Meeting of the Parliament (Hybrid)

Meeting date: Thursday, September 16, 2021

Official Report 1068KB pdf

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First Minister’s Question Time

We come to First Minister’s question time. I intend to take constituency and general supplementary questions after question 2, so please press your buttons during question 2 if you want to ask such a supplementary. I will take supplementaries to questions 3 to 6 as they arise, so please press your buttons during the relevant question. If we have any time in hand after question 6, I will take outstanding questions.

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Scottish Ambulance Service (Waiting Times)

Last week, I raised the crisis in the Scottish Ambulance Service. I said that the scandalous waiting times could cost people’s lives. This morning, we all read in shock and horror about 65-year-old Gerard Brown, who died after a 40-hour wait for an ambulance. When the paramedics reached him, all they could do was pronounce him dead. His body was still warm. His son, Dylan, said that the hardest part to accept was that his father’s general practitioner had told him that if the paramedics had got to him, his dad would still be here. Let us just think about being told, “If they had got to him, your dad would still be here.”

What does the First Minister have to say to ambulance crews who turn up to save people’s lives only to have to pronounce them dead? What does the First Minister have to say to Gerard Brown’s general practitioner, who said:

“This is third world medicine”?

What does the First Minister have to say to Dylan Brown, who is grieving the death of his father who should still be alive?

First, my condolences go to Mr Brown. The individual cases that are reported in the media this morning obviously require to be fully and properly investigated. It would not be right for me to pre-empt those investigations, but what has been reported is unacceptable. I am in no doubt about that.

As I said last week, the Ambulance Service is working under acute pressure right now, largely because of Covid. I take this opportunity to thank our paramedics and technicians for the work that they are doing in such difficult circumstances. Although crews are responding heroically to the challenges, I recognise that some people are not getting the standard of service that they should be getting, or indeed the standard of service that the Scottish Ambulance Service wants to deliver. That is not acceptable, so I apologise unreservedly to anyone who has suffered or who is suffering unacceptably long waits.

A range of actions have already been taken to address the challenges. For example, additional funding has been given to support new recruitment. A number of additional actions are also under active consideration. I will be happy to summarise those in later exchanges, but I confirm now that they include consideration of seeking targeted military assistance to deal with short-term pressure points. Such military assistance is already being provided to ambulance services in England. Of course, we have had military assistance in other aspects of the pandemic during the past 18 months.

I will meet representatives of the Scottish Ambulance Service to assess its progress on all the actions that are being considered, and the Cabinet Secretary for Health and Social Care will make an update statement to Parliament next week.

The service is under acute pressure. I think that people understand the reasons for that pressure, but the obligation is on Government to work with the service to ensure that it can meet that pressure in the interests of patients across the country.

The First Minister says that the cases will be “fully and properly investigated”, but this should not be happening in Scotland in 2021. Last week, my raising concerns about people dying while waiting for ambulances was met with groans from Scottish National Party members, and the First Minister did not answer me. Every day since then, we have heard about tragic life-threatening waits for ambulances. An 86-year-old woman lay in agony on a hard kitchen floor for eight hours with a broken hip. Just this morning, Evelyn from Kilwinning called a phone-in to talk about a 23-hour wait for an ambulance for her husband. She thinks that, eventually—these are her words—

“Their luck is just going to run out.”

Last week, the First Minister would not accept that the Ambulance Service is in crisis. Surely the past seven days must have changed her mind. Will she now accept that the Ambulance Service is in crisis?

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.

I listened to the First Minister really carefully, and it seems that she deliberately did not accept that there is a crisis. This is the second week in a row that I have asked that question. It is important that we recognise that there is a crisis. Admitting it matters, so I hope that the First Minister will admit it. That would mean that the Government could start to look for help in tackling the problem.

The First Minister mentioned that the Government is considering seeking targeted military assistance. The Unite union has called for that. It has also asked the Ambulance Service to declare “major incident” status. We support those calls.

What about the Scottish Government? Humza Yousaf’s response was to tell people to think twice before they call an ambulance. Telling people to think twice before they call an ambulance is dangerous and reckless. Will the First Minister apologise, withdraw those remarks on behalf of the Scottish Government and tell people that they should never think twice about calling an ambulance in an emergency?

