Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 21, 2021

Official Report 1012KB pdf

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Scottish Ambulance Service

Members may be aware that some details of the proposed ministerial statement on the Scottish Ambulance Service appear to have been made public via the media prior to being announced to the Parliament. That is extremely disappointing.

I make it clear that the expectation that statements will be made to the Parliament is about demonstrating respect for the Parliament. I consider the matter to be very serious. Given that I cannot be sure that all members will have seen the coverage, I will in this instance allow the statement to be made. However, if similar instances occur in the future, I reserve the right not to allow a minister to deliver a statement but to move straight to questions from members.

On a point of order, Presiding Officer. I welcome your comments. Paragraph 3.5 of the Scottish ministerial code spells out clearly that,

“When the Parliament is meeting, Ministers should ensure that important announcements of Government policy are made, in the first instance, to the Parliament”.

It would appear that the code has been broken.

Presiding Officer, I appreciate that matters to do with the ministerial code reside chiefly with the First Minister, but will you advise us whether the issue could be laid before the Standards, Procedures and Public Appointments Committee for further investigation?

I thank Mr Kerr for his point of order. I have yet to see the statement, as I have been chairing in the Parliament, but I am aware of the significant references that the Daily Record has made to what I expect we are about to hear from the cabinet secretary. As I said, I will allow the statement to go ahead, but I will certainly look further into the matter.

15:22  

Presiding Officer, I hope that you will appreciate that it was never my intention to cause you or the Parliament any issues when I spoke to the media ahead of my statement. If issues were caused, I offer an apology to you and to the chamber, and I give an assurance that we will take the necessary steps to ensure that it does not happen again.

The past 18 months has been a time of unprecedented pressure in the national health service, as it has faced the biggest challenge of its 73-year history. The Scottish Ambulance Service is the heartbeat of our NHS. It has a unique role in engaging with all parts of the health and social care system across Scotland, 24 hours a day and seven days a week.

I again take the opportunity—as, I am sure, other members will do—to thank all our hard-working Ambulance Service staff for the work that they are doing in such difficult circumstances. I understand that those who call an ambulance are often in considerable distress, but I hope that we all agree that our ambulance colleagues deserve to be treated with the utmost respect.

It is important to remember that, despite the significant pressures that our service is under, staff continue to deliver a highly effective response to our high-acuity patients—30-day survival rates for such patients are at their highest ever recorded levels.

That said, I recognise that some people are not receiving the standard of service that they should be getting or the standard of service that the Ambulance Service and the Scottish Government want to be delivered. I completely accept that some of the cases that we have heard about—in the chamber last week and in the media—are unacceptable. I have no hesitation in apologising to families who have been let down.

It is in that context that the Ambulance Service is currently operating at level 4 of its escalation plan, which is the highest level. That decision has not been taken lightly. In practice, it means that all clinically trained staff in support departments have been redeployed to the front line. The service has stood up its national command and control centre, and management teams, regional co-ordination cells and support teams are all working extended hours.

The situation in Scotland is not unique. The global pandemic has created the most challenging crisis in almost every sphere of our lives—including our national health service—in the history of peacetime Britain and certainly in our lifetimes. Ambulance services across the UK, as well as the wider NHS, are experiencing unprecedented demand. That is largely because of Covid, but it is also due to a combination of increasingly complex cases, delayed demand and exceptionally busy emergency departments.

Last month, our ambulance crews responded to 10,733 immediately life-threatening incidents, which was 20.7 per cent of all incidents that were attended that month. Compared with the figures for August 2018, when there were 5,788 immediately life-threatening incidents, which was 10.6 per cent of incidents attended, that clearly shows the significant increase in acuity of presentations to the service.

The vast majority of patients in those immediately life-threatening incidents require to go to hospital. With acute occupancy for most boards already between 87 and 96 per cent, and most mainland boards in excess of 100 per cent for intensive care unit occupancy, we can clearly see the pressures that our services are under.

That is why we have already taken significant action, both prior to and since the onset of the pandemic. That includes additional funding to recruit more ambulance staff, enhanced air transfer capacity through a contract with Loganair and setting up a strategic working group to implement actions to improve turnaround times for ambulances.

It is, however, important that I once again make it categorically clear that we are still firmly in the midst of a global pandemic. Today, I will outline to members the measures that we are putting in place to ensure that our Ambulance Service has the full range of support from our wider public services at its disposal as we enter what will inevitably be the most challenging part of the year, in the autumn and winter.

