If you were to teleport someone to today's slate for MLB DFS and just let them look at the pitching stars today without knowing what happened earlier on this year, they'd be pretty confused because these are the guys in order of salary for pitcher first night. It's Kyle Wright, who's highest, then Justin Verlander coming off injury, but very good pitcher. Lucas G. Alito, very good. Joe Ryan makes some sense given the surges he had a time last year, then Jesus Lizardo. So Kyle Wright, Jesus Lizardo, and then kind of Joe Ryan, all guys going to the year you wouldn't have expected to have salaries of $10,000 or higher. But in the context of the slate, it makes a lot of sense. We're going to break things down from a DFS perspective. Let you know our thoughts on those guys. If I think that their salaries are legitimate, how we're handling them, we're going for MLB DFS for today. Welcome on into the solo shop. That's right here on the FanDuel Podcast Network and NumberFire.com. My name is Jim Sonnis. I'm a senior writer and analyst for NumberFire.com. Here to break down Tuesday's 12-game main slate with lock set for 7.05 p.m. eastern for today. Do a couple of weather notes for today. Thankfully, just wind-related, no rain for today. The wind at Yankee Stadium for the Jays and the Yankees is in from center at 12 or 11 miles per hour. With downgrade hitters a bit there, but not too dramatically. In Chicago for the White Sox and Guardians, winds are in from right at 10 miles per hour. Downgrade bats there a bit too, although after the outburst last night after I went to bed, maybe not too much there. In Los Angeles for the Angels and the Rays, winds are out at 13 miles per hour. So slight upgrade to batters for that one as well. We'll talk about those rising pictures for today and get you set for today's main slate. Last one second, but first, a quick reminder to make sure you are subscribed to the NumberFire Daily Fantasy podcast feed wherever you get your podcasts because our PGA podcast back for today previewing the AT&T Byron Nelson, myself and Brandon Cadulla, back on that. Getting you set for that, we have a major coming out just around the corner too. So a lot of good PGA action, great deal with this week as well. So a lot of good PGA stuff. Of course, Austin Swain has you covered at USC. I've got NASCAR as well in addition to the MLB podcast every weekday. So make sure you are subscribed to the NumberFire Daily Fantasy podcast feed wherever you get your podcasts. And if you like what you hear, leave us a rating and review as well.  Introducing Captain Morgan's soccer pick, I'm a weekly fantasy contest that is entirely free to play. The contest is simple. All you have to do is answer 10 questions about Captain Morgan and that week's soccer matchup. People with the most correct answers will earn their share of cash prizes. Head over to Fanduel.com slash Free Games slash Captain Morgan and spice up game day with a free shot at cash prizes every Saturday. No purchase necessary must be 21 plus to enter. Location restrictions apply. Avoid we're prohibited. See full terms at Fanduel.com. Pitching preview for this Tuesday main slate. Kyle Wright checks in at $10,900, followed by Justin Verlander at 10-8. Lucas G. Alito is 10-3. Joe Ryan is 10-2. Jesus Lizardo is $10,000, followed by Aranola at 97. Brad Keller is 9,000. Then we have Robbie Ray, Carlos Carrasco potentially. The Mets have not officially announced who their starter is. We'll talk about that and things to watch. Corey Kluber, Martin Perez, Alex Wood and Cal Quantrill as the others at $8,000 are higher. Now again, entering the year, you probably would have viewed the Red Sox against Kyle Wright as being a good spot to stack. But Wright has been sick this year and the Red Sox have struggled. I think that Wright actually does great out well for tonight despite the high salary, despite the discombobulation associated with seeing this type of matchup. My strikeout projections like Wright a lot. They've come for 7.7 strikeouts, which is the highest mark on the slate for today. And most of the other guys in this realm are on the road. They're facing scrappy opponents, stuff like that. The Red Sox aren't either of those right now. Their WRC Plus against Wrightys since the start of last year is down to 101. They have a 23% strikeout rate. They're not drawing that many walks and that's a perfect combination for Kyle Wright. We're up to a 5-star sample on Wright this year and it's hard to nitpick his new approach because he has a 31% strikeout rate. His bad at ball data is great. He has a 2.47 skill interactive ERA. So the peripherals are very good. Baseball's Avant has his expected ERA at 2.51. So they think he's legit. I think he's legit. I'm having a hard time finding reasons not to buy into what he has done. 5 stars for a starting pitcher is a decent sample and plus, like I said, he is at home in a not bad matchup. So it may feel odd to pivot this far in such a short time. Go from stacking against Wright to having him as our top guy at 10-9. But I'm fine with that because he's doing so well in the areas that stabilize quickly. So to me, I'm fine being high on Kyle Wright here and making him my number one arm no matter how weird that may feel. Number two for me is Lucas Geolito. He checks a ton of boxes for today. He is a great pitcher. He's pitching well. He's fully stretched out because he went 100 pitches last time out. So that's all the boxes he checks. The one key thing that keeps him from being on top of Wright is the opponent. He's facing the Guardians and they've had great plate discipline numbers this entire year. Their strikeout rate against Wrightys is down to 21%. And that does matter. That pushes Geolito's strikeout projection down to 7.28, which ranks behind Kyle Wright. It is still a very good number, though. And the rest of Cleveland's profile, unless Josh Nailers of the plate, isn't all that scary because their WRC plus against Wrightys is 105. Their ISO is 167. They're not drawing a lot of walks. And the low number of walks could keep Geolito's pitch count down in addition to the fact that he may not get as many strikeouts as he typically would. So I would say that the most legit criticism recently of Geolito is that he hasn't been super efficient with his pitches. But again, if he's not thrown a lot of balls, his team's not super patient, he could get a boost in that department for this start. This will be just Geolito's second home start of the year. He didn't have huge home road splits last year. So not a bump up to be at home, but typically it's not a bad thing for pitcher to be at home. And the strikeout rate for Geolito is 41%, even with being on the road for three of his four starts this year. He has a 16.7% swing of strike rate. So if you put Geolito above Wrightys, I'm not going to fault you. I just like in terms of strikeout projection, the matchup more for Geolito than the one I like for Wrightys. So I think both these guys, Geolito and Wrightys, high upside, high full options, very okay with both. And I think that hastens Lizardo kind of in that same range for me, but I would put Geolito above him. I put Wright above him. And Lizardo kind of a third to consider. If I have one more guy, it could be that discussion it thinks to watch as well. As far as the value plays go, because all the risers for this year have had their salaries increase, you're going to have to make some exceptions. The value plays are pretty thin. And that's going to lead me to Alex Wood with the consolation I'm making here being pitch count. Because Wood is yet to hit 90 pitches so far this year, did get up to 89 last time out, but he got yanked in the sixth inning at 89. He's topped 85 four times, but never 90. So I can't tell if it's circumstance or if they're intentionally trying to keep him from going too deep. He does have an injury history, so I would get it if they were, but I've got him projected for 87. That's not a great number for this late. There are a lot of guys who are pretty stretched out, but 87 pitches for Wood at home. Still projects him for 5.8 strikeouts. That's pretty good for today's value plays. And there is upside for more if they let him stretch a tiny bit. If you were to go 95, we'd be probably in business at that point. Wood's ERA 4.38, so the results not great, but the peripherals are pretty good. Got a 25% strikeout rates with a 25% fly ball rate allowed. Just a bit too much hard contact so far. The Rockies on the road, not a huge threat in that department at the moment. They also don't strike out too much. So they're not a great matchup in terms of DFS. But as Carlos Rodan showed last night, they can with in the right spots. Obviously Wood is nowhere near Rodan, but he's a good pitcher and his salary is $8,200. So you do get some salary relief here with Alex Wood down to 82. I think that that's enough where you can make a consideration. Personally, I might not go down this low tonight. I think that I might stick with Geolito, stick with Wright, stick with Lazardo, maybe Tyler McGill if he starts. But I think that for me, Wood would be the top guy down here. But I think I prefer to spend up with the pitchers we have for today. Let's move now to the stacking section. This does play into it because I don't think the stacks are all that hard to get to. Outside of maybe the Yankees, we'll talk about second. But first, some of the Cardinals, they're facing Kyle Branesh today. The Cardinals offense is very righty heavy. So I do prefer that when they're facing a lefty for that reason. But I still think they are worth a look here as a top spot. Branesh has just two starts in the majors in his career. He was a big strikeout guy in the Miners. Going back to last year, 86 innings at AAA. And his strikeout right there was 28%. But it came with an 11.6% swing and strike rate. And that's not what you'd expect to be when the strikeout rate is 28%. This year, his swing and strike rate in AAA was 10.4%. Before his promotion. And his two starts this year, it's at 9.3% in the majors. So his strikeout rate isn't going to be at 12%. Which is where it's at right now. That will rise. That number will go up. But it doesn't seem like he's overpowering people right now. And Branesh has also struggled with hard contact. Across his two starts, he's led up a 44% hard hit rate. He did let up some five balls in the Miners too, which led to a 4.26 ERA and AAA last year despite all the strikeouts we just discussed. It's also super hot in St. Louis for today. I didn't talk about this in weather, but probably should have. It is 88 degrees for this game, which is even warmer than what it's at in Phoenix for the Diamondbacks versus the Marlins. So, yes, I would prefer to stack the Cardinals against the Lefty. But I think with Branesh, the way he profiles, this is a righty we can stack against. And I'm happy to do that with them here. And also the fun thing with the Cardinals is that stacking them today allows me to talk about Juan Yepez. He absolutely torched AAA this year before his promotion. He had a 2.99 ISO there last year, so over a larger sample, hit the ball really hard, hit for a lot of power, carried that into 2022, got the promotion. Last year also had a 46% fly ball rate. And the Cardinals said, hey, like you're going to hold down the middle part of this order. He's hitting around fifth. I'd fully expect him to stick there with how well he's played so far. And he's got a fun profile. So, Yepez has a mid-2000s salary. I think he should be a focal point within Cardinals stacks tonight. He's a good one-off if you got to save salary. I think he's really fun. So a good excuse to talk about Yepez with the Cardinals facing Branesh for today. Now, the Yankees mentioned them facing Yusei Kikuchi today. It's already the third time they've seen Kikuchi this year. And last time out, Kikuchi did well against them. He held them to just one run across seven innings. And he had seven strikeouts. But I think the familiarity with Kikuchi and the Yankees should put them in the stacking discussion for today. The key part of it is that even when Kikuchi did well against them, the Yankees hit him hard. They had a 54% hard hit rates in that game. They had a 75% hard hit rates in the first game they faced him as well.  