Chamber and committees

I set out in my answers to Douglas Ross and Anas Sarwar some of the substance of the issues, so I will not rehearse that again in answer to Paul O’Kane. However, one of the important investments that we have made is the investment in the hospital ambulance liaison officer service. It has proven to be effective in improving the turnaround of patients who have been brought to hospital by ambulances in a number of parts of the country. We are also expanding the capacity of the Scottish Ambulance Service through the investment that we have made.

The Government is taking those practical steps, in discussion with staff, to ensure that we have in place steps to ensure that people are supported when they need access to ambulance services and that they do not spend any longer in the ambulance than they require to. Obviously, that will vary depending on the condition and circumstances of individual patients as they arrive and are presented to hospital. I trust and rely on the clinical judgments that are made by staff in the national health service to ensure that patients get the treatment and care that they require.

It is abundantly clear that the Government and I want to ensure that ambulance time and capacity are used as efficiently as possible. Ambulances that are waiting at accident and emergency departments and not out collecting patients and providing support in the community are not in the right place. With the Scottish Ambulance Service, the Government is intensely focused on ensuring that ambulances are operating effectively so that congestion in accident and emergency departments does not delay them.

As I said to Mr Ross a moment ago, the issue is all tied up with the fact that a whole-system solution is required. We need to ensure that patients are able to leave hospital to go into the community with social care packages, and that accident and emergency departments have the capacity to ensure that patients can, if it is needed, be moved from A and E into hospital wards, or discharged as efficiently as possible

That is why the Government put in place a £300 million NHS and winter care package in September. The package allows for recruitment of an extra 1,000 NHS staff. There is £40 million for step-down care, £60 million to maximise the capacity of care-at-home services, £48 million to boost the pay of social care staff to ensure that we can deliver more social care packages, and £28 million to support primary care and community solutions. That investment has been made across the health service in order to ensure that the Scottish Ambulance Service can make its contribution as efficiently as possible.

I assure Mr Sarwar and the public that the Government is determined to use all available resources to ensure that individuals receive the care that they require.

Mr Rowley has made a number of contributions on that question in Parliament. I have handled a number of those, and we have discussed the question in the COVID-19 Recovery Committee. I acknowledge the significance of the point that he has made.

In my answers to the questions from Anas Sarwar and Douglas Ross, I said that, if we can address and build the capacity of the social care workforce, that will give us some ability to withstand some of the other pressures that the national health service experiences. The Government has already put in place an increase in the salary of the social care workforce to assist in resolving those issues.

One of the other issues is the availability of people in our community. I am sure that Mr Rowley would accept that the ending of the free movement of individuals from the European Union has diminished the size of the workforce that is available to us in Scotland. That has a real and practical effect in a number of sectors, one of which is social care. That is why we are encouraging the United Kingdom Government to arrive at a more sensible position on free movement than it currently occupies.

I value the contribution that all healthcare staff make to all the component parts of our national health service. We recognise the pressure on the wellbeing of members of staff. That is why we put in place the £12 million investment to ensure that staff wellbeing was supported and that individuals could be enabled to continue their activities.

I also have to recognise, as members of staff do, the significant impact that Covid has on the national health service’s operation. Anybody who comes to Parliament and seeks to diminish Covid’s enormous impact on our national health service is not recognising the reality of the situation that we face. It is why we have put in place the extra winter care package, strengthened the resources that are available to the Scottish Ambulance Service and will continue to invest as assiduously in the national health service as we have done since the minute the Government came to office, significantly increasing its budget over the Government’s term in office.

The under2 coalition, of which the First Minister is the European co-chair, launched a new memorandum of understanding at the general assembly this week, which set out a higher level of ambition for the coalition and committed it to achieving net zero by 2050. The First Minister signed the MOU at the general assembly and 27 Governments also signed up.

We endorse the new “Further, Faster, Together: Under2 Leaders Action at COP26” statement, which outlines the actions that coalition members are already taking to meet their ambitious 2030 targets. Forty-one Governments endorsed the statement, which demonstrates their leadership on that important objective.

