Officer. To ask the Scottish Government what steps it is taking to reduce the avoidable harms associated with drugs and alcohol. Beside, we have a range of activity underway to reduce harms from drugs and alcohol. This includes a national drugs mission specifically to save and improve lives focused on early intervention and prevention whilst also improving the quality and access to treatment and this was set out in the cross-government plan published on 12 January. Furthermore our national alcohol framework sets out our national prevention aims on alcohol. This includes the evaluation of our world-leading minimum unit pricing policy and our alcohol marketing consultation currently open to responses. These activities are aimed at reducing consumption and minimising alcohol related harm. Health inequalities are a feature of alcohol specific deaths. Deaths attributed to alcohol are 5.6 times as likely in the most deprived areas of Scotland compared to the least deprived areas. What steps is the Scottish Government taking within its powers to tackle the root causes of health inequalities and the disproportionate impact of alcohol as? Ms Tweed is right to highlight the social gradient of alcohol harms. Ms Todd will continue to lead the work on minimum unit pricing and the consultation to restrict alcohol advertising and promotion. That is crucial work to changing Scotland's troubled relationship with alcohol. Much of the work that I lead in the drugs policy national mission has a direct bearing on improving the quality and access to alcohol treatment, for example expansion of residential rehabilitation, support of families, tackling stigma and trauma. However, to overcome the wider root causes of health inequalities, the Government is for example investing £4 billion in social security, including the extension of the Scottish child payment to £25 per child per week for eligible families. This financial year, an additional £3 billion to help households faced with the UK's cost to living crisis, a £1 billion of which provides services and support not available anywhere else in the UK. I'm brief supplementary's first you ever. SNP and Green Ministers approved a cut of £1 million to the alcohol and drugs budget in November, yet over 100 families in November last year were grieving the loss of a loved one because of drugs and my thoughts and condolences are with those families. The SNP have stated it's a national mission to tackle this, but you cannot say it and mean it and then cut funding. Frontline services are key to saving lives. Will the minister commit to reversing the cuts to the alcohol and drug budget to ensure that those services are fully supported to tackle this on-going crisis? The draft 23-24 budget for substance use overall is at £160 million. That is an increase from £146.5 million. That includes investment in health boards, investment in the crossover between addiction and mental health. Crucially, for the alcohol and drugs budget, which is proposed at £99 million, an increase from £85.4 million. Of course, people can look at the budget line by line, but the overall budget is increasing. Of course, the synergy between the work that I do in drugs policy and alcohol is very important. For example, the £100 million over the lifetime of this Parliament to be invested in residential rehabilitation and aftercare will benefit as many people with alcohol problems as drug problems. On Monday, Public Health Scotland published its rapid action drugs alert in response quarterly report. It confirmed tragically an increase in the number of suspected drug deaths in October and November of 2022, an increase of 20 per cent compared with the same months in the previous year. Every single one of those deaths is preventable. Can I ask what action the minister is taking in response to those figures to ensure that we are making significantly faster progress, particularly on the implementation of MAT standards? Part of the national mission was to publish more data, more information and more quickly so that services could respond on the ground. Public Health Scotland has issued an alert around a new substance called nitazine. Suspected drug deaths over the first nine months of last year have went down, but the member is correct to say that there has been an increase over October and November. It is still too early to say whether there is a direct link between nitazine and suspected drug deaths increase in October. On the information and action that has been undertaken, the alert has been issued to drug and alcohol services, emergency services, healthcare and high risk settings. It has underlined the on-going importance of naloxone in terms of effective treatment, along with good harm reduction advice. There is also a warning on counterfeit medication in and around not to take oxycodone tablets unless they are prescribed by a medical person. There is also the importance of outreach facilities, which is part of the implementation of MAT, but Public Health Scotland has been engaged directly with the areas in which there have been detections. To ask the Scottish Government what its response is to the reports that some women have been denied transvaginal ultrasounds on the basis of not yet being sexually active. As stated by the Royal College of Obstetricians and Gynaecologists, no one should ever be denied access to healthcare on the grounds of virginity. Specific guidance on transvaginal ultrasounds has been produced by the British Medical Ultrasound Society, which all NHS boards are encouraged to adopt. As set out in the guidance, if a patient has not had penetrative sex, they are still entitled to be offered the transvaginal ultrasound in the same way that cervical screening is offered to all eligible patients, regardless of whether they have had penetrative sex. Not yet being sexually active should have no bearing on clinical decision making around access to diagnostic scans. I thank the minister for that answer, and as you say, it is critical that no one is denied access to vital healthcare on the basis of not being sexually active. Although a number of reported cases of that happening in Scotland is low, one is too many. Can I ask the minister if she would commit today to ensuring that the guidance notes provided for practising and future doctors regarding transvaginal ultrasounds are clear in