So the Yankees are seeing him well, even if the results haven't showed it. And now they get to face him for the third time this year. Kikuchi has struggled with hard contact beyond just these starts, too. He has been using his forcing fastball more across his past 10-start. That is his most relevant sample. And in that time, hard hit rate allowed his 54%. He's allowed up a lot of walks, just a 21% strikeout rate, and it's led to some really tough results for Kikuchi. His e-array is 4.69 in that time. And you can say, you look at that 10-start sample and say you faced the Astros a bunch, the Yankees, some tough teams. But the Yankees are tough, too. They got a 117 WRC plus against lefties and a 191 ISO. So they're tough and they know what he's throwing because, again, they just saw him last week and they've seen him twice already this year. So I think it's wise to stack the Yankees here and see if they can exploit that knowledge of what Kikuchi is doing. I know that Josh Donaldson hasn't been that great this year, but I do think we'll want to be on him for today. He had lefties really well last year, been fine in the small sample this year, 280 ISO since the start of last year against lefties, 41% fly ball rate. The hard here overall this year for Donaldson is still pretty good at 48%. He just hasn't had the results to show for it. I think a turnaround is more likely against the leftie for Donaldson than a rightie. So I'll be giving him a swim tonight. His salary is not low. It's $3,200, but I think that he has upsides. So obviously you want to prioritize Aaron Judge, you want to prioritize Jean-Carlo Stanton, very onboard of Glavor Torres, assuming he plays tonight, but I think that Donaldson, despite the poor results, still a guy I'd like to be on for tonight. Now, someone whose results had not been poor is Madison Bumgarner. He's been able to avoid regression thus far and now we get Matterbump, not just Madbump, Matterbump after his ejection last week. So a little angry Madison narrative for tonight, but it could be done to go against him, but the Marlins have a lot of lefty bangers on their team right now, and I think it makes sense to stack them here. Bumgarner has had a massive split between his results and his peripherals this year. His ERA is 1.50, but it's still interactive ERA. It's 5.17. He has a low strikeout rate, high walk rate, a lot of fly balls. The reason Bumgarner has escaped is largely because of the dead and fly balls this year, and he's done a decent job at suppressing our contact beyond that as well. And that's why if you go to Baseball Savant, the expected ERA for Bumgarner, it's 3.55. Basically what that tells me is that Bumgarner has done a good job at getting lazy fly balls, which will almost always lead to outs. And that could continue, and it may, but I don't think I want to bet on it. Instead, I'd rather bet on the fact that Bumgarner is living dangerously, eventually does bite him. That's more likely to happen when he's in the best or second best environment for offense on the slate out of Shea's field. And I also think it's more likely to happen when he's facing some guys who can really hit lefty as well. So it's possible I'm being stubborn and just beating my head against the wall here by stacking against Bumgarner again, but it's not sold on it yet. I'm going to stack the Marlins here and see if they can bring the regression that Bumgarner seems as if he is due for. The primary lefty bangers on the Marlins are obviously Haces Aguilar and Jorge Soler, but Garrett Cooper also a fly ball heavy profile for lefty or against lefties. Avicio Garcia is hit for good power. I'm not really as high in jazz Chisholm against the lefty as I was yesterday, and Chisholm obviously didn't do a whole lot there either, but I think that Cooper, Garcia, Aguilar, Soler, all those guys are guys we can feel good about against lefties and at least have a path to double-dong upside. So to me, I think those are the guys I want to turn to for today, just because they hit lefty so well, they got the continued advantage here today. So those would be the primary building blocks for me within this Marlin stack. Thanks to watch for this Tuesday's slate again. I don't know officially who will start for the mess today. They've not said yet. It could be either Carlos Carrasco or Tyler McGill. I think either is a consideration against the Nationals. McGill has a 28% strikeout rate through six darts. The hard hit rate and fly ball rate numbers have improved for him this year. So $9,500 is a very reasonable salary in my mind. I'd probably put him in the same tier as Lazardo. If McGill gets a start, I would put Lazardo higher, but I think McGill would be up there. As far as Carrasco goes, I think that Carrasco will be the guy. He is to me around the same area as Alex Wood in terms of value placed in. I mentioned that Wood's strikeout projection is 5.8. We've got 5.54 for Carrasco. So both are fine. I'm not objecting to either. I prefer Wood, but Carrasco would be a solid second option if he is the guy who starts for today. Another spot to stack here would be the Reyes. They're facing redetmers. Still hasn't quite unlocked his prospect potential just yet. Got a 6.33 ERA across 10 big league starts at 4.67 skill interactive ERA. Lot of fly balls. Wind is out for today in Anaheim. The Reyes have a 124 WRC plus against lefties, which is the top mark on the slate. So I'll go in on them for sure. I think you could justify putting the Reyes even higher than I have them just because they're a very good offense. And Debtmers are still struggling. Good park for any tonight. So would not push back if you decided to push the Reyes up to your personal board. Finally, I am okay going back to the White Sox again today. They're facing Cal Quantrill, and Quantrill doesn't let up enough hard contact for my liking, which is why the White Sox aren't higher, but he does let up fly balls, does let up hard contact, plus the Velocity is down this year.  And Velocity is down this year. So I'm fine stacking the White Sox, but I prioritize them behind the Reyes and behind the three teams we discussed for stacking earlier on. Let's finish up with some Dinger calls for this slate. The boring one is pretty boring. Aaron Judge facing Yusei Kikuchi. I always have a hard time choosing between Stanton and Judge, but with the way the judges hit the ball this year, I think that for me, it's making it a lot easier to just feel good going with Aaron Judge as my top guys. Aaron Judge, my number one home run call for today. The fun one, going back to Juan Yepez. I talked about him before with the Cardinals. Great power in the minors has been good enough in the majors so far this year for me to believe that will translate. So I'm fine going with him. Just the two biggest power hitters in the slate, Aaron Judge and Juan Yepez, as the home run calls for today. That is all that we have for you for today on the solo shot, but as mentioned, we are back once again later on to break down today's PGA DFS slate. Myself and Brandon Cadulla previewing the AT&T Byron Nelson. To get that right as it is posted, make sure you are subscribed to the Number Fire Daily Fantasy podcast feed wherever you get your podcasts. And while you're there, you like what you hear, leave us a rating and review. If you've got any questions for me, I am on Twitter at Jim Sonnis, J-I-M-S-A-N-N-E-S. You can also follow the FanDuel Podcast Network at FanDuel Podcast. Big thank you to everyone for tuning in for today. Good luck to you with your DFS lineup. We'll talk to you once again Wednesday to get you sad for another main slate. This has been the solo shot right here on the FanDuel Podcast Network.


Fibromyalgia is a common disorder whose cardinal manifestation is chronic, widespread pain. Well, not so common, affecting 2 to 4% of the population, though probably more like 2%, and especially women. For decades, some medical professionals dismissed fibromyalgia as all in people's heads, but this outdated view has been refuted by more recent research characterizing it as a disorder of pain regulation and sensitization.  Twin studies have shown that about half of fibromyalgia is genetic, but the other half we can do something about. There are lots of drugs with lots of side effects to help with some of the symptoms, but what about lifestyle approaches? Engagement in regular physical activity is considered imperative for effective management of fibromyalgia. A systematic review and meta-analysis of randomized clinical trials on the effectiveness of therapeutic exercise in fibromyalgia found that both aerobic and resistance exercises are effective ways of reducing pain and improving global well-being in people with fibromyalgia. Patients may worry and perceive that exercise will worsen their pain and fatigue and so you have to start slow and work your way up as tolerated, with the goal of eventually achieving 30 to 60 minutes of moderate intensity aerobic exercise, in addition to muscle strengthening exercises, 1 to 3 sets of 8 to 11 exercises, 8 to 10 repetitions, with a load of about 7 pounds or 45% of the max you can lift. But what about dietary interventions in terms of dialing down the pain sensitivity? Well, what causes it in the first place? Inflammation. During the inflammatory response, pain receptors are activated and chronic inflammation can cause chronic activation, which may cause chronic pain due to this prolonged hypersensitization of pain pathways. No wonder, then, that a pro-inflammatory diet was found to be associated with pain hypersensitivity in patients with fibromyalgia syndrome. Exactly which foods are pro-inflammatory and which foods are anti-inflammatory? Check out those twin videos, but broadly speaking, components of processed foods and animal products, such as saturated fat, trans-fat, and cholesterol, were found to be pro-inflammatory, while constituents of whole plant foods, such as fiber and phytonutrients, were strongly anti-inflammatory. The intake of dietary fiber, found concentrated in only one place, whole plant foods, is fundamental to reducing not only the risk of abdominal pain, but also muscle and joint pain. We think because of these short-chain fatty acids that are good gut bugs produce when we eat fiber. These short-chain fatty acids are important mediators of pain, fundamentally because they modulate inflammation.  