Our immediate actions will be backed by additional investment of up to £20 million, on top of the additional £20 million that has already been invested this year to recruit an additional 296 ambulance staff. That equates to additional in-year investment in the service of more than £44 million, which is an uplift of nearly 16 per cent on last year’s resource budget.

Many of the actions that we are taking are aligned with suggestions that have been made by the unions that are attached to our Ambulance Service, which have set out a number of suggestions for support. Those actions focus on immediate assistance from partners, continued workforce enhancements and improvements to the flow of cases into emergency departments.

In terms of the immediate, there are short-term pressures on the Ambulance Service that will be relieved only through the wider public and voluntary sector standing up to support the service at this incredibly challenging time. I can confirm that a request for military assistance was made immediately after First Minister’s question time last Thursday. Since then, officials have been working to finalise the package of support that the military will provide.

The assistance will consist mainly of the provision of 88 drivers to free up our paramedics and technicians to focus solely on providing patients with the best clinical care. Fifteen support staff are also being requested, which means that there will be support in the form of 103 military personnel. There are still authorisation processes to go through, but we do not envisage any challenges with gaining the required approval. All going well, some of those military personnel will be ready to be deployed and driving ambulances this weekend. As always, my thanks go to the Army for its responsiveness.

I have also reached out to the Scottish Fire and Rescue Service, and I am glad to say that, in typical fashion, it has risen to our call. It will scale up the Ambulance Service’s access to volunteer firefighters for driving, and that will now also include full-time firefighters. Again, that is with a view to providing more valuable paramedic and technician time on the front line.

The immediate assistance is not being sought only from the wider public sector. We have also brought in support from the British Red Cross, as well as private contractors such as taxi companies, to help with some of the Ambulance Service’s work where no emergency ambulance is required. I make it absolutely clear that, if someone is in critical or life-threatening need, they will be taken to hospital in an ambulance, if one is requested. Alternative transport arrangements are for patients with low acuity. Patient safety will, of course, remain our number 1 priority.

We should bear it in mind that, in August this year, around 27 per cent of calls to the Ambulance Service did not require an ambulance response and only 21 per cent of calls involved life-threatening situations, although that percentage has risen considerably recently.

The decisions that I have outlined are not ones that we have taken lightly, but, given the urgency of the situation, the Government needs to respond with decisive, if unconventional, action to save lives, as it has done throughout the course of the pandemic. I make it clear that the full range of measures that I am announcing today have been assessed as clinically safe.

Of course, it is important that we are not only freeing up paramedic and technician capacity, but creating additional emergency capacity in the wider Ambulance Service. That is why we are also aiming to bring on board 100 second-year paramedic students to work across the service, including to assist our ambulance control centres with call handling and dispatching over the winter period.

On specific clinical issues, we are also bringing in temporary clinical input to decision making on mental health, addictions, falls, breathing difficulties, high-intensity users and trauma. That will provide senior specialist clinical decision support to patients, thereby optimising the service’s response to people in need, and utilising additional clinical pathways where it is appropriate to do so.

Bolstering capacity at both the front and back ends of the Ambulance Service will be fundamental to saving lives, and I am thankful to all those individuals and organisations that have offered their support. However, I am mindful that it has been, and will be, a long pandemic, and we cannot solely rely on immediate, short-term measures to build a sustainable future for the Ambulance Service. That is why, as part of our recovery plan, we will deliver almost 300 additional Ambulance Service staff by April 2022. Last year, 148 new staff were recruited, and the service plans to recruit another 443 this year, 148 of whom will be new staff, with the remainder covering planned staff turnover; 172 have already been recruited this year, with 186 due to be in post by the end of November, and the remainder by April 2022. The service is taking forward recruitment plans at pace.

The breakdown of new recruits is that there will be 69 staff in the north of Scotland, 139 in the west and 88 in the east. The additional new staff are a mixture of paramedics, newly qualified paramedics and technicians. We are also funding additional fleet for the service, which will see the introduction of a number of extra ambulances over the coming months.

As part of our on-going commitment with the service to reduce and remove the requirement for staff to work on call in some of our more remote and rural areas, we are providing funding for 14 additional staff, which will result in the on-call requirement being reduced in Campbeltown and removed entirely in Fort William, Kirkwall and Broadford.

We know that our emergency departments are also under significant pressure. That is why we need to ensure that we are not just creating further problems for A and E departments that are already struggling. Therefore, we are also further investing in additional hospital ambulance liaison officers. We are almost doubling the number of HALOs from the 11 who are currently in place, with the result that there will be 20 posts throughout the country.

