Hey stampers! Welcome to another week of Watch It Weekly Wednesday. I'm Aubrey, part of the Stamp and Jill Creative team, and today I'm excited to share with you a card layout that you can use using any stamp set or designer series paper, but it's super fun and super cute. So let me just pull that in here. I'll show you the layout. So you'll start with a piece of paper, a card stock that's five and a half by four and a quarter, just card size. And then you'll have a piece of pattern paper. This piece will be five and a half by four and a quarter, and then you'll score at one and a half here. So this will be your five and a quarter size, or side, and this will be your five and a half side. And then you'll score here at the one and a half. Okay. And then you'll fold it over. So it's kind of laid out like that with this opening. And then this comes the really fun part. This is a seven by four piece of I have whisper white. You could do whatever color you wanted. You just fold it in half and then you put it right here in the inside. So let's put it together. And I can kind of show you how it all lays out together. Put that on top of there. And then I just put a little bit there and tuck it right inside. Yeah. And then it opens like this. And you have a fun little fold there. So fun, so cute. You can do it with any stamp set or paper.  Here's this card with the same paper. And it's just as always in my heart. So fun. And another one, comfort and hope. It just opens like that. Such a cute way to display that DSP. And then this one, I kind of added a little extra here. So it has this part that comes over the thanks. And then you open it like that. So fun. I love different card layouts and I always love finding new ideas. So I hope you can use this one. If you have any questions or comments or need need to place an order with us, make sure to visit us at stampinjill.com. And if you like this video, make sure to give us a thumbs up. Thanks so much for watching and we'll see you next week on another Watch a Weekly Women's Day.


Well welcome everyone thank you for joining us and we have we so this is the I think the third of the series I think there's one more after this and today we're going to be talking about grain drying storage and farm safety. So I'm Sam Markel I'm the interim and our director co interim and our director for probably pretty defined short period of time here since we're interviewing two candidates. We have two people with us. Ken Hellebang is a professor and extension agricultural engineer. So Ken has been a specialist for 42 years. So he's got a lot of experience. He also took one for the team as a as a department head for three years and a few months as an interim and our director before Mohammed and I. So he's done a lot of service work in there and we really appreciate that.  That's right. Yeah, so Ken was involved with that Angie was there the whole time to so so Ken will talk first and he's going to talk about some harvesting and drying for maybe 2025 minutes we'll have a Q&A, and then we'll switch to Angie. Angie was a county agent for seven years and now she's the ranch and farm and ranch safety coordinator they get that right Angie. Yeah, so then she'll talk about some of the safety issues that we face again maybe you know 20 more minutes or so and have another Q&A so that's what that's what today will be done we we will at 1115 will stop promptly or shortly before depending on the questions so Ken if you want to and Scott's wants us with us so if you have any technical issue with Scott's your guy. So, Ken, why don't you go ahead and take it away. Okay. Well, good morning everyone. And, and hopefully you can see my slides. I've been a good extension person I say that I can't talk without slides. And we're going to focus on kind of the harvest and drying situation for corn soybeans and sunflower. And I titled it October of 2022. I frequently will tell farmers and others that when I'm doing presentations that I like to cover the fundamentals because each year is different. Each year gives us challenges and so if we look at this year. As of the crop and report yesterday. Things are moving along. I always watch the crop report as we go through the growing season because I try to use that then to give me a signal of what I need to be covering for harvest and drying and storage. And it gives me an idea of where we're at, particularly this year with our late planting, but because of the warm temperatures we pretty much caught up. So, what I've got on the slide is this year's September 2022 versus the five year average and when we look at corn maturity, we're about 26% pretty close to normal soybean leaf drop 57% versus 72 for a five year average. But soybeans will will change quickly. And then if we look at sunflower. We're at about 30% versus 34. So again, pretty typical conditions. But I always say that reaching maturity is just the first step in the process. Corn, for example, has about a 35% moisture content once it reaches maturity. And of course, we don't want to be harvesting 35% moisture. And so then we start thinking about what is the dry down. So for soybeans, that's not as big of an issue typically, because they drive fairly rapidly, as long as we have decent drying conditions actually, there's potential for it to get too dry. And we'll talk some about that. So what's, what are we looking at. I always look at the weather forecast, trying to look at what are we going to be dealing with is it a dry harvest is it a wet harvest and it can start out wet and get dry or vice versa. The eight to 14 day temperature outlook is in the top left corner up in this area here. It looks like we're going to be above normal temps and even if you look at the 10 day forecast that the weather service and other places put out looks like we'll have no trouble reaching maturity. So we finish off this growing season. But when we look at October, we're continuing to be, it says potentially above normal temperatures. The central part of the country is got a much higher probability, but probably their guess as of right now is that October is going to continue the trend that we've had. When we start looking beyond that, then we get equal chance of above normal, normal conditions. And so that always worries me a little bit that as we get to November, that things might be turning the other girl away. And that's why we start seeing a change in that pattern. When we look at precipitation, we're going to continue to be dry for the eight to 14. But as we start looking into October, then we're at equal chance of being above or below, which I say ends up putting us pretty much at a normal probability. And that means that we could be wet, we could be dry. And that's the challenge. And if we start looking at even the seasonal, which is October, November, December, we're trending to that equal chance again. And so even though temperatures are looking pretty good precipitation as we start getting into October is less certain. If we get normal temperatures and conditions, how rapidly will will the grain dry down and we'll focus first on corn. And this table includes a number of different factors related to that dry down will skip September and just look at October. And if we're looking at the first column here, it says 16% moisture. So that's the moisture content that would be potentially the ending moisture content if we had good drying conditions so that's favorable. Number of primarily agronomy focus people look at growing degree days and try to make a prediction off of that I just was on and looked at pioneer, for example, they have where they say it takes about 30 to 45 growing days to take off a point of moisture. If you look at that predictor, that would only say we would drive four to 5% during the month of October, and that's not reality and so I've if you hear people talking about growing degree days and how it correlates with it was dry down. I wouldn't listen to intently to that. Iowa State University has put together a calculator that's on the web. You just do a search for Iowa State University. It's a dry down calculator. And it has you put in the moisture existing moisture content and date, and it'll calculate a prediction based on weather conditions over historically weather conditions. And if we use that model it'll show that we would expect maybe about a 14% moisture reduction during the month of October. So if we're starting out at 35 that would say that we would be at about 21% moisture at the end of October. I've used a prediction where I go to the North Dakota Agricultural Weather Network and look at potential evapotransportate transpiration, which is what we use to