In terms of phytonutrients, plant-derived polyphenols are widely acknowledged to also act as anti-inflammatory substances. Here's some foods packed with anti-pain pathway nutrients, berries, greens, citrus, nuts, spices like turmeric and ginger, edamame, and green tea. That's why you can do randomized double-blind crossover trials, showing that about three cups worth of strawberries a day can significantly improve pain and inflammation. If that's what a single plant can do, what about a diet chalk full of plant foods? Put people on a strictly plant-based diet rich in fresh fruits and vegetables, whole grains, and various legumes, which are beans, whipbeads, chickpeas, and lentils, as well as nuts and seeds, and you can drop C-reactive protein levels 33% in three weeks, which is a leading blood marker of systemic inflammation. But does that translate into less pain? And the answer is yes when it comes to migraine headaches, yes when it comes to painful periods, a significant reduction in menstrual pain duration and pain intensity in addition to premenstrual symptoms. In fact, even just a single plant, cinnamon, about a third of a teaspoon three times a day during your period, can help, though it doesn't work as well as ibuprofen. Ginger powder, on the other hand, ground ginger, has been found to be comparable to ibuprofen in relieving pain in women with painful cramps. You can learn more in my video on the topic. Whole food plant-based diets also alleviate the symptoms of osteoarthritis. Several studies have shown improvements in rheumatoid arthritis symptoms with diets excluding animal products, though it may be just as much a function of increasing the quantity of healthy plant foods. But it's not just because plant-based diets are so effective in causing weight loss, even at the same weight, there's an improvement in rheumatoid arthritis for more plant-based diets. And plant-based diets can also alleviate fibromyalgia symptoms. This is the latest study which enrolled anyone with chronic musculoskeletal pain, fibromyalgia, or not. Yes, diets high in animal proteins and fats have been linked to chronic pain and inflammation while plant-based diets produce anti-inflammatory responses. So, did it actually work when put to the test for pain? Yes. Consumption of a plant-based diet produced positive improvements in chronic pain and function. How much? Well, a minimally clinically important difference in chronic musculoskeletal pain is one point on the numeric pain rating scale, which is just a scale of 1 to 10 on how much pain you're feeling. And on the plant-based diet, perceived pain decreased, an average of three points on a 10-point scale, from an average of 5 or 6 out of 10 down to 2. Now, unlike most of the prior studies, there was no control group, but what's the downside of giving healthier eating a try? In fact, those with chronic pain are more likely to be overweight and have nutrition-related maladies, such as high blood pressure, diabetes, and heart disease, all of which can be prevented, arrested, and in some cases even reversed with a healthy enough plant-based diet. So, any pain benefit is just icing on the cake of health. Scratch that. How about the dollop of guacamole on your bean burrito?


Rwy'n gwybod i'r 7 ymgyrch o'r COVID-19 recovery committee i 2023. Rwy'n gwybod i'r apology ar Eilex Rowley, ac rwy'n gwybod i'r Jackie Bailly, ac yn ystod i'r ddechrau i'r ddysgu. Rwy'n gwybod i'r ddweud i'r cyfle i'r drwyth i'r fflaeniadau ymddangos drwy'r lockdown Jane is not wrong. There is a lack of consistency, a difficulty in accessing pathways, and that's why the implementation support note is so, so important, because when somebody does go to the GP, which will be the first port of call for, if not everyone, then the vast overwhelming majority, then there is literally a flowchart which can tell you, which can tell the GP where the referral pathways should be, what are the other support services that are available. In short, that work is very much under way. It is one of the key areas in which the funding is looking to support, but I take Jane's point in its entirety. We are trying to get a balance, I suppose, between absolutely having that national consistency, which is important, but that doesn't mean necessarily one model fits all, and letting local health boards—so Hyland's a great example. We all know about the geography of the Hylands, we know how disparate the population is, et cetera, et cetera, so they have a good virtual model actually in Hyland, which works well in their further developing that. Clearly, that is one model that the NHS Hyland have developed, but that is suitable to the local needs. There will not be a blanket approach, but I take Jane's absolute point, and she's correct in this, that there has to be consistency in terms of access to pathways. Thank you, cabinet secretary. That's helpful. Can I ask what actions has the strategic network taken to improve the consistency of care for people with long Covid across Scotland, and also what oversight of the strategic network does the Scottish Government have? We're obviously involved in the strategic network, and I may ask some of my officials to come in and add some detail on that. The strategic network is a model that has been used, for example, for trauma networks. It's a model that's well known, well tested and has some really positive outcomes. Essentially, what it has done is brought together the key partners, the clinical experts, those who are delivering the local services, and of course those with lived experience. Some of the actions that's taken and we can provide you more detail on this is to work with health boards to bring forward those referral pathways, particularly around the rehabilitative pathways, which we know are working well in some health board areas, but clearly need more work in other health board areas. It's also, what has come out of that, of course, is one of the core issues that I've already referenced, but one of the core issues that a number of GPs, those in primary care, have said, we do not have the information around where to refer to, for example, and that's why the development of the implementation support note has been really, really important. So there's a whole load of key actions that have come out of the national strategic network. There will be more actions that will come out of it, but the value in that network is that it brings those three groups crucially together in order to improve the services for long Covid. I don't know whether John or Ashley or any of my colleagues wish to come in on the strategic network at all. Chris probably has the best place, given the involvement at a closer level. I agree that the strategic network is a key tool for us to support improvement of the level of consistency at a national level. The strategic network brings together boards to share information and learning around the models of care that they're developing and implementing, and I think will be key to helping us learn and evaluate the models of care that they're delivering in order to make sure that we learn and capture that information. The other thing I'd like to add is that the strategic network has a clinical and subject matter expert group, which is collating information on current pathways of care for people with long Covid and has indicated that it will support the development of standardised guidance in addition to that work if that is appropriate. Thank you. Did anyone else want to come in on that question? On speaking to many of those suffering from long Covid, one of the issues is the prevalence of Covid still being in the community, and it's a major concern. I note that the Scottish Government is currently undertaking the autumn-winter Covid-19 booster programme, but, as of 12 March, we've only seen just over 2 million people take up that winter booster, whereas we had 4.5 million for the first booster and just over 4.300,000 for the second booster. There seems to be a bit of an apathy from the general public to take up the boosters over the time. First, does the Scottish Government still believe that it's important to continue to take up the offers of the vaccine programme? If so, what public health messaging is out there to encourage people about the importance of having the booster? Yes, thanks for that. You're absolutely right. When it comes to the vaccine, we were always concerned and have been concerned that there may be an apathy and a vaccine fatigue that may well kick in among certain groups and cohorts. It's really important when you see the breakdown of the data. Among some cohorts, there's not been that fatigue. If you look at, for example, our older population, if you look at those within residents, within a care home, for example, we still have good levels of uptake in terms of the vaccine, where we saw some drop-off as, for example, in the cohorts, 50 to 64-age group, for example. We had some concern about the uptake in relation to social care staff, and we put a lot of effort working with the likes of Scottish Care and others to try to see if we could boost those numbers. It's still worth saying, of course, that our uptake rates for autumn-winter vaccine are still highest in the UK, which is positive. We continue to work on a four-nations basis to see what we can do on a co-ordinated basis. We continue to do that. We also had, as you know, last year's Covid-sense campaign, as well as reminding people of good behaviours, what to do if they have the symptoms of Covid, for example, in our good hygiene, good ventilation, etc. That will continue to make the case in that regard as the immediate impacts of Covid are not so evident, are not in our news 24-7. That will be an important piece of work for us to do, because, ultimately, if we can reduce the number of people suffering from Covid, then we will hopefully reduce the numbers impacted by long Covid. I couldn't agree more with the premise of your question, which is that we should be doing everything in our