The first item of business this afternoon is portfolio questions. The first portfolio is rural affairs, land reform and islands. Any member wishing to ask a supplementary question should press the request-and-sweet buttons during the relevant question. I can advise the chamber that there is a lot of interest in both portfolios, so I would appreciate brief questions and brief responses, and I call question number one, Ruth Maguire. To ask the Scottish Government when it will report on its consultation on proposals to close fishing for sandale in all Scottish waters. The consultation on proposals to close fishing for sandale in all Scottish waters closed on 13 October, and my officials are carefully considering all the responses that we received. Following this analysis, we will publish the consultation outcome report, which is currently scheduled to be published by spring 2024. Scotland is important globally for its large seabird colony, supporting over 65 per cent of the British and Irish seabird population. Our seabirds, including the Manx Shearwater, are under multiple man-made pressures through predation, adverse weather conditions, which may be a result of climate change, and a lack of food as a result of climate change and fisheries. The RSPB described proposals to banned industrial sandale fishing as the single greatest thing that we can do right now to help our most threatened seabird species. Will the minister agree with me that Scotland's wonderful seabirds, including the Manx Shearwater, are a hugely important part of Scotland's coastal ecology, and that actions to protect populations in the face of current and future threats are vital? Yes, I absolutely do. That quote from Ruth Maguire about what the RSPB said about the biggest thing that we can do to protect our seabirds is warmly welcome and I agree with him. The results of the recent seabird census show that Scotland's internationally important seabird population is really suffering as a result of ongoing pressures. Ruth Maguire mentioned man-made pressures, which have resulted in climate change. Given the importance of the sandale to the wider ecosystem and the subsequent benefit in aiding that long-term sustainability in resilience, it is a priority to make sure that the population of sandales is sustained. It is not just the Manx Shearwater that benefits from iconic species such as puffins, in particular, that feed on sandales. That is something that we are prioritising to help to boost the seabird population. I thank the minister for being clear on that. Can I remind the minister and the chamber of my register of interests that I am a partner in a wild salmon fishery? Salmon do eat sandales, but I want to talk today about the damage that our seabirds have faced regarding avian flu, which has been catastrophic. There will undoubtedly be some losses when Scott Wind is up and running. Therefore, surely we must make sure that our seabirds are in the best possible condition and there are as many as possible to offset those losses. Therefore, sandales fisheries should be suspended immediately. Does the minister agree? I thank Edward Mountain for that very positive and constructive question and for his support in what we are doing about the sandale fisheries. He rightly points out that there is quite a lot of other factors involved in the decline of seabirds. This summer, in particular, we had a very unseasonable, about a really quite pernicious avian flu, which particularly affected our gannot population and gull population. We must do everything that we can in our powers to mitigate the effects of things such as avian flu. We cannot really control the source of that, but we can control how we respond to that. To ask the Scottish Government what impact the recently announced trilateral agreement on total allowable catch limits in management measures for jointly managed fish stocks in the North Sea will have on fishers in Aberdeen and the north-east of Scotland. Fishing agreements with our coastal state partners include a number of positive outcomes for Scotland, providing key opportunities to vessels and to coastal communities too. The trilateral agreement includes quota increases for all six of the jointly managed North Sea stocks. Those opportunities are worth an estimated £199 million to Scotland, and that is an increase of £68 million compared to the previous year. That is welcome news for Scotland's fishing industry as a whole, and the benefit to fishers in the north-east from that trilateral is currently estimated to be around £47 million based on 2022 prices. I understand that there has been an agreement to set quotas for North Sea cod at levels reflective of the latest science. What scientific data and analysis goes into the determinations and what was Scotland's overall approach to the negotiations? I would want to state first of all that the Scottish Government fully supports the headline scientific advice and setting fishing opportunities that are consistent with maximum sustainable yield approach, and of course doing that whenever that is most appropriate. While we used the MSY approach from ICES in a benchmark report from February, there was a significant change in the 2024 scientific advice for North Sea and west of Scotland cod. That new advice structure shows that the stocks in Scottish waters are doing well and particularly that north-western sub-stock, which spawns in the north-west North Sea and the west of Scotland. That ultimately reflects what we know our fishers have been seeing on the ground, and it is a step change away from the previous zero-tack advice for the west of Scotland. However, the actual scientific advice for the whole northern shelf was based on the poor state of the southern stock component, which we think is a logical in its approach. My priority for the annual negotiations was to secure catch limits, which reflect that positive outlook for the north-western stock, including an appropriate and evidence-based allocation to the west of Scotland. I am really pleased that that negotiated outcome was 15 per cent increase supported by that robust evidence. The cabinet secretary will recognise that this deal was made possible due to the UK being out of the hated common fisheries policy, allowing us to set our own total allowable catches, licence foreign fishing vessels in UK waters and regulate fisheries in Scotland. Will the cabinet secretary accept that Scotland's future is outside of the CFP, with decisions in consultation with our fishermen and our fishing communities made here in Scotland, the UK and not in Brussels, as the SNP would have? The member has ultimately failed to read the trade and co-operation agreement that