I think that what people are looking to me and the Government for is action to deal with the situation that we face. That is more important than what we choose to call it. I am not in any way trying to evade the reality that we and our front-line health workers are currently experiencing. It is probably the most challenging combination—or, at least, one of the most challenging combinations—of circumstances that our health service has faced since its establishment. There is no sense in which I am seeking to underplay that.

Douglas Ross said that the Scottish Ambulance Service should declare a major incident. The service operates at various levels of escalation; it is currently operating at level 4 of its escalation plan—the highest level. Again, terminology should not be allowed to mask reality. The service is operating at its highest level of escalation, and as part of that it is, for example, deploying a national command and control centre in order to utilise resources better across the country. We will continue to consider all ways in which we can utilise and deploy additional resources. I have already set out some of what we are considering with the service.

Finally, I turn to the health secretary’s comments. The health secretary was saying something that health secretaries have said many times—I remember saying it myself when I was health secretary—and I have seen comments from ambulance services in every part of the United Kingdom over the past few days saying exactly the same thing, which is that when people require an intervention from the health service that would better come from parts of the service other than the Ambulance Service, we should encourage them to seek that. When people consider that they need an ambulance, they should never hesitate to call one, if that is the intervention that they think is required.

As First Minister, I make it very clear that the Scottish Ambulance Service exists to provide emergency assistance to those who need it. It is facing the most intense challenges and some people are not getting the service that they should get. The answer is for Government and the service to work to ensure that it is meeting the challenges, so that no one who needs an ambulance hesitates to call for one and—which is just as important—so that they get the ambulance timeously, as they have a right to expect.

The First Minister said—I wrote it down—that she is not trying to “evade the reality”. Why, in that case, does she not accept that the Scottish Ambulance Service is in crisis? We are hearing that day in, day out from people across Scotland. We are hearing it from the front line—from the paramedics and technicians—and we are hearing it from Unite the union and others.

I am sorry, but I cannot sit here and listen to the First Minister say that the comments from the Scottish Government’s health secretary are the same as those that we are hearing elsewhere in the United Kingdom. I have heard no one else in the United Kingdom telling people to think twice before they call an ambulance. The way to tackle the extreme pressure is not to tell sick people to stay away, but to give ambulance crews the resources that they need to reach every patient while they are still breathing.

The health secretary should be providing solutions; instead, Humza Yousaf is the problem. This summer, he used misleading figures about children with Covid. He wasted months on a flimsy national health service recovery plan that is not cutting it. Yesterday was a new low: we have a health secretary who told people, in effect, “Don’t look after your own health.” He actually said that they should think twice before calling an ambulance. With Scotland’s NHS in crisis, is not it the case that it is Humza Yousaf who needs to think twice before he speaks?

People who are watching this will draw their own conclusions from the tone and tenor of the remarks that are being made. I will stay on the substance of the issues, because they are important for people across the country and have my full attention, as they have the health secretary’s full attention.

Douglas Ross continues to question me about terminology, so let us be clear. The pandemic has created—not just in Scotland, but across the UK and much of the world—crisis conditions for our health services. That includes the Ambulance Service, which is at the front line of the response of our health service for so many patients who need it. The point that I am making is that whatever someone like me chooses to call it is less important than what we do to support our service in meeting the challenges. I think that people who are listening today will have recognised that we are already taking a range of actions. [Interruption.] There are almost 300 additional paramedics and technicians—[Interruption.]

I appreciate that this is a very important and emotive issue and that people are rightly passionate, but could we please hear the First Minister?

A range of actions have already been taken. As I was saying, almost 300 additional paramedics and technicians are being recruited to help to meet the challenge. We are supporting the service in a wide range of ways.

In saying that, I in no way seek to underplay how unacceptable long waits are for anybody who experiences them. The majority of people who phone for an ambulance get an excellent service from the paramedics and technicians who provide it. We are considering a range of additional actions; I have set out some of them. The health secretary will make a statement next week to update Parliament on those actions. [Interruption.]