gift that we possibly can to increase the vaccination rates. I know that recruitment is a problem in the NHS at the moment, but how can health boards be supported to recruit for long Covid posts? To what extent would recurrent funding help address the recruitment issues that are highlighted by the health boards? That is a really good question. Recruitment undoubtedly continues to be a challenge. What we are doing with health boards is making it clear that the £10 million funding, which is on top of their core allocation, will be available throughout the next few years. We are making that clear to them. We know that there have been issues around recruitment. We are working with the boards to see what more we can do in relation to those recruitment challenges. We will continue to do that, board by board. Those challenges will be different. The challenges that our colleagues in NHS Grampian face will be different to what greater Glasgow and Clyde face. Those recruitment challenges undoubtedly are one of the reasons why the full £3 million has not been able to be spent this year, but I have made it very clear to health boards that that £10 million funding will still be available over the course of the next few years. Good morning, Cabinet Secretary, and welcome to your colleagues. Just to follow on from the line of questioning from the convener, we have heard a lot of evidence from long Covid sufferers during the course of this inquiry about the issues that they have trying to access services. I just want to read you an email that we had a couple of days ago from a long Covid sufferer in Aberdeenshire. I will not use his name and do not have permission. Just to give you a flavour of some of the feedback that we have had as a committee, as this individual says, recounting his experience, I have just been forced to make a private GP appointment due to the complete lack of support from the NHS. Actually, it is worse than that, as my current GP surgery is utterly dismissive. He has a diagnosis of long Covid. He says, in December, I was forced to take a day of work, a contact of the surgery. My GP told me there is nothing to be done for long Covid. The current nice guideline state, we are not to prescribe pain relief for chronic pain and you have to take responsibility and self-manage. Clearly, that is not acceptable. That is the response of individuals who have a diagnosis of long Covid are getting from their GPs. I agree with you. I wonder if it is the same person I met from Aberdeenshire again. I will not say the name because I heard a very similar experience from a young person in Aberdeenshire who felt that their GP was dismissive. I have heard it from people, not just in Aberdeenshire but in many other parts of the country. That is why not just the nice guideline but the implementation support note, which we can give you further detail in writing through the convener if you want, gives that level of detail the referral pathways that are available. That is why we have put so much work through the strategic network into the education tools that are available for GPs. I highlight the written evidence that was given by the RCGP to this very committee and to this very inquiry where the RCGP, and I agree with him, believe that primary care and GPs are the first port of calling the best place to give that holistic assessment before then perhaps onward referral. That is why so much work has gone into and again I am more than happy to provide some of the detail on this in writing but so much work has gone into trying to assist our GP colleagues who are facing a number of challenges in relation to the pandemic around where those referral pathways are. We have the implementation support note, we have an education strategy to raise awareness of long Covid, we have NHS Education of Scotland, we have their learning platform, TURAS, which I suspect members will know but it contains a video and webinar content on long Covid so there is a lot in that space that is largely trying to work closely with our primary care and GP colleagues to ensure that they know the correct pathways that are available. OK, thanks for that and I appreciate it as a work in progress and we have heard this over a long period of time but the feedback we keep getting from people is the experience on the ground is still lacking. This individual says that he has had to go private. Again, this has been a consistent theme that we have had from long Covid sufferers where people have had to go private to try to access a GP who has got expertise in the area. That is fine for those who can afford it, many people can't afford it. We have created, have we not, a two-tier system and isn't that unacceptable? I don't want a two-tier system, we have had this in other areas of health service where for example people have waited for elective care and again I won't rehearse the reasons why we're in the position that we're in and they felt they've had to go private. That to me is not what I want as Cabinet Secretary for Health and Social Care I want everybody to be able to access the services on the NHS. Suppose I go back to my comments and my opening remarks is that the science around treatment of long Covid and the symptoms of long Covid is still in its infancy and I think everybody around the table would probably accept that. There's not one treatment that we can give. There are a number of treatments to try to help with the symptoms or some of the symptoms of long Covid. Far too often I've heard from long Covid sufferers that when they go to primary care primarily, when they go to the GP, they are just either pass from pillar to post and there is not a single point of access. For me that is why the funding that we have given to health boards I think that I could safely say the majority of the health boards are using that funding, a significant number of them are using that funding to create that single point of access so that an individual isn't pass from pillar to post. To answer your question, of course I don't want people to have to feel that their only option is to go private and that's why we need to improve the services that we have. You've talked about the single point of access and that's a very important point and we've had that in a lot of evidence that we've heard. We've also heard from what the long Covid sufferers they would like to see long Covid clinics established in Scotland to provide specifically that service. So where is your thinking around long Covid clinics being dedicated and being established in Scotland as happens in other parts of the UK? We do look at the other models. For example Dr Sandish Gohani has mentioned the Hertfordshire model before so we've looked at other long Covid clinic models around the UK. For me I go back to the sign and the nice guideline on long Covid, one model would not fit all areas and I think we all probably accept that. What I would say is that I agree quite strongly with the RCGP on this and the written evidence to the committee and perhaps I can just quote it directly. Talk about long Covid, it often requires generalist skills to treat but most can be fully managed in primary care and the GP is best placed to provide this holistic approach. The RCGP go on to say there is an increased risk that patients presenting with long Covid symptoms may have instead another cardiac or respiratory condition which may have similar or even identical symptoms. Patient need a GP assessment investigation rather than being funneled inappropriately into a clinic that is designed for one condition and then requires further investigation on alternative management. I've never said this from day one, I've never been in principle opposed to long Covid clinics and that's why I've asked my team to go out and look at the Hertfordshire model. For me it's in effect trying to cut out the middle man or the middle person. We have GP's if they have the appropriate referral pathways through the implementation support note getting directly into then a Covid rehabilitation service within Lanarkshire as an example I keep using. That to me is a better model than a GP than having to refer for example to a long Covid clinic who then would have to refer on to another pathway. I'm not opposed in principle what I'm trying to do is allow local health boards to design the service that meets their local need. I suppose the key question if I was a long Covid sufferer in front of you now I'd be saying that this is fine, you're talking about developing pathways, you're talking about you recognise other issues when this is actually going to get to a state where we've actually got the services that people need. It's a very fair question, so again in some areas we do absolutely have that service and the Highland Service I've talked about has been 100 referrals and Lanarkshire well over 500 referrals being made where we're lacking is that single point of access and ensuring that there is that connect between the primary care and secondary care services and that is exactly what the funding is looking to do so I've got every faith that we're going to see more and more health boards developing these services in a much more consistent manner. Some are already doing that absolutely, there are some who are using this funding and giving us timescales in relation to when they'll have those pathways more fully developed but a murder phraser essentially hits the nail on the head that is the number one issue that comes up long over sufferers time and time again. It all sounds good but is it consistently working across the country? The answer to that is not yet but that is what we're working on. Maybe that will be a job for your successor in your health secretary if you're no longer in that role. Who knows? Is that one more follow-up question? Second person to sack me in a few weeks now. That's a follow-up question convener, it's a slightly different topic. You wrote to the committee yesterday with a list of funding that has been allocated. This is within the current financial year now. There's various funding streams that are announced for third sector organisations which is all very welcome. The total here is £334,000 that's been allocated. Is that money that was basically unspent in this year's budget? Yes, in short. There was a £3 million initially allocated. There was an underspend about £1.1 million of that. We then went out to third sector organisations because health boards could not spend that money because of recruitment challenges. What we've given a clear absolute guarantee of that £10 million funding, the profile of that may well change. It won't be necessarily £33 million per year. It would answer your question in short. That is part of that underspend. The funds that have been allocated are within this financial year. Do those organisations need to spend that money by the end of the financial year or can they roll that