his colleagues in the UK Government signed up to, and that saw a poorer deal for our fishermen than when we were in the CFP. I would strongly urge him to take a read of that and maybe come back and offer comments at that point. The North Sea and the Trilateral Agreement are important to Shetland's fishing fleet. The cabinet secretary recently committed to exploring solutions for several important fish stocks, which are classed as dated and efficient by scientists. How will the Scottish Government work with international partners to ensure adequate resource to ascertain the scientific advice that is so critical to sustainable fisheries management, and what timeline can we expect from that? Just to say that I am happy to engage further with the member in relation to that as well, but I would say that the work that we undertake and the relationships that we have with our international partners are really critical. Our chief negotiator and our negotiating teams have done a really fantastic job in terms of the negotiations this year, but they work incredibly hard on fostering those key relationships so that we can work together on those issues where there are problems presented. I am more than happy to follow up with the member via correspondence and provide further information in relation to that. 3. John Mason Thank you. To ask the Scottish Government what proportion of the costs of the licensing schemes contained within the wildlife management and Muirburn Scotland Bill will be covered by the licence fees. Thank you, Presiding Officer. NatureScot does not currently operate any licenses on a cost-recoverable basis, and this bill does not mandate charges for the three new licence schemes set out in the provisions. However, the Scottish Government has committed to review the wider species licensing system and assess the potential to apply the principle of full cost recovery to species licensing. The bill therefore allows for the possible introduction of charges for licences issued in the future by providing that licence authority may charge a reasonable fee. John Mason I thank the minister for that answer, but I wonder if there is any reason why she thinks that the full cost should not be recovered through fees, because that would mean that otherwise there is a subsidy from the public sector. I agree with the sentiment of John Mason's challenge. What we want to do is ensure that any changes to the policy are fair and proportionate. That is why our commitment to review that species licences include the consideration of potential to apply the principle of full cost recovery. Every licence will have complexities associated with the individual basis, so we want to make sure that it is proportionate, but Mr Mason can be assured that I am actively looking at the idea of full cost recovery for all licences. Graes shooting sustains 2,640 full-time equivalent jobs in Scotland in fragile and rural communities and contributes £30 million to the Scottish economy. Isn't it the case that the Scottish Government has no idea of the socio-economic impact of the proposed licence scheme for Graes shooting and Murrburn on land managers, which may cause job losses and disinvestment to the sector? When will the minister publish an impact assessment on the effect on a regional basis of the Government's legislation? It is very clear. It has been clear that all the exchanges that Rachael Hamilton has made in that she is fundamentally against licencing shooting estates. Licencing shooting estates will bring them in line with quite a lot of other practices that we need licences to operate. I think that that is going to be a very good thing for the sector. It will show public confidence in the sector that people are licensed to operate within the law. It is also in keeping with many other shooting estates across the whole of Europe. Ms Hamilton, you have asked the question to allow the answer to be raised. Minister, continue. I am going to leave it there, Presiding Officer. Question 4, Douglas Lumsden. To ask the Scottish Government whether it will provide an update on when the previously ring-fenced 33 million of funding allocated to the agricultural sector as a result of the BUEW review will be returned to its budget for the portfolio covering agriculture. The Deputy First Minister made clear in her budget statement yesterday that we are committed to returning all of that funding to my portfolio to invest in agricultural priorities at the appropriate time. £15 million will be returned over this coming financial year and will be entirely spent on agricultural priorities. We will also provide the same level of support through direct payments to farmers and crofters that were available before Brexit, and we are currently providing farmers and crofters with the most generous package of direct support anywhere in the UK. I am sure that that is something that the member would want to welcome and support. It is, of course, right that the uncommitted spend is deferred to mitigate the on-going cost-of-living crisis, and all portfolios have been asked to make similar and very difficult choices. I can assure the member that agriculture spending is ring-fenced for this portfolio, and it will return to ensure that it delivers for the needs of the rural economy. Cabinet Secretary, the NFUS is rightly furious that this SNP-green devolved government has failed to return £61 million of withdrawn agricultural funds in the draft budget. Today, we are only hearing about 25 per cent of that funding returning, while at the same time cutting other agricultural funds. Can the Cabinet Secretary explain to Scotland's farmers and crofters why the SNP is not standing up for rural Scotland, and when will our farmers get all their money back? This Government is the Government in these islands that is standing up for our rural communities and for our farmers and crofters. If I can answer the question that Douglas Lumsden has posed, because to say first of all in relation to the comments from NFUS, I absolutely understand their concerns, and that is why I would want to reiterate that the £61 million that has been deferred spending is ring-fenced. It must be returned to the portfolio, and as the Deputy First Minister has confirmed to the NFUS, as well as to this chamber yesterday, every penny of it will be returned to this portfolio to be spent on agricultural priorities. I would point out exactly what was put forward in the budget yesterday and the levels of protection that we have offered in relation to other schemes that are not available elsewhere in the UK. Again, I would ask that the member welcomes that when we look at our basic payment scheme, greening, LFAS, all schemes that