saying that women who are not sexually active are eligible for procedures to allow everyone to have the best opportunity to detect abnormalities? I am certainly happy to commit to that, and I am more than happy to work with the member if she wants to contact me or write to me with more details of ideas of ways that we can ensure that that message goes out loud and clear. I will take the opportunity, given its cervical cancer awareness week, to reiterate at that point that cervical screening is routinely offered to all eligible patients. That is one of many gynaecological myths that persist to the modern day. You do not need to have a cervical smear if you are not sexually active. The cervical smear is offered to all eligible patients, regardless of whether they have had penetrative sex. I thank the member for the opportunity to reaffirm that in the chamber today. To ask the Scottish Government whether it will provide an update on the number of hospice beds available in NHS Greater Glasgow and Clyde area. NHS Greater Glasgow and Clyde has a total of 38 hospice beds across the health board area. It is the responsibility of integrated joint boards to plan and commission palliative and end-of-care services and end-of-life care services in using the integrated budget under their control. It is a matter for health and social care partnerships working with NHS boards and independent hospices. Last week, I met a GP in my constituency who raised concerns over hospice beds in NHS GGC with patients being admitted to the acute hospital sector due to a lack of beds. After a discussion with one hospice, it was suggested that some of the capacity issues seemed to relate to on-going Covid restrictions. Can the minister confirm what restrictions are in place that could be affecting capacity issues and if there are plans for those to be removed? I thank the member for that follow-up question. It is fair to say that our NHS is experiencing immense pressure at the moment and that means that there has been a redoubling of our efforts across the board. There has been a power of work going on to ensure that patients can access the right care at the right time as close to home as possible. With regards to Covid-19 measures, the continued transition to national infection prevention and control IPC guidance sees a return to service user placement based on assessment of risk alongside the application of routine standard infection control precautions and transmission-based precautions, in line with the pre-pandemic IPC practices. However, some pandemic measures do remain. Those are subject to continuous review. That guidance remains in place for a large number of community-based services, including for hospices for the whole of Scotland. As part of our work in developing a new palliative and end-of-life care strategy for Scotland, we will seek to ensure that people ensure palliative care wherever and whenever it is needed. To that end, we are mapping services and support right across Scotland, delivered through hospitals, through community settings, including in people's own homes and care homes and also in hospitals. Question 4, Christine Grahame. Thank you, Presiding Officer, to ask the Scottish Government when it last spoke to NHS Lothian and NHS Borders. Both ministers and Government officials meet regularly with the leadership of all NHS boards, including NHS Lothian. Borders discuss matters of importance. It won't be a surprise at all to the member that the most recent discussions have centred around the challenging winter pressures. Ray Roberts, the chief executive of NHS Borders, was on the most recent Scottish Government resilience call, chaired by the First Minister last week at any role as chair of chief executives. I thank the cabinet secretary for his answer. The cabinet secretary will be aware that, in November last year, NHS Borders launched a single point of contact cancer hub for people who referred to the Borders General Hospital with the suspected cancer diagnosis. That was to provide support and information and to relieve some of the stress. Can I ask, therefore, that it's being phased in for everybody? It's just being phased in just now, but everybody should have access that requires it. By spring of 2023, like me, does he welcome this initiative? We'd like to comment on it. I do welcome the initiative. I think that all of us, as members across the chamber, whether we have personal experience of going through a cancer journey or know somebody who has or a constituent, perhaps we all know that one of the common points of feedback that we get is that they often feel that they are passion pillar to post. They want that single point of contact to help navigate what is a very difficult time in their lives. That is a key action. That particular initiative is one of a key actions as part of the current national cancer plan. As I say, it will remain an important part of our new cancer strategy, which is due to be published in spring. I commend the NHS Borders and the other boards who have the single point of contact cancer hub in place. We'll look to roll them out nationally, as the member says. Question 5, Jackie Baillie. To ask the Scottish Government when non-urgent elective operations will resume in NHS Greater Glasgow and Clyde. I've been clear that boards can and they should take the steps necessary to prioritise and protect critical and life-saving care. If that is deemed necessary, local health boards and healthcare professionals, local clinicians, they are of course best placed to judge what reasonable measures should be taken in each board area to manage those very severe pressures. Like other boards, NHS Greater Glasgow and Clyde have taken the decision to pause non-urgent elective procedures to ensure those with urgent healthcare needs, including cancer needs, are prioritised. The decision was not taken lightly. It's under constant review that I spoke today to senior management from NHS Greater Glasgow and Clyde, and they reassured me that this is something that I'm monitoring daily. I expect boards where there has been an impact on non-urgent elective operations that they are resumed as soon as possible. I thank the cabinet secretary for that response. In NHS Greater Glasgow and Clyde, there are something like 11,000 patients waiting over a year and nearly 2,000 waiting over two