Somebody is shouting at me, “Why next week?” That is because that will be the next parliamentary opportunity to make a statement. I am—[Interruption.]

Douglas Ross is saying, “Do it now.” I am standing here right now, setting out what we are doing. The health secretary and I will be dealing with the matter over the course of today, tomorrow, the weekend and into next week, for as long as it takes.

Those are the steps that we are taking. We will continue to take those steps. Governments across the UK will be doing similar things to support their services. We are in the most challenging set of circumstances that our health service has faced. My job is to make sure that we support the Scottish Ambulance Service to rise to the challenges. That is what I will focus on each and every minute of each and every day.

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Scottish Ambulance Service (Waiting Times)

The First Minister has evaded this issue for weeks. She tries to hide behind the pandemic, but let us look at the statistics before the pandemic. There were almost 1,000 cases where ambulances waited for over two hours outside a hospital to transfer patients. There were more than 15,000 times when an ambulance took over two hours to arrive with a patient. A staff survey found that 63 per cent of staff felt that the Ambulance Service was short staffed before the pandemic. I say to the First Minister: please do not use the pandemic as a cover for your Government’s failures.

The truth is that this is an avoidable human tragedy on a heartbreaking scale. Lilian Briggs broke her hip and had to wait for eight hours on the floor for an ambulance. Gerard Brown collapsed at home and died after waiting for 40 hours for emergency services. Pandemic or no pandemic, there is a simple truth: no one should be left to die on the floor while waiting for 40 hours—40 hours—for an ambulance.

Lilian’s and Gerard’s families have been courageous enough to go to the newspapers, but there are hundreds of families who have not gone to the media but are suffering in silence. How many hours will it take for the First Minister to fix this?

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.

I think that the First Minister misses a key point. We are going to have extra pressure added by winter, but if we cannot even handle the pressure pre-winter, imagine how hard it is going to be when winter arrives. That is the hard truth that the First Minister is trying to ignore.

Let us be clear about this. Our NHS staff, paramedics and call handlers are being failed, too. They are the ones who are having to answer those heartbreaking calls and tell patients that there will not be an ambulance coming any time soon. They are the ones who are having to turn up to distressing scenes in homes and who are expected to explain the First Minister’s Government’s failures.

Let us listen to the staff. They are telling us that there are not enough ambulances, not enough staff in the Ambulance Service or at A and E and not enough beds in our hospitals. Patients are not just having to wait for hours for an ambulance: they are also having to wait for hours outside hospital in ambulances. Things are so bad that the British Red Cross has been drafted in to deliver humanitarian assistance at Glasgow’s flagship hospital.

I note what the First Minister has said about the role of the British Army. Will she listen to calls from ambulance staff and Unite the union for a major incident to be declared, for pop-up wards in emergency departments and for the British Army to be drafted in. When will that happen?

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 First Minister does not understand the urgency. She wants to wait for a week before making a statement about actions that will follow that. She wants to consider options about the role of the British Army. How many more Lilian Briggs must happen in the next week before we take urgent action? How many more Gerard Browns must happen in the next week before we take urgent action? Urgent action must happen today, tomorrow, the day after and the next day. We cannot wait a week for this Government to wake up.

The First Minister says that she is taking action, but she and her health secretary have been in denial for months. Things are getting worse. People cannot afford to wait.

These problems have been years in the making. There are 600,000 people on waiting lists for treatment. We have record-breaking A and E waiting times. Tragically, people are dying as they wait for ambulances. The First Minister likes to remind us that the buck stops with her—it does. How many more families will have to suffer? How much more stress will our workers have to endure? How much more time does she expect people to give her and her health secretary to fix this mess?

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.

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Brexit (Food and Farming Import Checks)

The United Kingdom Government has confirmed that it again intends to delay post-Brexit food and farming import checks. Once again, Scotland’s vital food and farming sectors find themselves paying a price for the Tories’ extreme Brexit plans. Does the First Minister share my concern that that last-minute delay highlights that the Tory Government has no real solution to the Brexit issues that it has created and is just kicking the can down the road once again?