I am happy to confirm the Government’s support for the objectives that Fiona Hyslop has set out. As European co-chair, Scotland is committed to promoting values of justice and inclusivity. We hope to build a lasting legacy from COP26 by building a just transition alliance with members of the under2 coalition. We are also championing issues of global importance to mobilise increased action from our fellow members.

I recognise that there is a members’ business debate today that will be initiated by Fiona Hyslop. It will focus on ensuring that the global south is heard and understood, and the Scottish Government and the Stop Climate Chaos coalition have co-convened the Glasgow dialogues to enable that to be the case.

Today’s debate is, of course, the first members’ business debate in 14 years that Fiona Hyslop has been able to lead in the chamber, because of her service as a minister, and I cannot think of a more formidable parliamentary voice to be leading on this topic than hers. I wish her well for the debate.

Decisions on the issues in relation to Cambo are, obviously, for the United Kingdom Government, and Ariane Burgess will be familiar with the fact that the Scottish Government has made clear our desire for the UK Government to subject that particular development to a climate compatibility assessment, given the length of time that has passed since its original consent.

Specific issues in relation to marine protected areas will have to be the subject of statutory dialogue, were that development to take its course. However, of course, the Scottish Government’s stance is to ask for a climate compatibility assessment to be undertaken before we get to that stage.

The investment has been made. We are seeing an expansion in the number of staff and personnel working in the Scottish Ambulance Service. We are also seeing recruitment of individuals that is designed to support the flow of patients from ambulances into accident and emergency departments and on, either to destinations in the hospital or to a return home.

I would have thought that Dr Gulhane would accept that this is a whole-systems issue. It involves the roles and responsibilities of general practitioners, social care, hospitals and accident and emergency departments, as well as delayed discharges. The Government is taking sustained action in a number of areas to ensure that we deal with that in the context of a national health service that is under colossal pressure because of the impact of the pandemic. We are working our way through those challenges to ensure that we meet the needs of patients in all circumstances.

I recognise the importance of the points that Mr O’Kane raises. However, I am sure that he will appreciate that it is difficult to take account of all the circumstances and scenarios that he put to me, which are reasonable points, in a programme of such complexity and magnitude. The online portal system, which we are putting in place for younger age groups, is designed to give people a bit of flexibility and will address some of the practical circumstances that he mentioned.

Mr O’Kane asked for some data. The flu vaccination programme has so far administered more than 1.4 million doses and is making very good progress. Taking the flu and the Covid third dose programmes together, we have surpassed 2.5 million doses in the relatively short time since the start of the flu vaccination programme. I hope that that gives Parliament some confidence, because if we have 7.5 million doses to give by the spring, 2.5 million since the start of September is a pretty substantial effort in getting to that. I assure Mr O’Kane that we are trying to be as flexible as possible, but what is critically important is ensuring that we cover the volume of vaccinations that are required. Parliament should be encouraged by the progress that has been made to date.

Mr Cameron raises an issue that the Government has considered carefully. Ministers were given the advice when the pandemic situation was deteriorating. After taking further medical advice from the chief medical officer, ministers concluded that it was better to take a more cautious approach, given that the pandemic’s wider course was deteriorating.

Throughout the discussion with Parliament, I have maintained the argument that we must make a set of balanced judgments while looking at the pandemic’s overall course. Much as we might not like components of the steps that we must take, we must use a range of measures that will avoid the need for more dramatic interventions to stem the virus’s circulation.

I explain to Mr Cameron that the Government is looking at the evidence in the round and making a judgment. If we believe that there are opportunities for us to relax the restrictions, we will take them. However, we must be mindful of the pandemic’s likely course, given what I said today about the onset of winter, the possible impact of COP and people spending less time outdoors and more time indoors.

We must wrestle with a complex picture, because nobody wants our national health service to be overwhelmed at any stage in the future. We have consistently tried to avoid that. I marshalled before Parliament today, as is shared with members regularly, the pressure that the NHS is experiencing. Nobody wants the NHS to be overwhelmed.