calculate irrigation needs in the summertime. It takes into consideration temperature, wind, solar radiation, relative humidity, etc. I think it's a good way of making a prediction. And depending on year and where you're at in the state we're probably looking at about three inches of water removal based on that PET. That would then translate into drying of about 11 to 12%, not quite as optimistic as the Iowa State one. And I'll say we're looking at maybe two and a half or at most three percentage points of moisture removal during the month of October. So, likely, unless we're harvesting very high moisture corn, a lot of corn is going to need the whole month of October to dry. As we shift to November, unfortunately, we look at the equilibrium moisture content or that field moisture increasing. The amount of moisture removal is almost nil, we'll maybe pick up a point a week. And so my typical recommendation is that we need to be planning to harvest corn the latter part of October, early November, because pretty much the drying is done at that point. We look at following that moisture content, we're going to be using a moisture meter to measure that grain moisture content. Keep in mind though that the meters are calibrated for 15% moisture corn, and as the moisture gets higher, it's more in air. If you're checking 25% moisture corn, it's probably as much as a point or more off at that point. Also, we need to be adjusting for temperature. We start harvesting corn in November when we have temperatures that are below 40 degrees. Most of the meters are not going to allow you to take a reading or will give you an inaccurate reading below 40 degrees. Also, they are sensitive to moisture variations across the kernel. I really encourage people to take and do that initial moisture measurement, put the corn in a sealed container, like a Ziploc bag or something. Give it six to 12 hours to equilibrate to room temperature, and then recheck that moisture content, just to make sure that we're getting an accurate reading. We don't anticipate a lot of bags this year, but if some are using the poly bags for corn storage, that corn needs to be dry. If we're in the 25 to 35% moisture range, that corn will go through the in silage making process, which we don't want for most of our corn. In the 15 to 24% moisture range, we're going to have heating and spoilage unless we're at winter temperatures. If we can consistently stay below 30 degrees, then we may get by at those higher moisture contents. But essentially the corn or grain needs to be dry going into the bag if we're going to be safely using a bag. In addition to moisture content, sometimes we'll get people thinking, well, it's a sealed container and so that will prevent mold growth or prevent insect activity. Both of those are false. We recommend running the bags north and south so that we get even solar heating on the two sides. And keep in mind the temperature of the grain will be whatever the average outdoor temperature is. So the bags work well for winter storage, but if we're storing into spring, it really needs to be dry. There's lots of variations or options for high temperature drying. And I've just included a collection of different dryers on this slide. There is a presentation on my website on the different types of dryers and if someone has an interest, I could do an hour presentation just on the different characteristics of the different high temperature dryers. One of the things though that frequently comes up is what is the cost to dry. And if we're strictly looking at the energy, most of our dryers, high temperature dryers, drying corn, we'll be looking at about 2,500 BTUs of heat required to evaporate a pound of water. And we can then use that information to calculate what that cost would be. We take the multiplier of 0.022 times whatever the propane prices, and that gives us the cost or partial point of moisture removal. The newer dryers that include the more energy efficiency features might be down closer to 2,000 BTUs. And then that conversion factor is 0.018. But for example, if we had a dollar per gallon propane, we take that times 0.02 is kind of an in-between number between the two. And that shows us about 2 cents per bushel per point. And it's a straight linear relationship. So if propane is $2 a gallon, we'd be looking at 4 cents per bushel per point of moisture removed. Now that's strictly just the cost of the propane. It doesn't include all the other associated costs that are involved. So if we look at trying to calculate how much propane is actually being used, there's a fairly simple formula for that as well. Again, 0.02 times the bushels that we're drying times the point of moisture removal. So if we're drying 1,000 bushels and we're taking off 10 points of moisture, that amounts to about 200 gallons of propane. So one of the things they've been talking about for this fall is that you make sure that you have your propane contracted or available so that when it comes time to do the drying, maybe in late October, early November, that we know how much propane that we're likely going to be using. Particularly in some of the newer areas where they're growing corn for the first times, guys will try to get by with using natural air drying where we're just moving the air through the bin. If we're doing that, the maximum moisture that we can handle is about 21% moisture. We need an airflow rate of at least one cubic foot per minute per bushel. And I'll show you on the next slide that that works okay in October, but not November. So typically what we're doing is cooling the corn and holding it wet over winter and then doing the drying in the spring. And we'll normally recommend when outside temperatures are averaging above 40 degrees is when we start that natural air drying. Lots of numbers on this table. What to focus on is your the November roll that because of the cooler temperatures. We start looking at very little moisture holding capacity in the air. And we're looking at 70 days of fan time to do the drying. And even if we start adding heat, a lot of guys think, well, I'll just go out and buy heater and warm the air. And if we heat the air 10 degrees, it does shorten that drying time a little bit. But we also end up over drying the corn. We're now down at 12 and a half percent moisture and it's still taking 51 days of drying time. So pretty much I say that natural air drying just does not work in November. Spring drying works very well. Again, like I said, starting when temperatures are averaging 40 degrees and warmer. We're still looking at 40 to 50 days of fan time, but it will dry that corn down as long as we're starting at that 20 21% moisture. Every year, we have a few been roughs that are damaged, because as the air goes through the grain, it picks up moisture. If the temperature is at or below freezing, it'll ice those gooseneck vents open over the screens on those just seal up tight. So anytime we're running fans at temperatures near below freezing, I recommend leaving the fill and access door open as the pressure relief fell. Otherwise, it's just going to pop that been rough up and damage it. Let's shift gears and talk briefly on soybeans. Optima moisture is about 13% moisture. One of the characteristics of soybeans is that they change moisture very rapidly. So everyone is familiar with it might be 15% moisture in the morning and by a warm dry afternoon, we might be down to 11%. And the amount of breakage that occurs, the damage to the beans and the field loss shelling in the field go up as we start getting moisture contents below 13. So the farmers really need to be doing whatever they can to harvest as much as they can at that 13% moisture. If we get into a situation where we get rain showers coming through. It's very difficult to get soybeans dry out in the field. We can run them through a high temperature dryer, but we have to limit the drying temperature. And we're still going to end up with some breakage and damage going through the dryer. One of the characteristics of soybeans are that we have a significant fire hazard because the pods and other trash that it goes through the dryer tends to become lodged and then overdried and becomes tender. So we need to keep the grain flowing. We need to keep the dryer clean. We may need to be monitoring that dryer continuously and cleaning it maybe a couple times a day. Those that are familiar with sunflower know that the sunflower fires are part of drying sunflower.  Again, it's a housekeeping issue. It's dependent on the cleanliness of the dryer. And so maybe with sunflower we need to be cleaning that dryer. We do it even three times a day. We need to be monitoring it to make sure that the flowers are continuing to flow through.  