over? I think it has to be spent in this financial year, or certainly the work. They have to begin the work and spending that money this financial year. Forgive me. I can get your absolute clarity on that post the committee. They are essentially building upon existing projects that they already have under way. The end of the financial year is only two weeks away, so it doesn't give them very long to spend the money. No, the money was distributed before the letter was sent to you. How long before? I'm not sure if my colleagues know exactly when that money was given to those organisations. When we worked with those third sector organisations, we made it clear that this was becoming part of the underspend. The health boards could not spend and were they confident that they would be able to meet the criteria for that spend? That's why the amounts are, in some cases, relatively small, as you'll see, and in some cases, larger than that. That's why they are building upon existing programmes that already exist. The fundamental point is that £10 million that we've given to health boards and others will be available over the course of the next few years. Thank you. Can we move on to Jackie Baill's request? Thank you. Can I welcome the cabinet secretary's comments about improving services? Can I just pick up where you left off? You said there was a £1.1 million underspend, but the allocation that I have in the table is for £334,000. Where is the rest of the money being spent? It will be reprofiled over the next few years. Oh, okay. So you're carrying that bit forward? Forward. Given that it was less than £3 million that was allocated to health boards as part of that £10 million over three years, the cabinet secretary will, of course, recall that, at the point that he made the allocation, there were 74,000 people affected by long Covid. Of course now, unfortunately, there are 175,000 people affected. Do you intend to increase the overall resource available? It's a really fair question to ask. Of course, I would look to see where we can provide even more support. I suppose the point that I would make about the long Covid fund, which I know is well understood by colleagues around the table, is that on top of, of course, this financial year, £18 billion, next financial year, £19 billion, we are giving to health boards. We are giving to the NHS and social care and, of course, a chunk of that to our health boards. It's worth saying that when you look at our front-lines bend per head in Scotland, it's, of course, higher than, for example, the costs of the UK, £323 per person higher than in England, for example. If I take that Lanarkshire model and I keep going back to that, because I've seen it first-hand and spoken to some people who benefited from that service, when that rehabilitation service was up and running, of course they didn't wait for the allocation from the £10 million long Covid fund to use their health board allocation to create that team to hire those multidisciplinary team members and they are the ones who are providing that support to long Covid sufferers. I hope that that gives you some patience. It does indeed, but that's not been the case in every health board across Scotland so we have a postcode lottery. In May 2022, by that point, NHS England had allocated £224 million to support assessment and treatment of long Covid. £90 million was in 2223 alone. Our share of that, in Barnett consequentials, would produce £21.7 million in Scotland. Can I therefore ask the cabinet secretary where that money has gone and would you use some of that to enhance the Covid services that are currently a postcode lottery on the ground? For the benefit of your officials, the stats are from SPICE and the House of Commons library. I accept that. For me, every single one of our health and social care consequentials has been a commitment of ours in this Government for a number of years now. What I would do is look to see where we can possibly increase our funding for specifically long Covid. I go back to the point that I made to Jackie Baillie a moment ago. Our front-line spending for health per head is higher than other parts of the UK. Yes, the long Covid support fund is important to increase, supplement some of the work that is already on-going but it is just that. It is supplementary. It is complementary to the funding that is already spent by health boards not just in Lanarkshire, I have given that example but right across the country. I am more than happy to explore certainly in my role. I am sure that whoever is in this role after me will look to explore very much how that funding if it can be increased. I will take that as a commitment from the incoming First Minister to increase long Covid funding. Thank you so much, you've made my day. Can I take you to the primary care? It's not quite worth it. I'll take you to the primary care improvement fund because of course in your long Covid paper published in September 2021 you said that the primary care improvement fund will continue to support and expand the range of professional roles in primary care that play a key role in the provision of services that can support people with long Covid and so we all agree. However, the fund was cut by £65 million in the emergency budget review. Did that not have an impact on the ability of primary care and community-based support for long Covid services? In terms of long Covid services that is a further assessment we would have to do but I accept entirely the premise that it would not have an impact particularly when I had to re-profile £400 million of funding within the health and social care budget that clearly had an impact that would be foolish. I'd be insulting your intelligence and the intelligence of other people listening and watching if I didn't say that was the case. What I would say to Jackie Baillie and I do know she understands that of course these were decisions that were being made because our budget was so badly impacted by peak inflation at that point that our budget was worth about £1.2 billion less but also because we wanted to make sure that we were giving a fair pay deal to our NHS workers and something that I know Jackie Baillie supports fully in its entirety to do that we had to re-profile and that's why I was very keen that when we set the budget for 2324 of course we made sure that we put that money back into primary care but it's absolutely the case that when we re-profile that amount of money to do in a way that has minimal impact but of course has impact. You've taken me neatly to my final question which is about health and social care staff. We know that they were the ones who were on the front line of the pandemic initially operating without adequate PPE. These are the people that are suffering from long Covid and their employment protection for Covid was removed.  I've been contacted by a staff member from NHS Greater Glasgow and Clyde and she said that their objective was simply to get her out the door and quit her job. After 35 years in the NHS she feels very angry and very let down. What can the cabinet secretary do to protect our health and social care workers who have long Covid from being dismissed by their employers? Again these are obviously individual employment issues. We took an approach as Jackie Baillie will know in around long Covid that other nations took right across the UK including Labour run Wales Conservative run England and of course the approach has taken in Northern Ireland around the employment and the additional support we can give for those that were suffering from long Covid and actually we extended that beyond where other countries in the UK decided to withdraw some of that support. So these are important employment issues. I know there are various member's bills for example, such as Mark Griffin's member's bill around industrial injury there are calls for long Covid to be prescribed as a disability and of course under the equality act it's more the impact of a condition and the debilitating impact of a condition as opposed to necessarily the condition itself which has to be prescribed therefore it could be that long Covid and the effects of long Covid could mean that somebody then has a disability which would impact their ability to get certain benefits and social security benefits so I'll continue to look at this matter it is a challenge because we have to make sure particularly where employment law is of course reserved we have to make sure that long Covid we understand the unique impacts of long Covid and the fact that there aren't treatments there are some treatments for some symptoms but not treatment for others at the same time we have to make sure that employment law is being applied in a way that is consistent across conditions Thank you convener and welcome to the committee folks Can I just go back a little bit I want to come on to paediatrics in a minute but can I just go back a little bit convener is that all right Murdoff Razer talked about GPs and you say it at yourself if a GP does not accept that there is an issue and you are a long Covid sufferer you don't have the energy to fight the system one thing we keep hearing from long Covid sufferers is that they are drained so if they go to a GP who is dismissing them what is the route for them to get either a second opinion or is there a way of compelling GPs I don't know if that is possible compelling them to accept that this is a condition that people are suffering from so ultimately of course it is not for a Government or health secretaries or ministers to override clinical opinion and clinical judgment that's got to be up to the individual clinicians I'm really upset when I hear that people have been dismissed it's got echoes for me of a number of those mesh survivors that we've all interacted with I suspect who in their own words feel that they were dismissed by clinicians time and time again so I'm really concerned and that's why our work has been around the educational tools that we can provide for our front-line primary care workers who by the way are doing an incredible job under really difficult circumstances I suspect that all of us would agree with that particularly given the effects of the pandemic so that's why so much work has gone into the educational tools into the implementation support I'd be really disappointed if I was to hear a recent example of that being the case I don't know how recent example was that what Fraser gave or that you have given was really upset if there was a recent example of people being dismissed by the GPs because of the amount of work that we put in but I don't know Dr John Hardin might want to come in if there's anything else to add on that front and we've been taking a lot of advice from GPs I think Dr Amy Smalls has given you evidence for example she's the one that's attended some of the meetings that we've had on this but John, about what