Yes, that is absolutely correct. We have been warning for months and months about the implications not just of Brexit but of a hard Brexit. Just this week, as the member rightly says, we have seen a further delay to the necessary, though deeply regrettable, infrastructure that needs to be in place to support some of this. It is our food and drink and agriculture sectors that are paying the price. I very much hope to see solutions put in place to alleviate the situation as quickly as possible. However, I do not think that anybody should be in any doubt that those sectors will face the inescapable consequences of Brexit for some time to come. That is, of course, the responsibility of the Tory Government at Westminster.

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Older People (Impact of Pandemic)

Many people across my region participated in Age Scotland’s big survey of older people, which revealed that more than half of older people had reported that the pandemic had made them lonely. One third felt that their mental health had deteriorated, one third felt that they were seen as a burden to society, and a staggering 71 per cent reported having been targeted by phone scammers. Those figures make for grim reading and are a reminder of how marginalised older people feel in our society. What further action will the Scottish Government take to make sure that those trends are reversed?

The impact of the pandemic on older people, and on loneliness and isolation, is well understood, and there is a range of ways in which we need to seek to tackle and address that. As was narrated in the Audit Scotland report this week about Covid spending, we have spent disproportionately in comparison to other parts of the United Kingdom on support for the charity sector, because many charitable and third sector organisations provide a lot of front-line support. We will continue to provide as much support there as possible.

All of us, as individuals, have a role to play in ensuring that we look out for and look after some of the most vulnerable people in our own lives, whether that is family members, friends or neighbours. Critically, therefore, as we go into the winter months, it is incumbent on all of us, as citizens, to think about what we are doing to try to alleviate the loneliness and isolation that older people in particular will be feeling.

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University of Dundee (Industrial Action)

In the past 24 hours, Unison members at the University of Dundee informed management that they will take five days of strike action, starting in the first week of teaching of the new term. Proposed changes to the university pension scheme will hurt only the lowest paid of staff—disproportionately female workers—and could result in workers losing up to 40 per cent of their pension.

Will the First Minister personally intervene to bring parties back to the table to stop those workers being thrown into pensioner poverty and avoid disruption to the education of a generation of young people who have already lost so much?

Those are obviously matters for universities, which are substantially Government funded but independent institutions. However, I would strongly encourage the universities to get round the table with unions and workers in order not only to find solutions that do not penalise staff in the ways that have been set out but to ensure that there is no disruption to education. I will unequivocally call on our universities and trade unions to get round the table and find solutions.

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Scottish Qualifications Authority (Appeals)

The Scottish Qualifications Authority yesterday published an update on the arrangements for next year’s qualifications and assessments. It appears that some kind of provision for direct appeals will be maintained, which is welcome. Does the First Minister agree that any appeals provision must be free, and that we cannot return to the previous system, whereby the SQA charged a fee for appeals, which resulted in them being used disproportionately to the advantage of pupils at private schools, versus those in the public sector?

No decisions have yet been taken for the longer term around the appeals system. Those issues will be considered in line with some of the broader issues that are being considered around assessment in exams. However, I agree in principle that it is important that we have an appeals system that is accessible for young people. This may be one area—there are many such areas—where changes that have been necessitated by the pandemic are good changes, which we should look to keep and build on. I am sure that all of those things will be taken into account as decisions are taken for the longer term.

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Child and Adolescent Mental Health Services (Orkney)

NHS Orkney has written to those engaged with child and adolescent mental health services in my constituency warning that a lack of capacity will lead to delays and to people not being seen over the coming months. Young people are being directed towards local third sector organisations, but there is understandable anxiety about the impact that that will have on the mental health of many young people in Orkney. NHS Orkney is in the process of recruiting additional staff, but I urge the First Minister to engage with it to ensure that gaps are filled in the interim, so that young people in Orkney get the support that they desperately need.

I am happy to undertake that we will engage with NHS Orkney to provide whatever support we can. Liam McArthur is right to point to the fact that there are already record numbers of people working in our mental health services, and recruitment is under way across the country and in NHS Orkney, as he says. However, it is important that we provide support to fill any interim gaps, and I will therefore undertake to ask the Cabinet Secretary for Health and Social Care to have that conversation and to write to the member once he has had the opportunity to do so.