Keep in mind that sunflowers are an oil product and both with soybeans and particularly with sunflower we end up with an oil fire. Some again try to use natural air drying. I really discourage anything over 15% moisture. And again, it works well in October as long as we have adequate airflow. And this comes out of my publication, Natural Air Low Temperature Grain Drying. And you can see different airflow rates and drying times required to get it done in October. But as we look at November, same kind of table as before. We shift into November and all of our drying times become very excessive. And with sunflower, with just a little bit of heat, we can successfully dry in about a month as long as we have adequate airflow and so a little more optimistic conditions for sunflower. Well, getting it dry is just part of it. Then we have to manage it. And the types of things that we need to do are monitor, temperature, moisture, insects, mold. I recommend at least every two weeks except during the extreme cold of winter and manage means to direct with a degree of skill. So we need to have some expertise on how to manage the bin. We need to be controlling temperature, moisture and insects. Many years ago I put this visual together to show the temperature bands for insects. The curve line is the average monthly temperature in North Dakota. We recommend aerating the grain whenever it's 10 to 15 degrees cooler outside. And then we end up trying to keep it cool as we go through the summer. If somebody has questions or wants some of these, I still have some of them on and lots of technology available to help us manage that grain. But it is a tool that we don't want to replace going in and checking the grain. There are lots of hazards associated with the grain. This is kind of a lead in to Angie's portion. The one that I will touch on is a little bit on the moldy grain. For years I was telling people you need a mask that has two straps as a way to really indicate the N95 mask. One of the things with COVID is everybody knows now what an N95 mask is, but that's, excuse me, that's what we need for keeping those mold spores out of us. Like everybody else, just do a search for NDSU grain-drying storage and you'll find my information. And I think it's yours, Angie. Awesome. Thank you so much, Ken. You had a great segue into, I mean, our work goes hand in hand together in terms of the safety precautions that we need to consider when we're looking at working around grain handling equipment. And so for those of you on the call, my name is Angie Johnson as Sam shared. I am the NDSU Extension Farm and Ranch Safety Coordinator. I've been in this role for just about a year now and so I have one year under my belt but still so many more opportunities and much more knowledge to gain. And so it's been great to work with Ken and learn a lot more and understanding of what farm safety positions look like across the extension service system in the United States. And so it's been a really good opportunity and I thank you all for your support and your time this morning to learn a little bit more. I'm going to go ahead and just get started. Some of you may have seen bits and pieces of this presentation. I've done a recording or two for you to have available during pesticide training season as part of a component within your training materials, but also for fumigation, working with Andrew Thaustensen, our pesticide specialist here at NDSU and focusing on how we work safely around grain bins when applying a fumigate product. And so anytime I give a presentation or I work with with staff, it's really important to take a just take a moment to step back because the topics that I get to talk about are, they're not easy. They're really hard conversations to have. Nobody likes to be told that they're unsafe, not that that's what I do at all, right? That's not our goal. We're not enforcement. We're prevention and education. But the reality is, is taking safety seriously can be a challenge. And it's not that people don't want to be safe or aren't acting safe. It's just we become so comfortable with what we're doing that we take for granted the seriousness and honestly the hazardous conditions that we do work in. And so it's really important to just take a step back. And for any of you out there, I can only imagine that that some of you have been touched in your life by someone that's been involved in some type of farmer ranch related incident. So I always encourage growers or or any, any audience members out there that need to take a step back because of this heavy subject to please feel comfortable to do so. Because taking care of yourself is priority number one. I like to start off with showing this humorous little clip or meme, whatever you want to call it, because I think it gets all of us to start thinking and being realistic with ourselves that for those that I mean, you can just go to the local elevator or during harvest time you can see the long line of semis that are at the elevator and so, you know, I don't always wait in line at the green elevator but man when I do it makes me want to build one more bin and many of our growers have experienced that and my point being is that the grain industry has has changed. We're not just dealing with 5000 bushel bins anymore we're dealing with, you know, commercial facilities that have over a million bushel storage capacity whether that's not just grain bins but other confined spaces that they're using structured domes and whatnot, but our handling equipment you know we're using semis semi trailers pup trailers. You know, we can hold a semi can hold a grain cart load or more and versus the single axle trucks of yesteryear and so just keeping in mind about how the grain industry has really has really changed and how farmers are handling their grain storage and with that change comes comes problems right unintended unintended issues that we need to address but but it's a challenge and so one of the reality is and why we're all here is to understand a little bit about the problems that that come with working in confined spaces such as grain bins and one of the biggest questions that I get asked and asked often especially by the media is well, what, what's our number one, you know farm related injury or fatality and and the reality of folks is that it's it's not that simple. There is no formal reporting. You do not have to report if you have a farm injury or incident on your operation. There is no federal mandate that requires you to report that injury. What that means is that we don't have a great database or and we don't have a great understanding in terms of what we're actually seeing out in the countryside commercial facilities absolutely ten or more employees. They have to follow OSHA regulations, the Occupational Safety and Health Administration. So anytime there's a near miss incident I mean it has to be legally reported and some of the best information that we can get is from Purdue University doctor my colleague Dr. Bill Field. He's been working with a grant for for many, many years that really focuses on trying to understand and get an idea in terms of what's going on with confined spaces out in the agricultural workspace and they have been collecting this data since 1962 and so it's a very, very large data set and I just I'm not going to go through the details of these numbers with you but I think it's important to put into perspective that grain storage facilities are are a big big problem when it comes to injuries and fatalities. And what his report does is it looks at both commercial and on farms, and you might be wondering well, Angie you just told me that we can't, you know, there is no reporting system we can't monitor farm related injuries. And the reality is, is what our industry isn't the right word but what our, what our team does is really look at news releases, media reports, social media posts. There are a couple of networks out there that that is literally what they do is they scour and keyword search different terms in order to kind of get an idea of what accidents are in, excuse me, incidences are happening, based on what the media is reporting. And I think all of us on this call realize that well just because a farm injury doesn't make the news doesn't mean it's not serious because not all farm related incidences make the news, you know, typically, if, if, if it's a fall or if if there's survivors it may not even make the news it usually has to be a very tragic scene in order to make local media and so just to kind of give you some framework of the reality of, of what we're