are absolutely critical for our farmers and crofters, which are still being maintained as part of this budget. There are difficult choices that every single portfolio has had to be made and really difficult decisions, as the Deputy First Minister outlined yesterday, but I reiterate that commitment. The money is due back to the portfolio and it will be returned to the portfolio. I will take a supplementary, but I will remind those on the Conservative benches that they can ask a question and they can't then provide a running commentary throughout the answer. I will take Rhoda Grant for a supplement. Thank you, Presiding Officer. Agriculture funding is paid to devolve governments under historic EU settlements rather than through the Barnett formula. That formula sees Scotland receive around 17 per cent of agriculture funding due to the greater proportion of farming and crofting land. Does the cabinet secretary recognise that cutting the agriculture budget could put this payment framework in jeopardy and certainly does not help those of us making the case for a greater share of that funding? I reiterate the points that I made in my previous response. That is deferred spending that will be returned to the portfolio and which has to be returned to the portfolio, as the Deputy First Minister outlined yesterday. Critically, we are still protecting and ensuring that we are delivering at the earliest possible point that direct support for our farmers and crofters and we are trying to deliver it early to ensure that there is maintenance in that cash flow going forward. I want to give her an assurance on that regard, but one of the biggest threats that we also face is having no clarity on what our budget settlement is going to be if it is on the UK Government going beyond this coming financial year. That is where I would hope that all members in this chamber could join with me in asking that we get that clarity so that we know what funding is available going forward. Ask the Scottish Government whether urban areas will be included in its land reform legislation. Land reform is an on-going process and each piece of work that we do builds on the legislation and policies that have come before. In our forthcoming bill, we will be bringing forward a set of robust land reform measures whose key aim is to tackle the scaling concentration of land ownership in Scotland. In 2016, we extended the community right to buy and the funding that went with it to urban communities. Our proposals for the forthcoming bill are based on recommendations from the Scottish Land Commission. They will take account of the views of all those who responded to our consultation. In line with the established process, final decisions on the bill's contents will be made in due course by ministers and the bill will of course be published on the Scottish Parliament website following its introduction. People who own land or building that they are not using can severely impact urban communities, especially if the use of this land or building is not beneficial to their community. In this situation, urban communities need to be able to buy this land and use it for the purpose that will benefit communities. Can the cabinet secretary advise exactly who action the Scottish Government is taking to ensure that urban communities' rights are protected under the land reform legislation? The member raises an important point there. First, I want to emphasise that we currently have four community rights to buy that exist under various pieces of legislation. There are also community asset transfers through the Community Empowerment Act, which is being reviewed. We have made commitments previously in relation to considering compulsory sales orders. That is a really complex piece of work, which still needs to be undertaken. I know that Minister Joe Fitzpatrick is currently undertaking a piece of work on compulsory purchase orders, which I think will be considering that piece on CSOs. We have the forthcoming land reform bill. As I have said, we will set out the proposals in relation to that. It is also important not to forget the existing rights that are there. We need to make sure that they are operating as they should do, but there are also those on-going pieces of work. I will be happy to follow-up with the member and provide more information on each of those. Given that, through the new legislation, the Scottish Governments continue to spoke both rural and urban areas through the community buy-up process, can the cabinet secretary outline whether the new land reform bill will go further than before in terms of increased land ownership transparency? Briefly, it is possible, cabinet secretary. Yes, of course, that is certainly what we hope it will do. We really want this bill to ensure that it is as ambitious as possible. I would just want to reiterate that we are committed to bringing forward a bill that is ambitious in that sense and that I think will be a significant step forward in ensuring that our land is owned and used in the public interest and ultimately for the benefit of the people of Scotland. To ask the Scottish Government what discussions it has had regarding the sale of low-welfare pets ahead of the Christmas period. The Scottish Government works throughout the year to highlight the responsibilities of pet owners and those who sell domestic animals. Although we have not had specific discussions on the sale of low-welfare pets in the run-up to this Christmas, we work closely on an on-going basis, with key stakeholders, including the Scottish SPCA, local authorities and other UK Administrations, to raise awareness of low-welfare breeders and inform prospective buyers on how to buy a pet safely throughout the year. I would add that we have run comprehensive public campaigns to raise awareness amongst prospective buyers of pups on the realities of those unlicensed puppy trades and the information and messaging for those campaigns that are available online. Thank you. Organised crime contaminates many legitimate areas of Scotland's economy, one of those being the lucrative trade in puppies and dogs.  