Those liaison officers are important in supporting flow through emergency departments and improvement in ambulance turnaround times. HALOs will take part in the daily huddle and work across the hospital site in order to maximise flow as well as possible. The HALOs will be concentrated at our busiest sites.

Most of us have seen pictures from Scotland and across the UK of ambulances queued up outside emergency departments. Getting people the care that they need, in the most appropriate setting, is crucial, and is another key element in freeing up our ambulance crews to respond to other patients’ needs.

We need a concerted effort across the whole public sector to ensure that all parts of the system can respond to the demand that the difficult winter ahead will bring. Our forthcoming winter plan will set out the measures that we and our partners will take to ensure that we can deliver high-quality, safe care in a sustainable way in the coming months. That will create capacity in our community health and care services and in our hospitals, and it will ensure that there are alternative pathways that people can access, where it is safe to do so, in order to avoid their admission to hospital, as well as ensuring that they can be discharged from hospital as soon as it is clinically safe.

I know that some members have suggested having pop-up facilities outside our A and E departments. The issue has been explored, and, although we will keep it under review, our clinicians and the likes of the Royal College of Emergency Medicine have expressed patient safety concerns in relation to that option. However, with immediate effect, we are repurposing some spaces to maximise capacity at the front door of hospitals across the country to ensure that patients can be safely transferred to clinical teams as quickly as possible. Where necessary, that might include expanding the footprint of our hospitals, even on a temporary basis, and we are working with NHS boards on that.

This will undoubtedly be the most difficult and challenging autumn and winter period that our health and social care services have ever faced. As in other parts of the UK, Scotland’s health boards have faced unprecedented demand over recent weeks, whether in emergency departments, in elective activity or in local general practitioner practices. The next months will require us all to come together to support one another, as we are seeing through the brilliant response to the call for help from the military, the fire service, the third sector, volunteers and the private sector, as well as from Ambulance Service staff themselves.

The wellbeing of our Ambulance Service and of health and social care workers more widely is of paramount importance. Throughout this period, our staff need to know that we are doing everything that we possibly can to provide them with the support that they need.

The situation that I have described has inevitably resulted in additional pressure for ambulance staff with regard to rest break compliance and shift overruns. This year, we are providing £500,000 of funding for additional support to Ambulance Service staff wellbeing. That includes additional welfare for crews and a range of wellbeing initiatives, such as personal resilience packages and techniques that are supported by a dedicated wellbeing team. I am still very supportive of SAS discussions with its trade union partners about having a rest break action plan in place as quickly as possible.

I have outlined an immediate plan of action, which is backed by up to £20 million of additional investment. Our Ambulance Service and NHS have been there for us in our hour of need. This Government will, in turn, be there to support our public services during their hour of need.

I look forward to taking members’ questions.

The cabinet secretary will now take questions on the issues raised by his statement. I am conscious that his statement has overrun, for understandable reasons. I intend to protect the 20 minutes or so that have been allocated for questions. However, I would be grateful if members and the cabinet secretary could keep questions and answers as brief as possible.

I would normally have welcomed advance sight of the health secretary’s statement, but, on this occasion, it was published on the front page of the Daily Record first, rather than announced to this Parliament.

Shameful.

For weeks, we have heard stories of horrendous waits for ambulances. This morning, Jamie McNamee of Unite the Union said:

“This is as bad as it’s been, in my experience”

of 35 years in the Ambulance Service, and the Government is using the pandemic as an excuse for the long-standing problems in our Ambulance Service. He went on to say that the supposedly 300 new ambulance staff come from a totally different project that has been on-going since 2016. How many of the 300 positions are new?

The health secretary said in his statement:

“The Scottish Ambulance Service is the heartbeat of our NHS.”

Why, then, is the Government demanding that it makes £15 million of efficiency savings, otherwise known as cuts?

Will the health secretary commit to publishing weekly response data so that we know exactly how the service is performing across the country?

When I asked the First Minister when we would get a winter NHS plan, she did not answer, preferring instead to read a pre-prepared script. Will the health secretary confirm now when Scotland’s NHS will finally get the real plan that front-line staff and the public need?

I have given detail in my statement about the additional staff that we are recruiting. On the one hand, the Opposition is telling me that we should have taken action many months ago but, on the other hand, it is castigating us for taking that action months and months ago.

We have taken that action and we have invested an additional £20 million, which, of course, will see an additional number of staff recruited to our Ambulance Service. I am delighted that we have those additional recruits. In my statement, I have just noted the additional actions that we will take, which are backed by £20 million of investment.