dealing with where we're, we have a really really good estimate and some data, but it's not concrete and it's And I've been talking a lot about a confined space and I don't want to make the assumption that we all know what a confined space is that's that's not fair and because there's many different types of confined spaces when you get out into our large feedlot operations whether that's cattle or hogs, or whatever confined space working with livestock we've got miner pits as well and they classify as the confined space and so just setting this narrative that when we're dealing with a confined space we're dealing with a space that's not designed as a regular workspace, like a grain bin is not a shop. You know this isn't a place where you can go in and grab your welder and or get out of the rain I mean this is not designed as that type of structure to be working in. A confined space also is very limited there's there's not a lot of exit or entry points and as you'll notice in this photo. They are small okay it's it's not meant for quick access it's not meant for quick escape it's it's very very small it's meant to serve the purpose of storage of storing grain. And then a confined space also really looks at the physical and toxics hazards right and so Ken was talking a little bit about molds earlier okay we can also have few issues. In terms of when those molds are happening they produce toxins that that get into the air and you breathe in and can cause some serious health issues later on and so just kind of giving you a background of. You know what this is what we're dealing with in a confined space and for most of us here in North Dakota our confined spaces is related to grain bins. This is just going into the deep nitty gritty to give you a even deeper view of what a confined spaces and really looking at I just wanted to showcase this to get deeper into the hazards because. Most producers don't think about oxygen content when they're working with grain bins I mean oxygen can be a huge limiting factor and a problem right anytime we're dealing with with too low or too much we we've like Ken talked about earlier with dryer fires. We can actually have green excessively heat up within a bin and get so hot that it'll it'll combust it can start on fire and so just looking at the different the different true dangers that I think we take for granted. And don't always get an opportunity to shed a light on because we just work with grain bins so much we're around them so much that we don't realize. You know in most cases we think of engulfments but really some people can be overwhelmed with the air quality once they make that choice to enter a grain bin. This is looking deeper into the weeds because I think it's really important as as agents I know I loved seeing. Some numbers and I it really hit home to me when I could see a little bit more about North Dakota you know where does my home rank. And this is just looking at confined spaces from that Purdue reports and if anyone's interested it's available online or I can certainly send it to you. But I always I like to showcase this 2020 report and for some you're going to say Angie that's so outdated but just hang on with me bear with me. So in 2020 there were 64 total cases of confined space incidences. Of those 64 confined space incidences 35 of them were grain entrapments because remember grain bins are not the only source or are not the only type of confined space. So there are a lot of other mostly minor handling facilities are other confined space but just kind of giving you an idea of some of those detailed numbers. And I want to ask you where did North Dakota rank. So when you look at this map you're going to see the map of the United States of course but then you're going to see boxes within each state. You're going to see a gray box and that box is going to have a number that lists the total number of confined space incidences that they have been able to report and record since about 1962. That white box right next to that gray box is going to be the total number of 20 incidences that occurred in 2020 within each of those states. So when you look at that white box you're actually going to see that North Dakota and Minnesota tied for second in the amount of confined space incidences in 2020. Okay, keep that in the back of your mind. I promise I'll dive into it a little deeper. And this is a serious deal and that's why you're all here today to learn a little bit more and I want to give you some confidence to be able to talk about grain bin safety when you're working with your clientele. And so I get this really cool opportunity to work with the Sanford Health Trauma Center here in Fargo. Many people don't know this but the trauma center in Fargo is the only level one trauma center between Minneapolis, Seattle, Denver and Omaha, Nebraska. That scares me and it should scare all of us because the reality is is if we need trauma related care, we need critical, our individuals are in critical care, they need help now, emergency surgeries. These are the only level one hospitals that are able to handle that. And so I've gotten the opportunity to look at agricultural related farm incidences from some of the data from Sanford and between 2010 and 2020 there have been 292 farm injuries. And of those 17 of them were related to grain bins and 10 of those occurred between 2019 and 2020 alone. That just for me in this field that blows my mind and is a jaw dropper for me and the reason why I keep bringing up 2020 and showing that is how many of you remember that harvest? If you go back and look at end on data or if you have good long-term memory, that was a really, really, really wet fall. And that caused a lot of harvest challenges and this is why Ken went first in the presentation because we want to talk about if we want to prevent grain bin related incidences and fatalities, it starts with the condition of the grain going into the bin for storage. And so during that harvest period with that excess plant moisture within those within the kernels of whatever crop it didn't matter whether it was corn or whatnot. It caused some serious storage issues moving forward. And so hence when we had storage problems, there was more need to end up going into the bin. And digging deeper into that data, something that I think gets taken for granted and I've talked to Ken a little bit about this and we featured this topic at Big Iron is talking about slips, trips and falls. And so a lot of times media reports only look at or talk about grain engulfments. That's what makes the news and rightfully so. It's a tragic, tragic event and extremely serious. But we take for granted slips, trips and falls are just as serious. You know, we're talking about platforms that are, my goodness, 20 plus feet, you know, over and so it's, it's very, very serious and can have life altering effects and also cause fatalities. And so of that data from our, our Sam, Samford trauma center, 13 of those were related 13 of those injuries were related from falls, either falling from the bin into the bin or falling inside the bin. And this is just I'm not going to go through all these numbers but just to give you the severity of what happened. And I think it's really important to note that this data. I don't want to say it's limited but you'll probably notice there's a piece missing is that this does not talk about fatalities. Our Samford data only really looks at those that made it to the hospital and we're able to survive. So this does not include those that didn't make it. And again, just giving you some more demographics that it's not just one age that's targeted we had any individuals from 18 all the way to 81 years of age. So it's you're not people are not immune to it age age doesn't matter it's it's impacting the all of the producers as an industry. And so now that I've got you thinking a little bit about slips trips and falls because it is something that we don't hear in the news we don't hear of those reports often but they're happening more and more than we realize. What can we do to prevent that. And one of one of my favorite ways to do this and and Ken and I can go back and forth on this I'm okay with that, but utilizing ground opening lids, being able to open that bin directly from the ground is is huge. I've got a hopper bin system that this is this is the platform that I have installed on all of them because I do not feel comfortable climbing that high, nor should I expect my father to have to take on that endeavor if I don't want to do it and so using ground opening lids has been a huge has been a lifesaver literally for for us in our operation. Do they solve everything