Chamber and committees

I do not challenge in any way, shape or form the extent of the pressure on our Ambulance Service and all parts of our national health service. It is incumbent on me, as First Minister, and with all my colleagues across the Government, to support the service as it faces up to the current challenges.

Those challenges have, largely, been caused by Covid pressure, which is increasing the overall pressure that our health services are under. Obviously, it is my responsibility to deal with those challenges in Scotland, but such challenges are mirrored in health services across the United Kingdom and in many parts of the world, because of the realities of Covid.

The fact that anyone in our country has to wait an unacceptable period of time for an ambulance when they need urgent care is not acceptable to me or to anyone. That is why we will work closely and intensively with the service to support it to meet the challenges, which I expect will continue for a period as Covid pressure continues and we go into the winter months.

Last week, I set out some of the actions that we have already taken. We have provided significant additional funding to support significant extra recruitment of paramedics and technicians to the Ambulance Service. With the service, we are considering a range of additional actions, including provision of more support for rural ambulance stations; alternative transport arrangements for lower-risk patients, to make sure that the Ambulance Service resource is there for higher-risk patients; deployment of more hospital-ambulance liaison officers to help with transfer from ambulance to hospital and discharge from hospital; and temporary admission wards to ease the bottleneck that exists at the moment between ambulances and our hospitals. In addition, as I said earlier, we will consider seeking targeted military assistance.

I do not in any way underestimate the extent of the challenge that faces the service and, by extension, people across Scotland. It is the latest in a number of significant challenges that have been posed for us as a result of the pandemic. Our responsibility is to take the action to support the service to meet the challenges. That is what I, the Cabinet Secretary for Health and Social Care and the entire Government are focused on.

The buck always stops with me. Whether people agree or disagree with me, I have never tried to shy away from that, nor will I ever.

With the greatest of respect, I say to Anas Sarwar that the Government does not operate only when Parliament is sitting. I will go back to my office after First Minister’s questions to finalise the details of the request for military assistance so that that can be submitted as soon as possible. We will also finalise the other additional actions that we are taking, and which are in addition to those that we have already taken. Government is a 24-hour-a-day responsibility. We will continue dealing with these things in that manner.

I do not at all shy away from how difficult this is. I am not the only Government leader who is dealing with these issues. Health ministers and Governments all over the world are dealing with these challenges. Our job is not just to describe the problem; our job is to provide solutions. My Government is absolutely focused on doing that.

A number of health boards are taking decisions to pause temporarily elective surgery to enable them to deal with emergency services. That is not happening only in Scotland—we are seeing that in parts of the health service across the UK because of the pressure of Covid. We will continue to support the health boards to take the decisions that they consider are appropriate in order to provide care to people who need it.

However, the member should be in no doubt that our objective is to get the health service operating again in such a way that it can deal with the pressures of Covid without that having an impact on non-Covid and elective services. That is the focus of the recovery plan and we will continue to support the health service to do that.

At the heart of that is the imperative to get Covid cases down so that as that pressure reduces, the health service can get more back to normal. That brings me back to the central messages to everyone about all the mitigation measures that we all have to follow to keep Covid cases on a downward track.

We are working closely with a range of partners to deliver a safe and successful COP26. Reviews of Police Scotland’s preparations, including a recent report from Her Majesty’s Inspectorate of Constabulary, offer a high degree of assurance around the ability to balance business-as-usual policing with COP26 operations. The transport demand strategy is in place and the Covid adaptation plan developed by chief medical officers from the Scottish and United Kingdom Governments will be published shortly.

I had a meeting yesterday with the United Nations executive director on climate change to consider some of the broader issues around the COP26 negotiations.

We work closely with public sector bodies to raise the baseline standard of cybersecurity in line with guidance from the United Kingdom National Cyber Security Centre. A dedicated policy team together with a range of partners are delivering the strategic framework for a cyber-resilient Scotland across the public, private and third sectors to further build our cybersecurity and resilience capabilities.

The Government shares cyber threat intelligence, including during real-time incidents, as part of its early warning process; provides regular training, advice and support to the public sector; and encourages regular exercising and cyber incident response planning.