The criminals do not care about people, they certainly do not care about animal welfare. Will the minister discuss the issue with her justice secretary colleague about how to tackle those despicable crooks? I thank Russell Finlay for that. He absolutely lays out there that it does not matter what the commodity is, the unscrupulous people will use any kind of commodity regardless of what it is. In this case, it is live animals. The lives of the people that take on those animals could be left heartbroken when they are too ill to make it pass a certain point. It is an absolutely disgraceful trade. I point to the message from the Crown Office and Procurator Fiscal Service that they have done a campaign of their own this Christmas, which has been very helpful. Anyone can find it online. It is about highlighting the dangers of engaging in buying a puppy from unscrupulous people like Russell Finlay mentions, but also how that can be funding-organised crime. I think that it is a very effective campaign, and I urge everyone in the chamber to look it up online and to share it on their social media over Christmas because it is very powerful. To ask the Scottish Government, in relation to its cross-government co-ordination on islands policies, what discussions the rural affairs secretary has had with ministerial colleagues regarding any impact on island communities of its proposed EPC reforms? I thank the minister for that question. Ministers and officials across portfolios are aware of the need to recognise the impact of new policies on island communities. The minister for zero-carbon buildings has taken forward a long-standing Scottish Government commitment to reform energy performance certificates based on climate change committee recommendations, on which we consulted this year in our current proposals to reform EPCs. We do not suggest any new duties or obligations on building owners. We are considering the impact on island communities as we go through the analysis of the consultation responses in the new year, as required by the Island Scotland Act. I thank the minister for that answer and say that, given the rocketing levels of fuel, poverty and off-gas areas in particular and the upcoming heat and buildings bill, what specific support in terms of advice and funding will the Scottish Government offer homeowners to increase the energy efficiency of their properties by installing insulation and to lower their carbon emissions, install affordable heat options and upgrade their homes, for example, by being able to access grants to install solar panels to help heat or power their homes? I refer Sarah Boyack to the raft of initiatives in Home Energy Scotland, such as home heating fund in particular. She was saying from the budget yesterday that there was an uplift in the amount of money given in Mr Harvey's portfolio for the things that she has outlined in her question. I would also say that rural fuel poverty is an issue that is affecting Scotland disproportionately. I encourage Sarah Boyack if she has not done already to support me in my calls for the social tariff, which I have been calling on the UK Government ever since I have been appointed. To ask the Scottish Government how it engaged with fishing industry stakeholders as part of the annual fisheries negotiations. We work closely and collaboratively with our stakeholders throughout the negotiation period, and when the scientific advice is published, officials meet with stakeholders from the fishing industry and environmental groups to discuss priorities to feed into the negotiating strategy. We have to seek the best outcome for Scotland's environment, fishing interests and coastal communities, which means that we have to balance environmental, economic and social considerations, as well as looking at the short and long-term impacts on fish stocks in the fishing industry. Throughout live negotiations, there are regular stakeholder meetings with the chief negotiator, providing updates and allowing stakeholders to ask questions. If he will allow me, I want to take a brief moment to thank all those stakeholders who have invested so much time and the expertise in engaging with us and informing the approach to negotiations, as well as thanking our negotiators, who always work tirelessly and do their best for the fishing industry in Scotland. I thank the cabinet secretary for that answer, and I agree with her in the stakeholders on how they negotiate their business. I was delighted to read that the SFF had praised the work of the Scottish Government in this area, and among the quota increases reported were for Scottish fishers were North Sea Haddock and North Sea Whiting. I would say, though, that labour shortages are an acute problem in the seafood sector, particularly within the seafood processing. Can I ask the cabinet secretary to continue to represent the views of the north-east fishers to the UK Government to ensure that the opportunities presented by those increased quotas are not undermined by Brexit-related workforce shortages and the Tory visa rules announced this month? As briefly as possible, cabinet secretary. Just to say that the member does, of course, raise a really important point, and I really just want to emphasise that in Scotland we, of course, don't share the UK Government approach to migration, and we categorically reject their hostile environment rhetoric. Of course, we do continue to support new domestic entrants to the Scottish seafood industry, but we also recognise and value that really vital contribution that migrant workers make to the sector, as well as to the wider Scottish economy and to our coastal and island communities. By ending freedom of movement from the EU and imposing new visa requirements for qualifications and salary thresholds, the UK Government has made it significantly more difficult to access labour and to track people to Scotland. I have repeatedly called for urgent reform of UK immigration rules, and that has included offering to work with the UK Government to identify pragmatic ways to balance border security and enabling that access to labour. Of course, I will continue to do that. Thank you very much. That concludes portfolio questions on rural affairs, land reform and islands. I will take a brief pause before we move to the next item of business to allow front benches to change. The next item of business is portfolio questions on NHS recovery, health and social care. Any member wishing to ask a supplementary question should press the request to speak buttons during the relevant questions, as with rural affairs. There is a lot of interest here. I would appreciate brevity in both the questions and indeed the responses from the front bench team. I call question number one, Martin Whitfield. Deputy Presiding Officer, to ask the Scottish Government whether it will provide an update on what steps it is taking to address obesity. Addressing obesity is a public health priority and we continue to take forward the wide range of preventative actions to improve diet and promote health across the life course, as outlined in our diet and healthy weight delivery plan. This includes provision of core funding of £8.25 million to health boards in 2023-24 to deliver adult children and young people's weight management services