absolutely not because as Ken mentioned earlier, you still have to manage you still really need to be able to take a peek inside those bins. But this gives you an opportunity that when you're climbing the bins, the lids already open, you don't have to try and hang on to your fixed ladder and also open that bin hatch at the same time. This is the piece of safety equipment that we featured at big iron, I absolutely love it love it love it because it, it, it helps growers actually have a safety mechanism in place to be able to climb a fixed ladder system. So a fixed ladder is just like I just like it's a now pronounced is that this ladder is bolted it is fixed on to the side of that green bin. And this allows a cable and pulley system to be attached to a class three harness and and lifeline a fall protection. So you're able to climb that bin. And for some reason if it's if not that you should be climbing a bin on a frosty morning but we all know what frosty mornings they can have that frost layer on steps which is extremely slippery. And so if you're make make that choice to climb and you slip and fall, you are only going to fall as far as that fall protection will the length of that fall protection. So this is a really, really cool design that that folks can have installed on their bins in order to actually have some safety protection in place when when making those bin climbs. Stairs, I get a lot of conversation about stairs which I think are fantastic but the problem is is that stairs do not come equipped on all grain bins. Okay, usually they are purchase and we all know with inflation and the lovely situation our world is in right now that, especially any, any metal iron, you know, in this case, what we're dealing with with bins, it's going to cost more. And so that will be a deterrent for people to install stairs is just because of the sheer cost to add it on. And you'll also notice in the photo on the right. So the stair takes us up to the roof of the green bin. But how do we get to the top. Okay, you still have to climb a fixed ladder to get to the very tippy top and so that's again where you could have a ground opening lid installed at that point so you're to open up that lid. Right at the top of that staircase there and you could also have some fixed ladder fall protection installed as well. Again, the downplay is everything costs money but at the end of the day, putting a price on your safety in your life it shouldn't even be a question but I realize it gets expensive. The other piece that we featured at big iron and this is something that I would like to work with with agents more because I think it's a very, very simple but such an effective program is utilizing lockout tag out. Lockout tag out is it does not have to be complex. So basically, I know I've got a really busy photo on on the left side so just bear with it but the goal is is to really shut down all of your power sources before you start doing any maintenance or or working on your grain handling system, like I mentioned a lot of there's tons of dryer options out there and there's also so many different auger system, grain legs sumps been sweeps. A lot of them are mostly powered by electrical controls and so taking the time to completely shut it down get to that breaker box power it down. You can see that lockout clasp in the middle of your screen to go through the loop of the breaker box on and off switch and then actually taking a lock of physical lock or a physical little tag that has you can write your name on it your employees name on it whatever it is and and lock it or zip tie it in that lock or or tag represents is you it represents you as an individual that has taken the time to power down that equipment and nobody can unlock that lock except you when you are ready to turn on and repower that equipment. It's to help prevent someone from unintentionally coming over and say geez no wonder why this doesn't work. It's off and then somebody turning it on while the other person is working on it. And it's something that what I like talking about lockout tag out because it's not just a farmer ranch related piece this can be used for for homeowners in houses and especially with young children around not that they should be around breaker boxes to begin with, but you just you just never know where where kids and children can find themselves and so lockout tag out I think is a really really good tool that we can do a better job helping producers be able to use that tool. And this is just an example when I was in the county I ate a producer that they utilize lockout tag out when it came to maintenance of their equipment. So that tractor. You'll notice there's the tag that is attached to the door handle of the tractor that tag cannot be removed by any other person then then who's listed on that board and then this example would be Trevor Scott. They have drain, there's no hydraulic oil because they're fixing the axle seal. And so if someone were didn't know that and were to hop into that tractor and start it, you're going to have some serious mechanical issues moving forward and so they practice the lockout tag out system to protect their equipment so somebody doesn't unintentionally go in and operate that machine. And so if you're if I think about it this way if you're not going to do it to protect yourself. Start out by thinking about that equipment and keeping that safe I think it's a really good way to ease into it and to you to see and showcase the benefits of using it, even if you're working by yourself. We always don't remember to pull the keys if we've changed the oil, but if I take time to tag out and put a tag on that cab. I'm going to remember instantly when I see it that yep that's right I can't drive this I need to I haven't put oil back in shifting gears a little bit. And just being cognizant of time here. I always this role has been interesting because I've always said this and I will stand firmly behind it in the fact that my job is not regulatory, like I am not here to hammer down rules on you to tell you what to do. And and so people get really really really really anxious and I can see the hair stand up on the back of their neck when I say the word permit. And the only reason I bring this up because I feel that and I might not explain myself in the best way so bear with me, but I feel that there are already amazing tips tricks fact sheets whatever you want to call it there's call it regulations there's these amazing resources out there that really outline the hazards that are that are present when working with grain bins. So how can we help producers utilize the checklist the fact sheets that are already there and I'm not saying physical paper that's not my point, but just being able to go through and realize, oh my gosh, these are things that I never ever thought of, because how many, how many people are ever taught on grain bin management, you know you go to your grain bin manufacturer they come and install it and then it's your job to put grain into it. And so there's there's there's no training so you learn by doing I mean a lot of people, they've they've worked with can and really setting up their system and so nobody's ever been taught, and I think just bringing awareness to those hazards and talking about them. People mitigate that risk.  Have I locked out all the energy sources. Do I know what's going on with the air quality in the bin. I have a safety harness and a lifeline and I've put an asterisk by that because there's there's two, it's two separate issues having a safety harness versus knowing how to use it, or two completely different issues. And I could have a conversation on that all day. But the other thing is is, you know, what type of lighting do we have because remember, I hope this is familiar but these are all signs pointing to we're dealing with a confined space. Okay. And the part at the bottom talking about having basically having that what I call a buddy system. And guys will think well Jeepers I have I have a buddy with me, they'll be able to pull me out.  