Among Dr Gulhane’s other asks, he mentioned efficiencies. Let me be absolutely clear that there has not been and will not be a single penny cut from the Scottish Ambulance Service budget. The opposite is true. A moment ago, I told members that this year’s budget has increased by £44 million, which is almost 16 per cent. We will continue to invest in the Scottish Ambulance Service.

Of course, when efficiencies are made, such as by introducing electric vehicles, saving money on petrol and diesel, the savings are retained by the health board—in this case, by the Scottish Ambulance Service. Dr Gulhane will forgive me if I do not take any lectures on public spending from a Conservative Party that is responsible for a decade of austerity in Scotland that has hit the poorest in our society the hardest.

On whether I would consider publishing more data and statistics, I will give that call some consideration and return to the member on that. A recovery plan is already under way, backed by £1 billion of investment. However, as I mentioned in my statement, we will bring forward a winter plan imminently.

Before I call Jackie Baillie, I invite members who want to ask a question, if they have not already done so, to press their request-to-speak button now, or as soon as possible.

On a day of new records, and not good ones, the health secretary has been missing in action, refusing press interviews about ambulances for five days, which—I think he would acknowledge—is unusual for him. Ambulance delays continue at record levels and people are dying as a result. Accident and emergency waiting times are at an all-time high, despite the best efforts of NHS staff, who deserve our thanks.

Just this morning, John Thomson, of the Royal College of Emergency Medicine, said that the NHS needs an additional 1,000 beds to cope with the current crisis, yet there was not a single mention of additional bed capacity in the cabinet secretary’s statement. Is that because the Scottish National Party have cut beds in the NHS by 1,200 in the past 10 years?

Given that the problems with ambulance delays are actually about patient flows in A and E and a lack of beds in hospitals, will the cabinet secretary tell me whether John Thomson was wrong when he asked for an increase in bed capacity? Will he urgently consider setting up temporary wards or field hospitals like the NHS Louisa Jordan?

Ms Baillie is incorrect, and she may want to go back and correct the record, as I did interviews last week on Monday, Wednesday, Friday and Sunday. I suspect that, in order for her to suggest that I have been somehow missing in action, she has probably just not been watching the news. On the one hand, I have been castigated for speaking to the media, and on the other, I have been told that I have not been speaking to the media—[Interruption.]

The member may want to listen—I am referring to the fact that she may want to correct the record.

On additional bed capacity, Ms Baillie is, of course, correct that the problems that we are facing are undoubtedly due in part to the additional demand at our front door. We are having urgent discussions with local authorities and social care providers—this is one of the actions that relates to our winter plan, which I will bring to the chamber—about how we free up bed capacity among the delayed discharge cohort. It is reasonable for Ms Baillie to ask that question. We are urgently exploring that issue, and I will come back to Parliament with a further update.

As I announced, we are increasing the number of HALOs from 11 to 20. That will help to ensure that people are not just discharged from an ambulance, but that they work their way through into the hospital system so that they are not left sitting in A and E departments.

With regard to field hospitals, I mentioned that there are some concerns around pop-up facilities. As members would imagine, I have spoken to every single health board and mentioned that the equipment that was used in the NHS Louisa Jordan is available for them to use. However, it is not simply a case of setting up beds—those beds have to be staffed. We would have to take the workforce out of extremely busy hospitals and put them in—[Interruption.]

If the member just listened, as opposed to shouting from a sedentary position, she would know that I am trying to answer her question in all sincerity. I am not dismissing the idea in its entirety, but setting up beds is only part of the solution. We would have to ensure that those beds are staffed, and pull staff from sites that are already busy, which would present its own challenge. However, I would not dismiss the idea in its entirety.

Given that we are in the midst of a global pandemic, with unprecedented pressures across the health service, including resultant pressures on our Ambulance Service, does the cabinet secretary agree that we should look at having all hands on deck?

For example, I would suggest bringing back to the wards those nurses who are currently in NHS management or education roles, thereby avoiding the current redeployment of theatre nurses and operating department practitioners away from their key roles.

In short, yes. I know that health boards are already doing that, and they will continue to look at where staff can be redeployed to the front line when that is appropriate and necessary. In escalating to level 4, which is its highest level, the Ambulance Service has already taken clinical staff away from support roles and redeployed them on the front line.

We are also working with the appropriate bodies to think about making a call to arms to those retired staff who responded so well at the beginning of the pandemic, to see whether they can come back and help us during what will be the most challenging winter that the NHS has ever faced.