in line with our national standards and the type 2 diabetes prevention framework. I am grateful to the minister for that response. Statistics published by Public Health Scotland reveal that 22 per cent of primary 1 pupils were at risk of overweight or obesity this year. In 2018, the then First Minister made a commitment that the Scottish Government would halve child obesity by 2030. Our current P1s were born in that year, so by they are in S1, will half of the 22 per cent of pupils who are at risk of overweight or obesity be within acceptable standards? I thank the member for that question and that is certainly the intention of this Government is working towards ensuring that we have halved childhood obesity by 2030 from the original weights. I am working very closely with my officials and third sector organisations to work out the best way that we can do that. We know that junk food promotions can encourage overconsumption and impulse buying, so can the minister provide any update regarding work that is under way on plans to restrict in-premise marketing of food and non-alcoholic drinks that are high in fat sugar or salt in order to help to reduce consumption and related harms? The Scottish Government, as I have said, remains absolutely committed to legislation to restrict the promotion of less healthy food and drink. As part of an extensive consultation process, we have just concluded a series of round-table events with public health and business stakeholders that will help to further inform the development of our consultation document on the detail of proposed regulations. The consultation document will be published early next year and will provide an opportunity for stakeholders to comment on the detail of proposed regulations with a view to laying regulations subject to the outcome of that consultation. Apart from the impact and personal wellbeing that obesity brings, it is also a significant drag in our economy. We have economically and inactivity in Scotland is high. It will require behavioural change, both diet and access to physical activity, and the minister will know my passion for the education environment being the battleground. We need to fight that. With that in mind, can I ask the minister what work she is doing with the education cabinet secretary to deliver solutions to this problem? I thank the member for his question and recognise the passion that he has for exercise as well as healthy eating. The Scottish Government is clear that we work cross portfolio on those issues, and I engage with both the Cabinet Secretary for Education and the Minister for Young People. To ask the Scottish Government whether it will reconsider its reported plans to downgrade the wish on neonatal intensive care units. The aim of the NHS and this Government is to ensure that everyone gets the best care possible. That is especially true for neonate babies and their families. The restructuring of neonatal intensive care units was based on expert clinical advice that showed that this change was necessary to improve outcomes for the very smallest and sickest babies. The most pre-term and sickest babies do best when they are cared for in larger specialist neonatal units. To undo that would be to choose poorer outcomes for those babies and that is not a choice we would make. The member will agree that parents would very much expect us to act on such evidence in the best interests of their babies. Local neonatal units across Scotland, including in-wishaw, will continue to offer care to babies who need it, including a level of neonatal intensive care. The minister's answer will infuriate and worry my constituents in Lanarkshire and is a further below to the award-winning neonatal workforce. Almost 20,000 people have now signed a petition to stop the Scottish Government's downgrading of this award-winning vital life-saving service. We have a flawed proposal and process that has produced a flawed decision, and it is vulnerable babies, their mothers and families that will be failed unless the minister listens, looks again and does her job properly. Will she extend some festive goodwill to my constituents, to the wish of neonatal warriors and finally commit to a full independent review in the new year? I thank the member for her question but don't recognise some of the picture that she has painted. Tomorrow I am meeting with NHS Lanarkshire chief exec to discuss this situation. It is certainly welcome that local neonatal units, including in-wishaw, will continue to provide care to the vast majority of babies who need it, and the decision to move to three national neonatal intensive care units has been made in line with strong evidence and advice. Does the minister agree that, to deliver the best-care outcomes for the smallest and sickest babies born in Scotland, it is important that that expert advice is listened to, and does she also agree that it is vital that the voices of local people are listened to and recognised as part of the process? I advise what steps the Scottish Government is taking. I agree with Stephanie Callaghan that we must follow the best advice that is available. We are doing this to give babies born at the extremes of prematurity, and we are talking about babies who were born before 27 weeks of pregnancy—the best chance of survival. Larger specialist neonatal units have specialist staff and services available on-site to give these tiny babies the very best care. I met with families from Lanarkshire in November to hear their concerns, and we will continue to consult with families in affected areas so that they have the opportunity to input into the design of service delivery. The minister has said again that the decision to downgrade is based on clinical advice, which is why I asked in a question if the minister would meet the award-winning clinicians in Wishaw back in October. The minister agreed to meet, and I subsequently wrote to clarify arrangements, but no commitment now in that letter to meet those who lead the unit. Why has the minister gone back on that promise to meet with the clinicians who run that life-saving unit? As I said earlier, I am meeting with the chief exec of NHS Lanarkshire tomorrow, and I know that that is not what you asked if you let me finish my sentence, and that exactly will be discussed at that meeting. I urge members to ask the question and allow ministers to respond. To ask the Scottish Government whether it will provide an update on the work of its NHS fourth valley assurance board. The latest version of the improvement plan has recently been agreed by both the health board and the insurance board, and there is a clear expectation from all involved that progress needs to continue to