I have already covered much of this in previous answers. The Ambulance Service, like other areas of the national health service, is under considerable pressure as a result of the unprecedented demand, which is caused largely by the impact of the pandemic. Our Ambulance Service staff are doing a heroic job delivering emergency healthcare to the people of Scotland. However, some people—as I have already reflected on—are waiting far too long for ambulance services.

We are in constant dialogue and engagement with the Ambulance Service. We have provided additional funding, and we have already taken a number of actions. As I set out previously today, a number of additional actions are currently under consideration.

I accept that there were pressures on the Ambulance Service, as there were pressures on the entirety of our health service, before the pandemic, but I think that for anybody to suggest that the pandemic is not a significant contributory factor to what our health service is dealing with right now is simply stretching credibility. The pandemic has created what are probably the most challenging conditions for our national health service since it was created. That is being felt acutely in Scotland and in countries across the United Kingdom and the rest of the world. Our responsibility is to help the service to meet those challenges.

I am very clear in my mind that it is not acceptable for one person, let alone more than that, to wait anything like the times that some people are experiencing right now. That is why we are taking the actions that we are taking. There are, right now, over 1,000 people in our hospitals with Covid. That puts an additional pressure on our hospitals, and that feeds through into longer turnaround times for ambulances. Of course, the Ambulance Service is often the front-line response for those who need hospital care for Covid or for anything else. That is the reason for what we are experiencing right now, but my job is to provide the solutions, and that is what we are seeking to do with the Ambulance Service.

Anas Sarwar specifically asked how many hours it will take. Because of the pandemic and all that it creates, we are facing probably the most challenging winter for the health service and for society in any of our lifetimes. I could stand here and say that, in a number of hours, we will do X, Y or Z, but it is going to be a responsibility of Government right through this winter to support our Ambulance Service, our accident and emergency departments and our wider health and social care services. Every day over this winter period, that will occupy my time and the health secretary’s time and it will be the focus of the entire Government.

As I think that I said in my first answer to Douglas Ross, we are actively considering the detail of the request for targeted military assistance. It is important that we make that request in detail so that we know exactly what we are requesting from the military. That request is currently being prepared.

On the call for a major incident to be declared, as I said to Douglas Ross, we are getting lost in terminology. The Ambulance Service is operating at its highest level of escalation. The fact that we do not call that a major incident—it is escalation level 4—does not change the reality of the situation. It is more important to focus on the substance of what we are doing than to have manufactured disagreements about terminology.

Mr Sarwar asked about pop-up wards. I will be corrected if I am wrong, but I think that I referred earlier to the consideration that is under way on temporary admission wards. Pop-up wards may not be appropriate because we are going into a winter period. They might not provide the best conditions for patients. We are looking at an equivalent, which would be to have temporary admission wards.

We are already taking forward all the things that I have been asked about today. This is an incredibly challenging situation, more so for those on the front line. I stated earlier, and I repeat, my deep gratitude to those who are working on the front line of our national health service. We will continue taking steps and providing solutions. We all know what the problem is. We may disagree about the cause of that problem. It is my job, working with others, to find solutions. I will focus on that for as long as it takes.

The report from Her Majesty’s Inspectorate of Prosecution in Scotland is an inspection of the Crown Office and Procurator Fiscal Service’s management of criminal allegations against the police. The report rightly recognises that the public should be reassured by the robust scrutiny that is applied by prosecutors to on-duty criminal allegations against the police.

The report notes a historical practice of freezing targets while further information was awaited from an investigating agency. That practice ceased in April this year, which means that it will not have an impact on target performance in this reporting year. It was an administrative exercise that had no impact on the investigation or outcome of any cases.

The Lord Advocate—this is, of course, entirely a matter for the Lord Advocate—is carefully considering all the recommendations in the report and will make changes where appropriate to implement them.

I agree with that, and I am sure that the Lord Advocate, were she here, would fully agree with it as well.

As I said in my original answer, it was an administrative practice, and I am assured that it had no impact on the investigation or outcome of cases. Often, in such cases, and in cases more generally, the Crown Office will require information from other investigating agencies—that might be the Health and Safety Executive, for example—and that has an impact on its ability to pursue cases.

Pauline McNeill is right in what she said about transparency. These matters are for the Lord Advocate; I know that she will consider the report carefully, and I am certainly willing to ask her to write to Pauline McNeill in due course with more detail on the action that she intends to take in the light of the HMIPS report.