The past 18 months have been a time of unprecedented pressure in the NHS, but the problem is historical. In 2018, only 20 per cent of ambulance staff thought that there were enough staff to do their jobs and, even before the pandemic, the number of ambulances that recorded turnaround times of more than an hour had doubled. GMB Scotland recently said:

“The understaffing crisis in the ambulance service was already understood pre-Covid”.

Why did the SNP not recognise that at that time? Why did it actively choose to ignore the historical call from front-line staff to fix the problem before we reached the crisis? Does the cabinet secretary agree that the forthcoming winter plan that we are waiting for should have formed an essential component of the NHS recovery plan?

Sue Webber is clearly not talking to her front-bench colleague, because he just said that we announced the investment in additional staff before the pandemic. Her own colleague has recognised that we were already addressing the issues around staffing in the Ambulance Service. The additional investment in the Scottish Ambulance Service will mean 300 additional—I use the word “additional” again—staff, which will help us in that regard.

On the winter plan, we are working closely with the UK Government to get finalisation of the additional consequentials that will come our way. I will inform the Parliament imminently about the detail of the plan.

Will the cabinet secretary say more about the 103 military staff who will be helping? For example, will they be driving their own vehicles or normal ambulances? Will the situation here be similar to the way in which the military are involved in England and Wales?

I am sure that it will be. I have not seen the detail of the military aid to civil authorities—MACA—requests that the UK and Welsh Governments have made, although I know that they have been made. I put on record my thanks to the Army and military personnel for always answering the call with such responsiveness and pace.

The final details are being discussed by the Ambulance Service and the military. As I referenced in my statement, 88 of the military personnel will be driving ambulances and 15 will be in support roles. Once further details become available from the Ambulance Service, I will be happy to share that with John Mason.

The cabinet secretary says that there will be additional ambulance staff on the ground by April 2022 and that, of the 443 staff who will be recruited this year, only 148 will be new additional staff, with the rest being recruited to cover staff turnover. Does the cabinet secretary intend the British Army to support ambulance services all the way through until April 2022? Where will the military personnel be deployed, and when will members be made aware of that?

I will send the final detail to members once it has been officially agreed between the Scottish Ambulance Service and the military. We expect some of the military personnel to be deployed at the weekend. As members might imagine, that will be in the areas where we are facing the most acute pressure.

Paul O’Kane will see in my statement that we will recruit 300 additional ambulance staff by April 2022, but he is right that some staff will be recruited to ensure that we do not have any gaps from staff turnover or retirement.

As I said, once the detail has been finalised, I am happy to provide further detail to all members on the military assistance request that has been made.

I note that only 21 per cent of calls in August were about life-threatening conditions. Although I welcome the 100 additional call handlers, will the cabinet secretary consider reviewing the 999 and 111 call triage information technology systems to ensure that cases that can be dealt with by other services, such as out-of-hours GPs or minor injury clinics, are referred appropriately and are not sent an emergency ambulance? I stress that I am referring to the IT systems and not the call handlers themselves.

The issue of the IT systems is looked at regularly by SAS clinical advisers in control centres. They already signpost patients to alternative services. However, increasing clinical capacity in control centres and strengthening the links to and availability of alternative pathways, including GPs, are a key part of the work that is to be done in support of patients getting the right care at the right time in very much the right place. By extension, that means making emergency ambulances available only for those patients who are most in need of that resource. I will look again at Christine Grahame’s point about the IT system; we have looked at it previously, but we will look again to see whether it can work in a more efficient manner.

The situation is unacceptable. It is not just down to the pandemic, and to suggest that it is undermines the concerns that staff have been expressing since long before we heard of Covid-19. We should never have reached a stage where the fire service, the Army and taxi drivers have to bail out front-line care staff. The British Medical Association said just this morning that no realistic workforce plan can get the NHS to work 10 per cent harder.

All of this is caused by an interruption of the flow throughout our NHS, from GPs to the lack of social care provision that leads to delayed discharge from hospital. How long does the cabinet secretary expect the crisis to last?

We are still in the midst of a global pandemic. It is unbelievable that the member stands there and says that this has nothing to do with the pandemic. Of course it has something to do with the pandemic. We are still in the midst of that global pandemic. Case numbers and community transmission are still too high.