be made across a range of areas, including leadership, culture and governance. The NHS fourth valley assurance board continues to meet regularly, with the most recent board meeting taking place on 20 December 2023. The assurance board will continue to monitor and scrutinise the board's agreed improvement plan. Minutes from the NHS fourth valley assurance board meeting are published and can be viewed at the Govscott website. A copy of the improvement plan is available on NHS fourth valley's website. I thank the cabinet secretary for that welcome update, but the waiting times at fourth valley royal hospital A and E have been a long-running concern and have highlighted the strain that dedicated NHS staff are under, particularly in winter. What assurance is there that staff across health boards, including in fourth valley, are going to be properly supported through this winter period, particularly so that we can get safe staffing levels, with proper breaks and hot meals provided to all staff? Those are a range of areas where the improvement plans that have been taken forward by fourth valley are starting to indicate some improvements in the way in which the board is performing. We have saw that over the close of recent weeks and also the firebreak that is currently operating has been extended for a further two weeks in order to help to support and sustain some of the improvements that have been made. During the course of our winter period, our NHS is under enormous pressure, particularly at the front door around our A and E departments. We expect boards to ensure that there are appropriate welfare arrangements in place for staff to support them during the course of their clinical duties. To ask the Scottish Government when it last met with the Scottish Medicines Consortium. There are quarterly meetings between the chief pharmaceutical officer and medicine policy officials and the Scottish Medicines Consortium. The last one took place in September 2023 and the next one is scheduled for January 2024. In addition, both the chief pharmaceutical officer and the head of medicines policy meet with representatives of the SMC on a regular and routine basis. For her response, a new drug, Trastuzumab deruchstikon, has been approved for use in Scotland for the type of breast cancer called HER2-Low. The treatment's loss is spread of the cancer and proves the patient's chances of survival. When compared against chemotherapy and will come as very welcome news to people living with this disease, there will of course be an eagerness for treatment to begin as quickly as possible. Can I ask the minister what steps the Scottish Government will take in tandem with the Scottish Medicines Consortium and NHS Scotland to ensure that hospitals have access to this life-saving drug as soon as possible? I'm delighted to advise that patients in Scotland will be amongst the first in the UK to receive this life-extending medicine to treat HER2-Low breast cancer. The Scottish Medicines Consortium published advice recommending Trastuzumab deruchstikon for routine use to treat patients with HER2-Low breast cancer within NHS Scotland on 11 December 2023. As with other new medicines, once the SMC publishes its advice, it is expected that health boards across Scotland will make this a medicine available for routine prescribing within 90 days of the publication of that advice. We'll be supplementaries for Sandesh Gohani. The Scottish Medicines Consortium does not consider that drugs such as paracetamol and ibuprofen require significant advice, given that they are readily available over the counter and also available on pharmacy first. However, schools in NHS Fife state that they will not give basic medication like paracetamol and ibuprofen unless the GP has prescribed it. Does the minister think that this is an appropriate use of GP time, given the pressure that we are under, and will the minister undertake to work with the Cabinet Secretary for Education to ensure that this is resolved? I thank the member for that question and, yes, I'd be happy to speak to the Cabinet Secretary of Education with regard to this. I also thank my chief pharmaceutical officer to understand more about the situation that he's raised. People across Scotland are waiting to find out whether life-changing drugs such as corcambi, symchefi and calf trio will be available on the NHS for those suffering from cystic fibrosis, including those under two years of age. I know that the Scottish Medicines Consortium is working with NICE, but can the minister commit to ensuring that whatever the outcome, those life-saving drugs will be available to everybody in Scotland without a postcode lottery at health board level? I thank the member for her question. Along with Jackie Baillie, I recently met families representing the cystic fibrosis community and was able to reassure them that in Scotland, while the National Institute for Health and Care Excellence in the Scottish Medicines Consortium, multiple technology appraisal is on-going, all existing in new patients who are on or started on a treatment for cystic fibrosis will continue to have access to that treatment after the issue of their final recommendations irrespective of outcome. To ask the Scottish Government what its response is to the recent Public Health Scotland report Infant Feeding Statistics Scotland. I am delighted that the current infant feeding statistics show that breastfeeding rates across Scotland continue to increase, with more than two thirds of all babies being breastfed at birth and more than half continuing to receive breast milk at 10 to 14 days. Rates at 68 weeks have risen to 47 per cent, the highest rate on record, showing that many more babies are being breastfed for longer than ever before. We are committed to protecting, promoting and supporting breastfeeding as the normal nutrition for babies and giving them the best start in life with over £9 million of additional investment over the past five years. I welcome that further investment and, encouragingly, increases in breastfeeding over the past 10 years have been greatest among those groups, with historical lower rates such as young women in those living in the most deprived areas. However, only 34 per cent of babies born in Scotland's most deprived areas were breastfed at their 68-week review, and that compares to 63 per cent in the least deprived areas. What further steps is the minister planning to improve levels of breastfeeding in deprived areas? Will she consider making additions to the baby box? I thank Stephanie Callahan for that really important question, and I'm pleased to see that the latest infant feeding statistics show a continued narrowing of the breastfeeding