you want to hear As a clinician I'm sorry that that's people's experience that's extremely the minority or not happening now as Cabinet Secretary has just said we have done a lot of work through the implementation support note work with Royal College of GPs work with the NHS Education for Scotland to try and raise the awareness and the education levels within healthcare providers to make sure that they have the knowledge to recognise these symptoms and signs so as a practising clinician myself I'm an emergency medicine consultant but as a practising doctor we're pattern recognisers effectively that's what we do we listen to people's stories we look at their symptoms and signs and we try to piece together what we think is going on in the context with which the patient's presenting and in those circumstances sometimes we get it wrong sometimes the majority think we hopefully get it right but unfortunately sometimes we're led down a route in that conclusion of long Covid initially that's not a bad thing it shouldn't stop us delivering treatment for patient symptoms but sometimes it means that we want to exclude other potentially more sinister conditions first and with the breadth of symptoms that we see with long Covid it cross cuts across so many other conditions it's very difficult for clinicians to know whether it is specific to long Covid or not and the danger here is that clinicians are sometimes wanting to jump to the conclusion of long Covid before they've excluded other aspects okay, and as you've put on the record this is a tiny minority of people that I'm talking about and I'm not entirely sure where we are in terms of people not getting that so I just want to clarify that point the other thing is that this partnership between third sector and NHS myself and my colleague John Mason attended a chest heart and stroke event actually in this room and it was excellent is the room for you to expand that partnership more as we go forward because clearly NHS is under huge amount of pressure and if other areas of society third sector groups are able to help surely that would be something we would want to do yes, the short answer is yes to that we've already provided some additional funding to Chest Heart and Stroke Scotland but I'm very keen to see what more they can do you'll know of course the unique digital pathway that they're working with in relation to NHS Lothian that's what NHS Lothian want to use their allocation of that £10 million funding so I'm very keen to see the evaluation of that and to make sure that we do not suffer from what I often call pilotitis if it's working well let's make sure that we get it rolled out even further so I'll be keen to see how that particular programme in NHS Lothian is working and the evaluation of that I'm going to quickly go on to paediatrics because you mentioned the children who have got long Covid in your opening remarks and I have to say some of the most harrowing stuff we've listened to has come from parents of young kids who are certainly completely debilitated so what pathways and healthcare services are available for children with long Covid right now? I agree with your assessment and your description I should say some of the most harrowing testimony has been from young children and I think it's worth paying particular tribute to Helen Goss who I suspect is known by most people here in terms of what she does with long Covid kids Scotland she is a force of nature but is dealing with her own personal circumstances and has helped a lot of families of those who have children and young people who are suffering the effects of long Covid so I want to pay particular tribute to the work that she does and she would be the first to say that we've got further work to do in this particular area so to answer your question directly for children and young people with symptoms of long Covid assessment and initial investigation is still provided by the primary care team primary care conditions can of course then refer to occupational or physiotherapy for further advice or support when it comes to that implementation support note so I've referred it to a couple of times that support note which is there for GPs it's got the referral pathways there the other support that exists that was developed in consultation with the Royal College of Pediatrics and Child Health so it does set out that where self-management for example is not effective and there's a significant impact on the young person or child's education or the quality of life they should be referred to paediatric services for investigation so the funding that we've made available to NHS boards that £10 million that I've referenced numerous times already that does include strengthening services for young people with long Covid in one example that would be greater Glasgow and Clyde so greater Glasgow and Clyde through the letter I think that I sent you earlier they're recruiting additional paediatric occupational therapist support to support young people, to support children and indeed their families should also mention finally perhaps that the national strategic network again that we've done so many times now during this session they're progressing a dedicated workstream that brings together those clinical experts those with lived experience to identify needs and priority actions that are specifically for children and young people too one of the things, one of the gaps that we've also heard about is that transition from children to adolescents and adult services are you doing any work around working for young people who are going from children's care to adult care I think that's exactly why the strategic network is so important because it's got those dedicated workstreams but what it does is it brings them all at the national level together so where we're trying to improve services for adults for children we make sure there's no gaps in between if there are those young people who are in that transition phase I have to say it's not an issue that's been raised with me specifically around long Covid it's an issue that presents itself in many other parts of the system as you'd imagine it's not an issue that's been raised with me particularly in relation to long Covid but I'm happy to take that one up with long Covid Scotland but also long Covid kids as well educational support for children and young people with long Covid is there a consistent offering across Scotland so I think again it's an area where we want to get better in terms of education a number of young people who have suffered from long Covid in fact it was just outside of this Parliament actually we had a meeting a number of months ago now and the educational support some families were telling me this school was excellent others telling me not so much so this is why it's really important that I'm having those conversations as you can imagine I am with the education secretary and we're bringing in education officials as well as fair work officials going back to Jackie Baillie's question around employment as well in that regard but fair to say that it's continued work in progress okay I'm going to move on to theme 6 at the moment in my previous life as a farmer prevention was always better than cure we are now dealing with the effects of people having been infected but how are we going to stop it continuing to circulate if the convener's point at the start of this session was that we've only got two plus million people who have taken up the booster what more can we do is it more messaging how do we get over that vaccine fatigue just to remind people that this disease hasn't gone away and that there are people who are still suffering from it and people still dying from it I think it's a really good point and I think for me when it comes to the vaccine we still should say that it's been a really successful vaccination programme you're right if we compare it to previous programmes you can see where the uptake level is if we compare it to other vaccination programmes we have done incredibly well and I want to thank all those the kind of army of vaccinators that we have right up and down the country for what they've done in this regard for me it's about everything you've said it's about not just the vaccination that is the game changer though that is going to be front and centre of our response to Covid and to hopefully reducing the numbers of people who contract it and lessening the effects of Covid as best you possibly can continued work around ventilation and that's in educational settings that's in work settings there's still work to do in that regard it is about the messaging messaging is really important a reference to Covid sense campaign that we've got which is just reminding people about the measures they can take so it's all of that there's not one single answer but clearly there's work around surveillance as well we continue to be vigilant should there be any other mutations or variations of variants of Covid and continue to work on a four nations basis in that regard and the rest of the UK continue to work internationally with global partners in that sense too so there's not one answer to the question there's multiple things that we have to do and we'll keep that regular drum beat of campaigning as well as of course vaccine which we continue to take the advice of the JCVI so we know that the ONS are going to be stopping doing their surveillance but SIPA will continue to do theirs in the wastewater plants are you confident that that will give us enough data to know how much of that disease is actually circulating in the community so I think again we're getting the balance there and we will continue to work on a four nations basis with the UK Government in relation to the various surveillance measures that we have and it's very effective it's giving you that real time data in a way that other data doesn't necessarily do so we'll continue to ensure we have that it's also fair to say there's a comic we're getting to that almost transition phase so we had the height of the pandemic we're going from that transition from pandemic to endemic and as we do that of course we will end up treating Covid in the way that we treat other viral infections but that will be a transitionary phase to you Thank you Good morning cabinet secretary good morning to your colleagues I just move a point forward that Jim Fairlie made earlier around education I like to talk maybe about education of our healthcare professionals around long Covid now JPs are supposed to have built into their day or into their week and I'm out of time for CPD but I'm harping back to my time in the health and sport committee where every time we did an investigation into any kind of condition it was around we need to educate our healthcare professionals in this particular condition that's fine in theory but we know that they're under incredible pressure at the moment and