For the member to suggest that the pandemic has played no role does him no favours. He can wag his finger all he wishes from a sedentary position, but he will lack credibility if he does not acknowledge that fact. I have stood here and given the detail that 20.7 per cent of cases that the Ambulance Service responded to this August were of high acuity, in comparison to just over 10 per cent of cases in August 2018. That shows how the pressures of the pandemic are feeding through not only to the front door of our NHS but to its back door also.

We do not know how long this will last, as we are still in the midst of the pandemic. I do not have a crystal ball; life would be easier if I did. The Government will take immediate action, as I outlined my statement, to ensure that we bolster our NHS and our Ambulance Service. [Interruption.]

We had enough sedentary interventions, Mr Cole-Hamilton.

I have spoken to frustrated first responders in my region who, despite being ready and willing, are not being offered the training that is required for them to help with these workforce issues. They are baffled that the Army is being brought in before they are being used, despite many of those first responders having had blue-light training in their day jobs. Will the Scottish Government encourage the Scottish Ambulance Service to make use of the around 1,500 community first responders to help tackle the crisis?

The amazing community first responders to whom Ms Roddick refers serve in partnership with the Scottish Ambulance Service to provide exceptional support to patients. I know that the SAS is planning to increase the number and the range of codes to which CFRs can be dispatched and is in advanced discussions about implementing digital solutions to support CFRs in keeping patients safe in ambulances that are en route. There are no immediate plans to train volunteers to drive under the blue light, predominantly due to United Kingdom-wide issues with driver training at present.

I have previously raised in the chamber the pressure that is being put on out-of-hours GP services. Is the cabinet secretary concerned that people who are faced with long waits at A and E or for ambulances might turn to out-of-hours general practice, putting further strain on a service that is already under extreme pressure? What impact does the cabinet secretary think that the increased demand for out-of-hours and emergency services will have on out-of-hours GPs? Will a similar package of support be put in place for out-of-hours practitioners and services?

We are committed to increasing funding for primary care by 25 per cent. We made that commitment and I know that the member welcomed it. In short, we are looking at the entire system. The member is right to raise the point. The focus of this statement is understandably and rightly on the Ambulance Service, but we know that we must take a whole-systems approach. Therefore, the announcement that I intend to make about our winter plan will demonstrate the actions that we are taking across the entire system.

Of course, we would always say that individuals who call 999 should listen to the clinical advice about the best place for them to go. If they need an ambulance and if it is critical that they be in an emergency department, they will be taken there.

What steps are being taken to ensure that Ambulance Service transport, including patient transport other than blue-light ambulances, can be utilised to free up ambulance capacity?

I said in my statement that we will look at other transport. I thank the British Red Cross for the support that it has already provided. Let me be clear, as I was in answer to the previous question: if anyone clinically requires an ambulance, an ambulance will come to them. Following clinical triage and ensuring that there are no patient safety issues—which is of paramount importance—it makes sense to use all reasonable options to ensure that patients get to the right place at the right time. I have outlined some of those measures and some of the actions that we are taking that will have an immediate impact in that regard.

I thank the cabinet secretary for coming to Parliament to repeat his statement. For someone who is in contempt of Parliament, he has shown little contrition.

Senior police officers have told me that significant front-line policing resources are being lost due to delays at A and E departments. Many police officers are now spending hours transporting patients from the scenes of incidents as a result of severe ambulance delays. What contact has the cabinet secretary had with Police Scotland to assess the full impact that the crisis in our NHS is now having on the fight against crime?

As the member can imagine, my officials and I speak across the Government and across portfolios about the pressures. I thank Police Scotland. I know from my previous role the importance of joined-up working between our emergency services, and I thank our police officers for the incredible work that they have done in that regard. Even pre-pandemic, they were often at the forefront when it came to challenges around vulnerable people, and particularly those with mental health challenges. We continue to work across all the emergency services and across Government, and I thank all those emergency responders who have responded to our call during this time of great need.

I ask Colin Smyth to be brief.

The cabinet secretary has just admitted that the reason for the reluctance to establish temporary wards and field hospitals is that health boards are struggling to safely staff existing hospitals. What does it say about the Government’s more than a decade of utter failure in NHS workforce planning that health boards have been unable to recruit enough nurses and doctors to meet pre-pandemic demand, never mind the extra demand caused by the crisis?

Of course, the NHS workforce under this Government is at record levels. Not only that, here in Scotland we have the best-paid NHS staff anywhere in the entire United Kingdom. We will continue to pay them the best in the UK and we will ensure that our NHS remains at record levels.

That concludes the statement and questions. I thank the cabinet secretary and members for allowing us to get through all the questions.