inequalities gap. Our additional investment has been both targeted and based on best evidence of what works, scaling that up as part of planned next steps. Our infant feeding teams are pivotal in this effort, and we will continue to use all means necessary, including Scotland's baby box, to normalise breastfeeding in Scotland. For teenage parents, many of whom are in the lowest SIMD areas, the family nurse's partnership has had a crucial role in supporting them to breastfeed. The disparity in income deciles and breastfeeding rates is a matter of great concern. Will the minister consider enhancing support for GP surgeries, particularly on aspects such as community link workers and connections with charities such as Home Start, to further enhance promotion of breastfeeding in the most deprived communities? I thank Paul Sweeney for that question, and I highlighted in my answer the important work of the family nurse practitioners, but I also agree that there is a lot of work, and it is clear that that is being done by third sector organisations, which the Scottish Government is working with. I am very briefly bob Doris. Minister, do you agree with me that, although we want to see increased breastfeeding rates, it is not always easy or appropriate for all women to breastfeed, we should not stigmatise those who find that they are unable to breastfeed. All mums need to be equally supported. I think that Bob Doris raises a very important point, and I do not disagree with him. I think that it is important that all new mums are supported, and I hope that, as I have previously referenced, the family nurse partnership is able to support mothers and families in all situations. To ask the Scottish Government when it plans to establish a specialist endometriosis centre within every NHS board in Scotland. The role of specialist endometriosis centres in Scotland is to provide co-ordinated, multidisciplinary treatment to individuals with complex systems of endometriosis, and to those requiring complex surgery. Scotland operates three centres in Aberdeen, Edinburgh and Glasgow. That was recommended as the optimal approach for effective treatment in Scotland by a specialist working group of expert clinicians and representatives from patient groups and endometriosis UK. There are no plans to establish a specialist centre within every NHS board. I thank the minister for that answer. Local charities in the south of Scotland are dedicated to improving endometriosis treatment. One of them, EndoSOS, says this. Having local centres saves money for patients and the NHS, travel times are reduced, missed appointments are lower and referrals to specialist care is faster. They added, we need more locations to support the rural population and to reduce diagnostic and general waiting times. Will the cabinet secretary find some time to meet with me and local campaigners to discuss the need for a specialist endometriosis centre in the borders? I thank Rachael Hamilton for that question. If she is happy to have the meeting with the minister, I would be very happy to meet her and her constituents. We know that how substantial an impact Endometriosis can have in women's lives. It is clear that we need to continue to press forward with research into this condition to ensure that the most effective treatment options and support can be provided. Can the minister provide any further information regarding work that the Scottish Government is undertaking to support research into endometriosis-associated pain? I thank Emma Harper for that question. We are jointly funding a £250,000 endometriosis research project with the charity Wellbeing of Women. The research project, which will primarily be run by researchers at the University of Edinburgh, will look at the drug dichoclur—no, I did work this out—chloroacetate, I think, in the management of endometriosis-associated pain, and it's a fantastic project. I was privileged enough to visit them in the summer. Additionally, in January 2023, our chief scientist office announced funding for the endocan project, led by researchers at the University of Edinburgh, through a large-scale UK-wide trial. The research will investigate whether a cannaboid can reduce endometriosis-associated pain funding of just under £300,000 has been committed to this 30-month project. As well as expanding the number of specialist endometriosis centres, it is also critical that the impacts of endometriosis are recognised in the workplace. I was pleased to learn that East Asia Council has become the first local authority in Scotland to officially recognise the impact that endometriosis has on female employees, taking on the endometriosis-friendly employer scheme. What engagement has she had with the scheme, and if she would take some necessary steps to encourage all councils to engage with this important scheme? I thank Carl Mockham for her question. I think that the schemes are so important. I recently launched one across NHS Scotland staff with regard to menopause and various other areas. It is incredibly important that workplaces absolutely appreciate the impact that various conditions have on their workforce and get the right policies in place to ensure that workers are able to be there and do the best in their jobs. To ask the Scottish Government whether it has reviewed GP services model, including in relation to whether patients are getting appointments when they need them. I am clear that patients should always have access to general medical services and that all local NHS boards should ensure that GP services continue to be provided to all patients. Patients should always be able to see GPs when they need to. Five years on, from the joint agreement between the Scottish Government and the British Medical Association on the 2018 GP contract, our health and social care partnerships have made significant progress in recruiting multidisciplinary teams to support general practices. We currently have over 4,500 staff working in these teams, providing services, including physiotherapy, pharmacy and phlebotomy. There are a rapidly increasing number of patients seeking GP appointments, but combined with cuts to primary care development fund as demand is placing immense pressure on GP services and leaving many patients facing long delays or simply unable to get an appointment when they need one. GPs are often working double, if not triple, the recommended limit of 25 consultations a day, and all that Scotland have said that the Government is unlikely to deliver their promise of 800 new GPs by 2027. Could I ask the cabinet secretary to address the specific point about the design of the appointment system? That is that some patients report that they