But the reality is is that buddy is not there to pull you out that buddy is there to call 911. And because you will not be able to react fast enough to to grab a hold of somebody that's becoming engulfed in grain. And what ends up happening is that second person try ends up becoming the victim as well because they try and go in and rescue that first person. And so as cruel as it sounds, that buddy system you need to have it but the reality is is they're there because they need to be ready to call 911. If I shouldn't say if it happens it's it's when it happens. Okay. And going back, just just talking about grain bin entry this is just specifically looking at entrapments now earlier we looked at all total confined spaces. This app is is again from my colleagues at Purdue University really looking at the number of entrapments in Purdue and again North Dakota ranked second and really contributing to that that high moisture crop that was going into the bin during that really awful wet wet fall. And again not going to detail but just showing you some some different demographics of that. Sometimes I'll get questions alright Angie like it's just corn right I mean I don't have to worry about it I raise, you know I raise flax or whatever. It's not my problem right. And let's be real here. Grain entrapments can happen with any of the crops that we're dealing with whether it's corn soybeans I mean any any of the crops that you see on your screen, it can happen. And the truth is of the documented cases that we have. Remember documented there's a lot of cases out there it's estimated about 30% of farm related cases are not reported. Over 50% of those documented cases have involved corn, and that's because it's been out of condition, as can had talked a little bit about earlier those those pieces that lead to that. It's really important when you're working with your growers that sometimes it's, it's, I don't want to use the word oblivious but just realizing like it happens more than, than, than just a court people that are storing corn and bins. These are the different types of entrapments again this could be a whole PowerPoint on itself so I don't want to get caught into the weeds of this. I think some of you have, have heard me talk about these before and if for those of you that would like to learn more I'd love to sit down with you and we can talk through these but just wanted to go through some of these pieces. And I added to this list storage bags. I know a few years ago in Kidder County, I believe is Kidder County there was a very, very dangerous incident that happened with the suction power of that that that polygrain bag those storage bags. Ken mentioned them earlier as well but but they are definitely a risk for some entrapment situations that can occur as well.  You can see clearly see the funnel cone shape of grain that's going down and and and that grain is horrible. I mean you can it is in sheets and so any of the any different collapses or there could still be some open hollows or caverns underneath because of that crusting. We just have a serious situation on our hands and so with flowing grain. I talk a lot about how the there's a suction action right and that that suction is so strong that you physically cannot swim out of it you know you can't swim your way out of it to try and pull yourself up, and you can't you can't walk or climb yourself out. And these are just some clips from from Ken's publication on don't get caught in the grain, just showcasing the reality of how many seconds it can take to become engulfed and fully buried. So that deals a lot with the grain demo that we got to make outfall conference last year. And so if agents are on this call that are interested in learning more about making your own demo talk to me I've got some supplies left over. And this is just looking at the sheer amount of force you know gravity takes hold in those engulfment situations and so when you're buried at certain levels at certain depths within the grain. This is showcasing how many pounds of force it would take to be able to pull that person out. And, and I know how strong Sam Markell is, but there's no way Sam would even be able to pull a person, you know, using over 1500 pounds of force if they're buried that deep into the grain. So just kind of a really good picture to help reiterate the fact that that second person that's on scene can become a victim really quickly if they try and pull that other person out. This is just looking at bridge drain where we have that crusting on the top and that hollow center, and we try and break that crust and once it breaks, we can easily become entrapped into the remaining flowing grain that's taking place. When the sidewall collapse, I usually think about this like an avalanche actually at big iron last week we had some students come through and they they claim to me that there is no way that can happen in a bin and I said yes, absolutely this can happen in a bin. Sometimes you get really, really high moisture moldy corn that's starting to solidify essentially into this wall, but you'll still have free flowing pieces that once you break that crust layer, it can quickly avalanche. And now you're going to see a scene out of a playground I'm getting close to wrapping up here I promise, but you know, it's all about perspective. Okay, I show this slide because to all of us looking at it. It's a pretty innocent slide right it's a pretty innocent ladder. We take kiddos to the park all the time and a lot of times these these are the different pieces of equipment that kids get to play on. So to a child this is, this is a playground. But then I ask you, well what about this, how is this different. And so it's all about perspective and making sure that not only are we concerned about people going into the bin, but then also what are those hazards. When when we have kids on the farm, because a lot of times are our farm yards are not separated from the house it's it's all or nothing it's a whole entire yard and so taking the time to not only, you know, not go in the bin but to help put aids together such as on the right side you're going to see this panel door which simply is just, you know, a piece of sheet metal or a piece of tin that that they've locked in front of that ladder to prevent people from an even kiddos from climbing and going in.  It starts with really good grain going in the bin. If you have poor grain going in the bin that doesn't get dried properly or has issues to start with, it's not going to get better over time that that's a huge misconception is that oh if I leave it in there, it'll work itself out it's it that's not true. I always say have a plan in place. And, you know, ultimately, I don't want any I don't want I don't want producers in the bin, but I realize that's easier said than done. And that's why having a plan in place and talking with you as agents is really important to hash that out and figure out what that looks like. And then making sure that you you're ready to go that fall protection is ready, your observers ready, lockout tag out, and then realizing that if you make that choice to go in every action you choose has a consequence to it. All bets are off the table. The minute you make that choice. And so to finally follow up, I guess I ask you and I asked this to the producers, you know, what's, what's your biggest asset on your farm and what's it worth.  How about any quad track fans out there that that piece of equipment's pretty awesome. For those that are loving livestock like me, you got this million dollar bull that sold a few years ago, that's a pretty big asset to own. I think I'd be scared to own that. And then for any of you or if it's just me out there. Sheep producers, you know, a couple years ago we had a $7,000 ram sell at the Headinger Ram sale and so we've got some pretty big assets and a lot of our farm yards. They have entire commercial elevator systems now it's it's not the days where your local elevator was the only elevator most most farm systems now have an entire elevator themselves and so we're looking at millions and millions of dollars of equipment here, but the reality is the correct answer is the biggest asset on your farm is you. You're the one that that needs to come home safely every night and there's no amount of equipment or livestock in this world that is worth more than you and your family. And how are you going to protect it and that means taking some time to plan invest in safety. And so with that, I will stop and take on any questions or comments from the crowd. People are thinking I'll just add that not only can that avalanche of green cover you in the band. We've had one fatality in North Dakota, where the farmer was standing outside of the door and the corn come rushing out the door and covered him up, knocked him down and covered him up. So, surprisingly, you're not even safe outside the bed. Yeah, and I mean it's just realizing the hazards that are there I mean we unfortunately it takes it takes a casual a bad situation for us to learn and that can totally be prevented with more awareness and education. So folks if you have questions, please reach out to Angie and Ken. They've got a lot of great resources and a lot of great experience and I would take advantage of that.