so the practical in practice is that CPD is probably the last thing on the list so with that in mind how do we create a health service that is we've heard stories here of perhaps JPs lack of knowledge potentially around long Covid so how do we allow them the time to breathe if you burn the expression to take on that CPD I think it's such a good question so it's an issue that I've been engaged with in the course of GP for quite some time so pre-pandemic what traditionally would happen in many GP practices as Brian Whittle probably knows is they'd close on a Friday afternoon in NHS 24 where we'd have an agreement to pick up any calls and inquiries that came to the GP practice and that would give them the flexibility to do that and of course their patience the patience of confidence that their calls would be picked up by somebody else not being able to do that how much pressure even NHS 24 is under so we've got to find another model and that's what we're working on with the BMA and also the RCGP because for me that protected learning time that CPD time is absolutely pivotal and it's really important for our trainee doctors it's important for everybody of course but really important for me for our trainee doctors in particular and giving them the confidence to progress in a role as a general practitioner absolutely on that at the moment it's because of the pressure that NHS 24 is under GPs I've been into a GP practice not far from here actually where they are effectively having to use half an hour in the morning to go through some of their educational CPD and that's not ideal so practices are doing it in a way that suits them as opposed to the model that was previously involving NHS 24 and I would give my commitment to the RCGP and BMA to see what more we can do to support them in that regard Thank you, that's helpful I want to go on to me Scotland have got a world-renowned reputation in research in medical research and quite rightly I think where we potentially and we collect we've heard evidence in this committee of the collection of data again pretty good at that we've fallen down as the deployment of that data and using that data to the best advantage and I know the Cabinet Secretary and I share a bit of an interest around IT and we've discussed this before but I think long Covid and now long Covid has highlighted an issue around how we utilise that data and an IT system potentially that is not capable of using that data to the best advantage so if we strip this right back to the start aren't we in a position now where we should re-look at the way in which the IT system across our nation interact with each other so we can deploy that data to be most effective We do share an interest I don't think I'm paraphrasing Brian Whittle when he described himself as a data geek which I think is a data nerd but I am in the same vein I think that data is crucial and key to this and actually so many of the challenges that we face across health and social care have been because we simply have not dismantled the barriers to data sharing effectively and that's why I refer to the health and social care data strategy that we have I'm certain I've offered and forgive me we've not had the chance to sit down Brian Whittle and I with my team to go through that in great amounts of detail I think he should meet with my officials in that regard because what we're trying to do is not necessarily have one system right across the NHS and social care but actually can we use the cloud infrastructure in order to make sure that anybody across the NHS across our health and social care systems that has to access data has the ability to do so through that cloud based system so the sharing of data is incredibly important when I look at some of the work of the data strategy one of the key pillars so there's eight priority areas for action one of them well I'll mention a couple of them one of them is data access but one of them is also sharing data which is high up there is one of the eight priorities so I couldn't agree more with Brian Whittle and if he'd find that session with my officials who are leading on the strategy I'd be happy to make sure that's arranged I would appreciate that Cabinet Secretary in terms of looking at long Covid specifically and I think that highlights the issues that we're just talking about is that gathering that world-class research that we do have in this country and gathering that data around for our healthcare professionals around what does long Covid look like what are the symptoms and how do we deploy that best in the communities and what we've heard is that practically what's happening on the ground doesn't match the research that we're doing so it's how we connect that up and I'd be really interested to hear Cabinet Secretary the work that's being done because I think that's the start point that has to be the start point for me so what work are you currently doing just now to as you say it's a cloud-based thing it's gathering all that knowledge together so we can deploy that and we have a number of research or data points that are important to us so we've always referenced the ONS study and the EVE2 study is helpful in that regard so there's a variety of different data sources the other thing I've said to my team and we'll have these discussions obviously on a four nations basis is also to look at the international data that exists in the international research that exists as well and we obviously have those nine research projects mentioned so accurate local data is obviously required, I've mentioned the international but local data clearly is required the strategic network itself that I've again referenced it's got a dedicated work stream to agree outcomes indicators monitoring evaluation to accelerate the progress on capturing data and that's going to help us to inform the planning of our health service provision for those who suffer from long Covid so again that national strategic network of course the country has that dedicated work stream I've mentioned the EVE2 study I think you'll know about it if not obviously we can provide you detail on that EVE2 long Covid study and the initial report we've published just earlier this month on the prevalence of long Covid among adults in Scotland as well as again another helpful data point I can see you're indicating to come in Dr Arden Thank you very much Mr Whittle I think the sign nice RCGP guideline that's been published is quite unique in that it's a living guideline it's constantly reviewing the research that's published and then incorporating that into updates to the guideline as it goes along the most recent one that they did the guideline was fully updated last year but the process that sits behind that is still ongoing is still constantly looking at the research as it's published unfortunately none of the research that has been published has led to any significant update to the guideline as yet but that process is on-going and as we see this research coming to the fore as it's published we've already seen that EVE2 studies start to be published there's a number of other studies funded by the CSO's office that are about to probably give the results in the next coming months as that data starts to come out and research studies sign nice RCGP guideline will review that evidence and update its guideline and then that's pushed out into the clinical space as early as possible I think finally for my area here is how do we take the knowledge that we're gathering around long Covid into our community and educate our community around what long Covid looks like another thing we're hearing a lot is that long Covid numbers are an estimate because there's many people not coming forward who have symptoms that could be a long Covid so how do we take that knowledge and furnish that in our community so they know to come forward so we have run a marketing campaign to direct people obviously to NHS and forum in relation to some of the symptoms it was just refer Brian Whittle to a poll that came out just last month actually in February a UGov poll of 1001 members of the public found that 94% of people had heard of long Covid and 76% of people agreed with the statement that and I quote, long Covid is a serious condition for those that experience it so I think there is a good level of understanding of not all the intricacies of long Covid in the way that those around the committee table that there's acknowledgement that long Covid exists and also that it can have a serious impact on people's lives so we'll continue to do more and to make sure that people know about long Covid but importantly the services that are available locally to them for it but that UGov poll certainly suggests to me that there's a good public awareness of long Covid at least at a high level okay thank you convener thank you Jim Mason please thanks so much convener I take your point that there may be general public awareness of long Covid but we continue to have problems that certain sectors of the community are not engaged with health services anyway men in more deprived areas hardly ever engage unless there's something very seriously wrong again the vaccine uptake tends to be worse amongst some ethnic minorities and in poor areas so in that kind of area can we what are we doing what can we do to engage with these kind of people who haven't been so engaged in the past again it's a really good question and for me there has been a lot of learning from the vaccine programme we have really had to understand where the uptake has been lower and what we do to be able to respond that's on mobile clinics in areas of higher deprivation having mobile clinics available mosques and gwaras and temples and so on and so forth so I think we've got to take that learning from the vaccine programme and make sure that's right across various different parts of health and social care the UK level survey data indicated that what John Mason says absolutely right that the prevalence of self-reported long Covid was greatest in people 35 to 69 years female people living in more deprived areas and those working in social care going back to Jackie Baillie's point as well so we know the data is there and I can just give a guarantee to John Mason that everything we are doing within health and social care is focused often focused to those areas where we know there is usually accessibility issues where there are for example issues of lower take up so it's something that we've learnt from the vaccination programme very well but it's something that we're making sure is embedded right across the health and social care approaches that we have I wasn't sure if you'd finished your point or not there is a lot of misinformation and the committee looked at that previously about vaccines and vaccine damage and things like that I mean I certainly with my view I don't know if you'd agree that the one that I use a