years for elective surgery, an increase of almost 50 per cent since you took office. Can the cabinet secretary perhaps offer clarification on whether urgent and day case surgery is still going ahead in Glasgow? I know of patients who have had urgent procedures cancelled at the last minute, and given that day surgery doesn't require overnight beds, can he explain what's going on? Again, it is the pausing of non-urgent elective surgery. If Jackie Baillie or any other member in this Parliament has cases that are deemed urgent and have been cancelled, then of course I'm happy to raise them with the health board. Equally, Jackie Baillie I know can raise them herself, and she will get an explanation of why those particular elective procedures were cancelled. So it is non-urgent elective care that is cancelled in terms of outpatients as well. Of course, this is a decision, again, taken locally. We spoke about this today with Greater Glasgow and Clyde. The ability to free up beds, the ability to free up staff can be very important to be able to relocate them to busy sites and busy wards such as those in Greater Glasgow and Clyde. However, I want to give an absolute assurance to Jackie Baillie and other members that I've got similar concerns not just about Greater Glasgow and Clyde, but other health boards who have made similar decisions that this will not be in place for a minute, a second, longer than it has to be. It is under daily review, and I'm happy for Jackie Baillie to pass on any individual concerns, constituency concerns that she's got to me. I'm happy to raise them with the health board. Thank you, Presiding Officer, to ask the Scottish Government whether it will provide an update on Scotland's trainee doctor workforce. Trainee doctors account for approximately 42 per cent of all doctors and hospitals, and therefore they play a major role in service delivery. I'm grateful to them for all the work that they have done, particularly throughout the course of the past few years. The number of doctors and training is up over 24 per cent under this Government, or 1,295.6 whole-time equivalents. The recruitment of trainee doctors in 2022 was the most successful to date with 1,073 post-filled. More broadly, we're continuing to implement recommendations that form part of the 48-hour maximum working week without averaging for junior doctors in Scotland expert working group report. I thank the cabinet secretary for that response. In 2011, junior doctor Lauren Connelly from East Kilbride tragically died driving home from work. Since then, her father, Brian Connelly, has been campaigning to reduce junior doctors' working hours to make them safe. I'm grateful to Humza Yousaf for meeting with us last year. Could the health secretary provide an update on the work being done to make the working hours of junior doctors safe? Does he agree with Mr Connelly and me that junior doctors should have a maximum 48-hour working week without averaging, which the First Minister committed to work towards in 2017? I thank Collette Stevenson for such an important question. Once again, I pay tribute to Mr Connelly, to Brian Connelly for continuing to campaign tirelessly to improve working conditions for the medical workforce. He has gone through the most unimaginable tragedy, but he is making sure that he is campaigning day in and day out in relation to advocating with his local MSP or directly with Government to ensure that working conditions are improved for the medical workforce. Over the last year, the Scottish Government has worked in partnership with junior doctors and in partnership with employers to restrict the consecutive days of long shifts, which are shifts that are greater than 10 hours. We have reduced those or limited those to four in any seven days for junior doctors. Progress continues to be made on implementing the broader recommendations of the expert group, including improvement to facilities, rotor design and staff governments. In respect to the specific question on a 48-hour week without averaging for junior doctors, the Government remains committed to pursuing that goal. Collette Stevenson is a longer-term issue that we are seeking to address. Achieving a 48-hour working week will be a process that requires a careful consideration to ensure that we get the right to make lasting improvements for the working conditions of our junior doctor workforce. I am grateful to the cabinet secretary for sharing those details on junior doctors in Scotland, but he will know that extensive marketing and recruitment campaigns have been carried out by Australia and New Zealand targeted at junior doctors working in Scotland's NHS exacerbated by a lack of available specialist training posts and general burnout due to high working hours. He could advise us what proactive steps the Government is taking to retain those doctors once they are completing their foundation training, and why he sees those doctors as being such an easy target. What can I say? It is, of course, right to raise this issue. First and foremost, for our trainee doctors, we are making sure that we are creating the training places necessary for them here, so we have increased those by an additional 725 places. 152 of them just agreed recently and will be recruited in 2023. What we will also seek to do is to try to make the improvements that I have outlined to collect Stevenson so that their working conditions are improved, and I think that that will help to retain them. On top of that, we will continue to discuss with junior doctors and the medical workforce more generally what we can do around pay, around pensions, to make sure that we retain them here in Scotland, as opposed to losing them elsewhere. Ask the Scottish Government what discussions it is having with NHS Shetland to address waiting times for NHS dentistry and orthodontic treatment. The Scottish Government continues to meet regularly with NHS Shetland to review all aspects of the board's service delivery. Current areas of focus for dental and orthodontic treatment include addressing waiting times in the context of the board's response to Covid-19. In addition, the board is developing an improvement plan for dental service provision, which is due to be concluded in the coming months. Beatrice Wishart. There are continuing and long-term issues for people in Shetland trying to access