use one system and that they can get an appointment. Other patients report that the GP uses a completely different system and that they have to wait longer. Does the cabinet secretary agree that every patient across Scotland should expect the same design of service to get the same service? I deal with the specific issue that the member raises about the appointment system. It is down to individual GP practices because the vast majority of them are independent contractors. It is their responsibility to design a system that best meets the needs of the contract in order to deliver appointments to patients. The member may be aware that, in October, we published the outcomes from what was the general practice access principles work that was taken forward to look at helping to try to get greater consistency, and it made a set of principles that it has asked GP practices to apply. However, because of the independent contractor model, it is down to individual practices to decide on what the model is that they use locally. Despite the heroic efforts of GPs and their teams, too many of our constituents are struggling to see their doctors. Earlier this year, a constituent in the Scottish Borders received a positive bowel cancer test, with a letter saying that a blood test was urgent. The local GP practice said that an appointment would take at least 10 days. With cases like those right across South Scotland, isn't it time that the Scottish Government properly invested in GP services and matched the Scottish Conservative commitment to invest 11 per cent of the NHS budget into primary care? We are investing in primary care services. I recognise the concern that the member has raised, but there is a variation in how some GP practices operate. There are practices in terms of how they operate. It depends on how they approach certain issues and how some patient services are actually being provided. I have witnessed that, first hand, from my own personal experience and also from my experience as health secretary. It is important that we make sure that people receive good quality services from GPs, which is why we are increasing recruitment of GPs, and the number of speciality places that we are offering for training as GPs has been increased this year. We will increase next year again in order to make sure that we continue to invest in primary care. I am afraid to tell the cabinet secretary that the recruitment of those additional staff that he has talked about, pharmacists, physiotherapists, mental health staff, lobotomists, is not progressing well in my constituency in North East Fife. I met GP practices last week and they told me about recruitment difficulties with NHS Fife. Would the cabinet secretary consider transfer and responsibility for recruitment of those additional staff over to the GP practices so that they can make some progress? The challenge with what Mr Rennie has suggested is that it introduces further variation because different GP practices could take a different approach that might not involve the provision of the wider multidisciplinary team that we are trying to achieve. However, I have said to the BMA that I am open to looking at alternative models from the existing model that we have operating, but the outcomes for patients must continue to be improved as a result of expanding a multidisciplinary team. I am more than happy to continue to engage with the BMA on that issue, but it is essential that we make sure that there is a consistency of approach on how the multidisciplinary teams are being provided across the country. I apologise to those who have not been able to call that to conclude portfolio questions on NHS recovery, health and social care. There will be a brief pause before we move to the next item of business to allow front benches to change.


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Naturally, when you start improving yourself and get on the path of self-actualization, people will find it hard to relate with you.  They start wondering why you're doing all these things that they're not doing. Because naturally, what you're doing is exceptional. The majority of people on planet Earth don't really put in that much work to self-improvement. A lot of people just coast by day by day, start in the, you know, human trap of law consciousness where they just do the mundane, they do whatever happens. Whatever life offers them is what they go with. They watch whatever's on TV, they listen to whatever's on the radio, they sleep, they do whatever their friends want.  We don't do that. We strategically look at what we are gonna put in our brains, what we're gonna listen to, the material we're gonna watch, the things we're gonna read, the quality. Try to get down to the bottom of things because you need this type of self-knowledge and knowledge of the world around you to make an impact. That's the problem. A lot of people are too happy with being mediocre, they're happy with being normal, they're happy with not standing out. That's not what I want, right? For what I want to do, I want to be remembered. I want to live a legacy.   So all you have is the things that you have done to influence other people's lives. How do you impact into humanity? A lot of the greats have impacted humanity on a grand scale, Newton, Tesla, these scientists, Gandhi, Malcolm X, you know, all these great people have impacted humanity at some scale and they're remembered for that.  Are you going to be remembered for being mediocre? If so, what's the point?  And there's no legacy, you haven't impacted anything, you haven't changed humanity for the better. See, in an ideal world, everybody is doing something that's, you know, helping push humanity up a little bit, you know, helping make the planet a little bit better for the next generation and stuff like that. But in the world as it is, the majority of people are not doing anything. They're just working in, you know, a rat's wheel and a set few select people, other ones that are making the world shake, that are turning the wheels and pulling the levers. And these people understand that in order to make that kind of impact, they need to work on themselves. So that's what personal development is all about. That's what self-improvement is all about.  So next time your friends or someone around you looks at you weirdly, take it as a compliment, kind of feel a bit sorry for them because they are not going to be feeling as filled as you at the end of your days. Naturally, the person who works hard on themselves and the person who works hard on bettering humanity in some way is going to feel a lot better when he's on his deathbed and the person who wasted it trying to live a mediocre life.