lot is still the one that vaccines save 20 million lives I assume that's getting up but I still use the 20 million figure but just some kind of simple messages like that maybe to get through to people because I mean had somebody come into my office last Friday and still very wary of both of the vaccines basically and needing some reassurance I think I think we've got to do our best to use the data that we have so for example there's a study out that I'm certain John Mason will know about that with some World Health Organization commissioned study I believe we saved well over 20,000 lives here in Scotland with the vaccination programme that number I'm certain has gone up given the recent autumn winter booster vaccination programme so I think it is just about relying on data on evidence and trying to counter some of the misinformation there are some people I'm afraid that we I think we will almost never be able to convince I think the vast majority we can and that will just continue to be reliance relying on the strong evidence base we've got for the vaccination programme I think the other thing is just using as many different people in society so people may not trust politicians short-coror but we should make sure that we are empowering the clinical voice to speak about the benefits also those people who have benefited from the vaccine of course all of us we should make sure they are also speaking about the benefits of the vaccine and the vaccination programme as well anything just on vaccination there's evidence now coming out that the vaccination act reduces your chance of getting long Covid as well so that's another reason for individuals to make sure to get their vaccine particularly in those harder-to-reach groups and the more likely susceptible individuals to make sure they get their vaccine so as we learn more about long Covid we start to learn about what is the things that can prevent it and vaccination does seem to be one of those things that does reduce your likelihood of getting long Covid yes I think we had evidence earlier on that it was primarily a lot of the people with long Covid were people that got Covid before there was a vaccine available is that broadly the case? pretty much so yes it's hard to do because we weren't testing people for Covid at that time so the link is harder to establish but yes we did see a more rapid rise at long Covid cases from the first wave and wild type virus variants with subsequent variants we've seen a less of a rise with each variant but we have had vaccination in the mix there as well so it's hard to separate that out on the theme of educating people we'd expect that in the health service and so on there's a good understanding of long Covid but a lot of other employers in the private sector and so on may not understand long Covid and what they could and should be doing to support employees is there any working on or can there be any working on for that kind of employer maybe a small employer who doesn't know enough about it so we are working with fair work colleagues and colleagues in employment around long Covid I have to say again there are issues I've certainly had long Covid sufferers come up to me to tell me that they have not had the most supportive employer and of course we are working with a variety of organisations to try to help and assist in that regard to get the messaging out there for me though I've been heartened to say that the majority of interactions around business that I've had is that people have felt supported by their employer in relation to Covid and long Covid but that's not universal and it's not consistent enough so yes we are engaging with employment colleagues perhaps I can ask colleagues in employment to write to the community and give you more detail around the specific actions they're taking with employers in relation to long Covid if that's helpful and one of the themes that has come through this inquiry has been comparisons with ME and clearly ME has been around for 40 years or has been recognised at least for that length of time and I think we probably all know sufferers from ME and again we've never really reached a one a cure or one thing one answer for ME and it's been very difficult to pin down I mean is it your feeling that basically that's where we're going with long Covid that it's going to be continued to be incredibly difficult to pin down and we probably are not going to get just one simple solution so I'm going to go to the clinician to give a response to that because it wouldn't be right for me without clinical knowledge to assert what I think will happen in relation to long Covid in its comparison to ME CFS as well Chronic Fatigue Syndrome because there are clearly some similarities in relation to how that's presented, the disbelief I think the Murdoff Razor referenced in his question that's something we sometimes hear from ME and CFS sufferers as well but if you don't mind in terms of the clinical the question that you ask really I should pass to the clinician Dr Hardin to maybe give a view on that. Thanks for that, cabinet secretary. With regards ME CFS there's huge amounts of research still on going to understand fundamentally what is behind ME CFS there is parallels with some aspects of long Covid and ME CFS and that's not surprising because there is an association with ME CFS and previous viral infection and we know that certain viruses do lead you to be more likely to develop ME CFS so I would imagine that there will be a significant proportion of people who have long Covid are likely to have similar type symptoms to ME CFS just because they've had a significant viral episode or they've had a viral illness that being said the research is now showing that there's multiple pathologies sitting behind the symptoms that people get from long Covid a recent article in Nature broke them down into five different pathological processes all with overlapping symptoms and signs and the difficulty there is until we know how much each one plays in what symptoms and in what patients it's very difficult to know how best to treat those individuals because you have to find out what's their symptoms are they linked along Covid what pathology is going on in their body and then treat it with the treatment that works for that particular type of pathology the chances are that we will find that it's not just one pathology process going on in individuals, it will be multiple in the one individual at the same time so you're asking me to delve into my crystal ball as a clinician I'm a perpetual optimist and I think that we've seen medicine come on leaps and bounds in its drive to tackle the Covid pandemic and I think that if you think about where NHS and medicine was 75 years ago when the NHS was founded to now it's a whole different situation and I think that will continue we will develop treatments for diseases but sometimes it will take longer than others depending on the complexity of the illness okay, thanks so much thank you very much we do have a little bit of time if I may just go back to one of the questions that Jackie Baillie touched on early and it was the impact of health services do we have any figures or numbers on the amount of NHS or social care staff that are currently off work as a result of long Covid and what action is being taken to address this? we should be able to get those figures to you so forgive me I don't have my finger right in front of me but we might be able to get those figures to you and if I am able to give them I'm happy to share them of course with you convener and then to share the committee, I think that that should be possible but if you don't mind I'll take that one off table and see what we can provide that would be great I'm going to open up to members of supplementaries Brian did you want to come in? I was just thinking at a point that murder Fraser made he raised the issue of long Covid clinics and the potential advantages or disadvantages of long Covid clinics I wonder if one of the considerations you might have gamut secretary is if we have long Covid clinics coalesce around that is our ability then to gather data because we know where people with long Covid are so maybe one of the advantages of a long Covid clinic that could be but I don't think that in the absence of a clinic we should take our foot off the pedal at all in relation to that data gathering because I agree essentially with the first point that you made in your questioning to me which is that data is going to be vital in order to improve our services that we're providing I think my challenge is to spread around the different models across the UK and it's fair to say that the different models in the UK is not just one long Covid clinic model is that for me tend to essentially end up being a bit of a middleman it's like the Oscars when you've talked too much the music comes on and they tell you to tell you to get off there was no need for that Miss Bailey there was no need for that so there could be that advantage about coalescing but I don't think it's necessary in the sense that if I look at the Lanarkshire model we've had about 585 of their abouts but oh well we're 500 referrals so there's a rich data source in one sense Thank you very much Cabinet Secretary and I just wanted to add to that how the evaluation tool that's going to be developed by NSS will be incredibly helpful with this basically as we've already outlined essentially long Covid is a new illness and new disease we've got to learn a lot about it and also what works so we're hoping that the evaluation tool being developed will give us more of a picture both nationally but also locally around what kind of people are getting long Covid what the impact is on them the impact of our services too and shed more light into what's working and also more importantly what's not working so that will definitely be helping us to collect more data across Scotland it will also hopefully help with the health inequalities aspect as well for kind of that evaluation tool will show us what demographics current services are working for and also who's not been engaged and where we're not having the most impact that our services could possibly have and then more importantly it will give us that evidence base for us to adapt and also learn from what's working and to encourage other health boards to pick up those useful services I suppose that concludes our consideration of this agenda item and our time with Cabinet Secretary I'd like to thank the Cabinet Secretary and his supporting officials for their attendance this morning the committee's next meeting will be on 30 March when we will be considering our work programme and an approached paper for the recovery of NHS Dentistry Services inquiry that concludes the public part of our meeting this morning I suspend the meeting to allow witnesses to leave and I move the meeting into private thank you