NHS dental services. My 16-year-old constituent is on a waiting list to join an orthodontic waiting list, and she says, and I quote, I was told that I needed a brace when I was 10, so I've been waiting for six years with a sense of insecurity. They were confirmed as a priority case and have been waiting indefinitely to start treatment. This delay in treatment could have lifelong impacts on my constituent's dental health. I am in dialogue with the minister about this specific case, but does she think that such delays in treatment are acceptable? First of all, I understand the challenging position facing NHS Shetland with respect to orthodontic treatment. In certain areas across Scotland, NHS dental access is undoubtedly challenging. In many cases, that has been exacerbated by Brexit controls, as well as the unique difficulties following the pandemic. With regard to this specific case, I can reassure the member that the board has recently taken a number of successful mitigating actions to improve the provision of specialist orthodontic services. That includes the recruitment of a new specialist orthodontic consultant who has additional capacity at weekends. Provisional assessment by the board suggests that the service is now seeing substantially increased numbers of patients compared to what was previously seen. The board is also currently in a recruitment process to replace other clinical staff, and we understand that that is looking very positive. There are other mitigating actions on the way, including additional training in particular, the prospective remote training for orthodontic therapists. With regard to the individual case that the member raises, I understand that the board adopted a new model for prioritising patients, which was communicated to patients in October 2022. All patients on the waiting list have been fully informed as a current situation. The immediate priority in terms of catch-up is for the patients who are currently under treatment, and on completion of that cohort of patients, the service will focus on those patients waiting for treatment. I understand that that is disappointing for the constituent that she mentions, and it falls below the standard of service that we would hope for, but, undoubtedly, all our dental services have been challenged by the pandemic, and I am glad to see that it is an improving situation. I must say also that the board is waiting— Minister, I have a couple of supplementaries, and I will keep taking them in. First, Amy Halcro Johnston needs to be brief. Too many dental practices across Scotland are going private or clothing than completely in next month's sky and locale. Dental practice will close its doors for good. Has the minister made any assessment of the impact that cuts to NHS dental services will have on rural dental practices? How will she expect dental practices across Scotland to provide NHS service at a loss now that crucial social funding has been withdrawn? Let me reiterate, as I have done previously in the chamber, that this Government provided an enormous amount of funding to sustain the NHS dentistry during the pandemic, a period of time during which it could not operate at all, and without that, Government funding would have gone completely under. We are now working with the dental sector to review and reform dental payments, and our intention is that there will be a more sustainable model going forward. I have to say from the Conservative member to mention the challenges that have crossed the industry without mentioning the word Brexit. I think that that is a serious omission, because, if, like me, the member were to visit any dental practice in Scotland almost and certainly many of them, what he will find is that European dentists are no longer able to come here and sustain our workforce in Scotland, as they previously did. I will take question 8, but the responses will have to be briefer. To ask the Scottish Government what its responses to the report leave no one behind from the health foundation. This is an opening report that is deeply concerning. In 2019, there was a 24-year gap in healthy life expectancy between people who are living in the most and least socioeconomically deprived 10 per cent of localities. We know that one of the driving forces and reasons for that is, of course, the impact of conservative austerity on public services. That is why we are using all our powers and resources available to us to create a fairer Scotland. I thank the cabinet secretary for that answer. Infant mortality in the most deprived areas two and a half times that in the least deprived areas. People living in the poorest households almost eight times as likely to report poor health as those living in the richest households. Life expectancy is already the lowest of the UK nations for the last 70 years, not going up but coming down even before the pandemic. Health inequalities are rooted in wealth inequalities. Wealth inequalities are rooted in class inequalities. Does the SNP Government have any plan, strategy or idea whatsoever for tackling the inequalities that are identified in this report, which, at their root, are based on the divisions of economic and social class? I say to Richard Leonard that I do not disagree with him that the public, the cost crisis that we see the Conservatives—of course, who are the architects of that cost crisis—is a public health crisis. That is why we are committing £19 billion to NHS and social care services over the next year. The Conservatives might well laugh at a cost crisis and public health crisis, but they do well to listen to the points that we make here. That is why we are providing £4 billion in social security and welfare payments over the next financial year. That is why we are extending the Scottish child payment to families with eligible under-16s and increasing it, of course, as he knows, to £25 per week per child. We will continue to make the necessary investments that are absolutely focused on those in the most deprived areas. However, I say to Richard Leonard that, as opposed to leaving the powers in the hands of the Conservatives who are the architects of the cost crisis, we will not be much better to have all the financial levers here in this Parliament. That concludes portfolio questions. Time is tight. We are going to move straight on to the next item of business.