Adding a trend line and equation to an existing scatter pod is not difficult. Left click to select a data point. Right click to open a menu. Select add trend line. Find linear. Make sure we select that. Then go down to the bottom and select display equation. Display R squared. Close that menu and there you have your equation in R square.


The next item of business is a statement by Michael Matheson on planning for winter 2023-24 and ongoing resilience across health and social care. The cabinet secretary will take questions at the end of his statement, therefore there should be no interruptions or interventions. I invite cabinet secretary for around 10 minutes please. Thank you, Presiding Officer. We are in no doubt that this winter will be extremely challenging for our health and social care system. We continue to see change in the demand for health and care services, the population's needs and care packages required are increasingly complex. This sits alongside the rise in the number of patients who see every winter with respiratory illnesses and winter-related injuries from falls and accidents. The winter plan that we are publishing today has been developed jointly with our COSLA partners. It is the articulation of a huge amount of planning and preparatory work already well under way across the whole system. The Scottish Government and COSLA have been supporting the system to be as ready as possible for the pressures it will face since the end of last winter, so that people can continue to have access to health and social care services and the support that they need when they need it most. This winter plan is built around three critical principles. First, the actions that we take must centre around our citizens and the best outcomes for them, so that they can access the right care at the right time and in the right place. Second, we are taking a whole system approach, recognising that pressures in one part of the health and social care system create challenges and pressures elsewhere. Third and finally, we are building on the lessons that we have learned from previous winters and must consistently, with Bairn wavering in our focus, undertake local and national actions that we know that work. There are a number of key differences in our approach to winter planning this year. The planning cycle for this winter started in early spring, earlier than ever before, and recognises that such in demand for health and social care services do not only happen in winter. As on tension that in future years we undertake such planning on an ongoing basis given the sustained pressure, the system is under all year round. We issued a delayed discharge on hospital occupancy action plan to NHS boards and health and social care partnerships in March this year. The actions and best practice this outlined are critical to improving outcomes for patients, flow through the system and capacity in our hospitals. Those fundamentals are reiterated in the winter plan and I would want to urge system leaders to redouble their efforts to adopt and sustain those actions. Additionally, we convened the first NHS and social care winter summit in August. This summit brought together more than 300 leaders from across Scotland's health and social care services to share best practice and local plans for this winter. I was particularly pleased that social care providers, local government leaders and the third sector were all present. We also issued a winter preparedness checklist to local systems in September and have subsequently been taking action on returns from that checklist, ensuring that we have a clear understanding of risk to the system both locally and nationally. We have vastly improved the quality of data and reporting needed to help us and the system to spot issues as they begin to emerge and for us to understand when escalation is appropriate. Let me now turn to our highly skilled and committed workforce, who are the cornerstone of our response every winter, both in health and in social care. In order to meet increased demand and provide the best care possible for our citizens, we are continuing to focus on recruitment and retention of our workforce, ensuring that we support the wellbeing of our staff throughout the challenging period ahead during periods of high demand. We are pursuing a range of different strategies to nurture and grow the workforce in both health and social care over the longer term. Within our health workforce, for example, I am pleased to see that, as a result of significant Scottish Government investment of over £15 million, an additional 1,000 nurses, midwives and allied health professionals from overseas have joined NHS Scotland in the last two years to bolster our existing workforce. In addition, we have already made available £3 million to support the recruitment of up to a further 250 registered personnel. Recruitment is presently on-going and many of the staff will be in post this winter. In social care workforce, we are working with partners and have a number of national social care campaigns in place, in addition to an international recruitment pilot. This investment in our workforce will continue. I am pleased to announce today that £50 million funding boost will be given to the Scottish Ambulance Service this year to help to support with increased demand, particularly ahead of the winter period. Helped in part at this funding, work is presently under way to recruit a further 317 front-line staff to increase capacity for emergency response, as well as additional staff within call centres. That builds on the record number of additional staff that have been recruited to the Scottish Ambulance Service with 1,388 people joining the service in the last three years alone. That investment will help to reduce the need for people to go to hospital by increasing the number of clinicians working in the services integrated clinical hub, improving triage for patients who may not require an emergency response and enable people to receive the right care for them in the right place. Crucially, we are encouraging the system to adopt a home first approach when it is clinically appropriate to do so. Assessing and providing care in a home setting is better for people, better for their families and carers and also frees up workforce capacity, not only in our hostels but also across the social care sector. We are supporting our services to deliver this improvement in care delivery. The Scottish Government is significantly increasing investment in hospital at home, an initiative that provides acute care at home, which provides more personalised care for patients in their own home. This way of delivering care is preferred by the majority of people seeking support with improved levels of patient satisfaction and consistently achieves equivalent or better results. We are already investing an additional £3.6 million this financial year for local systems to expand the service and increase the number of patients treated in this way. I can also announce today additional funding of up to £12 million to further expand our hospital at home service. This funding will be targeted towards the expansion of hospital at home during this financial year, with anticipated delivery of at least 380 more hospital at home beds this winter, significantly increasing capacity in our system. This will have an all-con impact of reducing the need for emergency admissions every single week, and in turn, this will have an impact on reducing pressure on A&E and throughout the system. Of course, it will be better for people who need acute care. This winter plan clearly seeks to address the specific operational pressures experienced across the health and social care system over winter, with actions already under way to improve services. However, we know that longer-term solutions are needed, and we are continuing to engage separately with local government, the NHS, trade