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Ferguson Marine

Back in 2016, Nicola Sturgeon declared that her Government’s intervention at Ferguson Marine in Port Glasgow was going to be an incredible triumph. She said at the time that it was

“living proof of how the SNP stands up for ... Scottish jobs”.

In 2019, the yard was forcibly nationalised despite much protest and warnings that it would be a complete disaster. Which bit of welding together Scotland’s future ferry fleet in Romania is standing up for Scottish jobs?

Due to this Government’s interventions at Ferguson’s, there are hundreds of people working at Ferguson’s today who would not be working at Ferguson’s, because it would not still be operational had we not intervened in that way. Ferguson’s is on a journey to recovery. It has a way to go in that journey, as I think is self-evident. Its priority is to complete the two ferries that are currently under construction and, of course, continuing the work to ensure that it is in shape to compete successfully for contracts, both domestically and further afield, in future. We will continue to support the yard in that vital work.

Let us be in no doubt that, but for the actions that the Government has taken, Ferguson’s doors would be closed right now, and those hundreds of workers who are there would not have a job.

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Scottish Ambulance Service (Waiting Times)

To ask the First Minister how the Scottish Government will support the Scottish Ambulance Service in coping with reports of unprecedented pressure that is resulting in significant increases to waiting times. (S6F-00255)

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 am very grateful for that reply. We have heard the stories of Lilian Briggs and Gerard Brown, but they are not alone. I have mentioned Catherine Whyte before. She is a retired nurse of 40 years, and she has given her life to the care of others, but she waited 15 hours for an ambulance last month. She fell again last week. She suffered fractured feet, a fractured pelvis and delirium, yet she waited another eight hours for help. Only when my constituent told operators, “My mum is dying,” did the ambulance come—after yet another hour. The Scottish Ambulance Service has been failed by the Government, just like Lilian and Catherine. It is not just the pandemic; the service simply does not have the resource to prioritise such cases.

Calling in the Army is evidence of a Government that has done too little too late. What discussions has the First Minister had with the service about the integration of the armed forces, and when does she expect them to be deployed?

Those discussions are under way. As I said, we will be finalising the request for military assistance shortly. That is one of many actions that we are taking. We are providing additional resource, and I think that resource funding to the Ambulance Service is at record levels, with staffing at higher levels than it has been in previous years. There is further recruitment under way.

The problems that the Ambulance Service faces are to some extent caused by pressures elsewhere in the national health service, not least in our accident and emergency departments. A lot of work is being done to try to alleviate those pressures. We will continue to take the actions necessary to support those who work in the Ambulance Service to provide the level of service that patients demand and have a right to expect.

I have already said today that I do not think it is acceptable for anyone to have to wait for the kinds of periods that are being reported at the moment. That is not acceptable even during pandemic conditions. That is why we are focused on finding solutions to allow the Ambulance Service to provide the level of response that it wants to offer and that people have a right to expect.

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Hospitals (Suspension of Treatments and Elective Surgery)

It is clear that the pandemic has exposed the weaknesses that were there before. We have heard concerning reports from NHS staff that the Golden Jubilee hospital, Stobhill hospital and the Royal hospital for children are seriously understaffed and are struggling to cope with the volume of patients and that treatment at each hospital site is now severely limited. Can the First Minister confirm whether any departments have been closed to new patients and whether elective surgery has been stopped in any of those hospitals?

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.

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Single-crewed Ambulances

Between 2016-17 and 2019-20, more than 11,000 ambulances were sent out with a single crew member, which is an increase of nearly 39 per cent. When the First Minister was health secretary, she said that she would take action to eliminate rostered single manning and that ambulances

“should be double crewed, with at least one crew member being a paramedic unless in exceptional circumstances”.—[Written Answers, 27 July 2007; S3W-2125.]

In the midst of the crisis in our Ambulance Service, will the First Minister tell Parliament how many ambulances have been single crewed since the start of the pandemic and why her Government has failed to eliminate the practice as she pledged to do 13 years ago?

I do not have that information in front of me, but I undertake to provide it. We effectively eliminated single crewing. When I became health secretary, it was at unacceptably high levels. It is the case that ambulances are single crewed only in exceptional circumstances. During a global pandemic we face exceptional circumstances on a daily basis. The routine rostered single crewing, which was endemic under previous Administrations, was dealt with by the SNP Government and we will continue to make that a priority as we come out of and recover from the pandemic.

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26th United Nations Climate Change Conference of the Parties

To ask the First Minister whether she will provide an update on the preparations for COP26. (S6F-00261)

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.

The conference of youth has always been funded by the Government of the UN member state that is hosting the COP. What discussions has the First Minister had with the UK Government on its decision not to fund the conference of youth? I thank the Scottish Government for stepping in to ensure that the voices of young people, who have been so important in pushing for change, are not lost.

I do not know why the UK Government has decided not to fund the conference of youth. I understand that it is the first time that the host nation has not done so. However, I am not particularly interested in the UK Government’s reasons for that. It is important that the voice of youth is heard. I was therefore pleased to confirm that the Scottish Government will fund the conference of youth, which brings together young people from 140 countries, I think, in the days leading up to the COP to formulate and then present their demands to world leaders. There will be a good opportunity for young people throughout Scotland to take part in that, and it will ensure that the voice of children and young people is heard loudly and clearly during the COP discussions.

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Cyberattacks (Public Bodies)

To ask the First Minister what action the Scottish Government is taking to prevent cyberattacks on public bodies. (S6F-00250)

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.

Audit Scotland has warned that cybercrime is a

“serious risk to Scotland’s public sector”.

Twenty-seven separate attacks have been recorded since 2017. Given the considerable cost to the public purse of the ransomware attack on the Scottish Environment Protection Agency in December 2020 as well as the on-going impact on its operations, is the Scottish Government satisfied that public bodies have achieved the standards that are set out in the Scottish public sector cyber-resilience framework?

I thank Audit Scotland for the work that it has done on the issue. However, with the greatest respect to Audit Scotland, I do not think that any Government is under any illusion about the threat of cyberattacks in our countries to the public sector, the private sector and, indeed, Governments themselves. We take the risk extremely seriously.

There have been significant cyberattacks on public sector organisations in Scotland—obviously, SEPA is a case in point—and the question whether we are satisfied that public sector organisations are taking all the appropriate steps is a reasonable one. We are working with them to ensure that that is the case. I would hesitate to sound as if I am complacent about the matter—indeed, every Government should hesitate to do that—because there is a real, present, ever-changing and evolving risk. We must ensure that, on a day-to-day and week-to-week basis, we provide the protections and support the public sector to do likewise. We will continue to do that.

I call Christine Grahame.

I am sorry, Presiding Officer. I thought that we were going to finish that question.

A fair work joint statement on Covid, which was agreed by the Scottish Government and organisations such as the Convention of Scottish Local Authorities, the Scottish Trades Union Congress and the Institute of Directors, states—

I am sorry, Ms Grahame, but I think that there has been a slight misunderstanding. I am taking supplementaries on specific questions as we go along. There may be an opportunity for you later.

My question is not on that issue. I thought that we were on to general questions.

In that case, we move on to question 6.

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Crown Office and Procurator Fiscal Service (Targets)

To ask the First Minister what the Scottish Government’s response is to analysis by Her Majesty’s Inspectorate of Prosecution in Scotland suggesting that the Crown Office is masking the time taken to decide on criminal prosecutions. (S6F-00256)

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.

The First Minister acknowledged that the practice ended only in April 2021. The analysis from the watchdog—HM Inspectorate of Prosecution in Scotland—revealed significant concerns that the Crown Office’s criminal investigations of a police division had been set in cases to show that it was meeting targets for investigation and prosecution by freezing cases and ignoring the time taken when they were frozen.

Another analysis by the watchdog last year concluded that the resetting of key target dates had led to “unacceptable delays” in progressing sexual crime cases, and had served to

“mask the true journey time of these cases”.

That practice is seriously concerning. It looks as if the Crown Office was trying to make its performance look better than it actually was, which is a serious matter.

Does the First Minister agree that there must be no return to such a practice, and that transparency is vital in our Crown Office and Procurator Fiscal Service in order to ensure public confidence?

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.