unions and other key partners on the wider improvements needed in the development of the national care service. Longer-term, our joint working towards establishing a national care service is a key means to delivering sustained change to respond to the challenge that we know our social care system is facing this winter and beyond. Even with the significant level of effort that has been over the past few months across the whole system, winter remains a concern. If we arrive at a point where measures set out in the winter plan are simply not enough to cope with the surges in demand for health and social care services, we will not hesitate to act to support the system, working closely with our partners in COSLA and beyond. This winter plan is not a starting point for action. It is the articulation of many months of whole system collaboration for this winter. Building on the lessons learned from previous years and partners working together to deliver the best care for the people of Scotland. The Scottish Government and COSLA have been working tirelessly to create the conditions needed for the whole system to deliver, and we are united in our resolve to provide safe and timely access to health and social care services over the winter period. Those, while sobering, will be of little surprise to anyone who had to wait hours to be seen at A&E last winter, to those who were unable to be seen by their GP, and thousands more who were left languishing on NHS waiting lists, despite the heroic efforts of clinical staff. That makes it all the more important that the SNP Government get things right this winter and all year round, so that patients are never again subjected to these kinds of conditions. However, all the signs once again point to another disastrous winter for our NHS under the SNP. John Paul Lowry of the Royal College of Emergency Medicine told the Health, Social Care and Sports Committee that this is no longer a winter problem, this is an NHS in crisis problem and short-term winter reactions is only crisis mitigation. Does the cabinet secretary agree that we need to take a more holistic approach to secondary care rather than simply moving from one crisis to the next? Let me deal with the first point that Mr Gohani raised and that was in relation to the mortality rates. I am sure that he will recognise that there are a variety of reasons as to why there appears to have been an increase in mortality rates, not just here in Scotland but across the UK, which is noted within the actual publication that was issued this morning in itself. I think to try and apply that as though some form of reflection on the present performance of the A&E would be inaccurate. I do not think that it would give people the correct impression as to why there has been an increase in mortality rates. I would also turn to the second point and that is the need for a holistic approach because I acknowledged in my statement the winter plan acknowledges that the system is under pressure throughout the year. It has become particularly acute during the winter months for particular reasons with an increase in respiratory conditions, weather that can have an impact on health, all of those factors that add additional pressures to it. I accept that there is a need to take a holistic approach to it, which is why we have taken a whole systems approach to it this winter, to try to make sure that we do everything that we can, not just on the healthcare side but also on the wider social care side, to help to support the system through what will be a very challenging period for those who work within it and those who will be making use of it during that time. Jackie Baillie I welcome the cabinet secretary's statement and thank him for an advance copy. I also want to thank the many staff in our NHS and social care that support us all year round. I also too want to raise the report from National Records Scotland that revealed that 24,427 people died in Scotland last winter alone. That is a staggering 11 per cent jump on the previous year. This is the highest number of winter deaths in over 30 years and at the same time delayed discharge was the highest it has ever been last winter and this would have had some effect on the number. Does the cabinet secretary acknowledge that last year the Scottish Government failed to deliver a comprehensive winter plan, resulting in a last minute scramble to roll out additional support in January? Given that delayed discharge was sitting at 1,700 in August, assuming that his plan works, what does he expect the number to be in January? Jackie Baillie Let me turn to the issue of mortality rates. The increase in mortality rates are not peculiar to Scotland. There has been an increase in mortality rates across the whole of the UK, a significant increase. As the report recognises for a variety of reasons, one of the biggest drivers of an increase in mortality rate over the course of last decade has been austerity policy, which is quite literally killing people as a result of the impact that it has directly on services. You only have to look at the report that was published earlier this year from the sense for population health in Glasgow, highlighting the real impact that austerity is now having on our most deprived communities in driving up inequalities and also rates of mortality overall. In relation to the point that the member made about the need to make sure that we have appropriate planning, what I have been keen to do is to try to make sure that the plan that we take for this year is looking at all aspects of the system, the interrelated nature of them, the way in which the health service is dependent on social care and the way social care is dependent on the healthcare system. As the report acknowledges, we have learned lessons from last year and we have tried to implement the actions that we can take to try to address some of the challenges that we faced last year. However, I will not be foolish enough to come here and suggest that this will resolve all the issues, that this winter plan will make sure that we will not have pressures in the system, that everything will go perfectly, that there will be difficulties and challenges in the system. What the winter plan does is to put in place a mechanism to try to deal with those as effectively as we can and the different parts of the system in which to do so. On the final point about delayed discharges, the challenges that we have around delayed discharges are not so much about the figure in themselves. It is because the length of time that patients are now staying in hospital has increased, the level of acuity has increased. As a consequence, pressure is across the whole of the system. Those who are delayed will end up having harm caused them because they cannot get discharged into the community at an early enough stage. That pressure on the system is critical to trying to address that issue. To do that, I believe that the most effective means to do it would be through a national care service. We can get a consistent approach across the country because we can see in different health and social care partnerships performance, which is good and other areas where it is not. That is why we need to move to a service that will allow us to deal with this more effectively across the whole of the country. I will need a bit more brevity with the responses that I now call Christine Grahame to be followed by Tess White. I reference in the cabinet statement the increase in weather-related injuries from falls and accidents. I have read the winter plan and the humble word pavements does not appear. This is not a frivolous observation. Icy pavements are an obvious contributor to winter pressures throughout the health and social care service at all levels due to avoidable falls. Can I therefore ask in discussions with COSLA, for example, on providing self-service sand and salt bins by street, do we have progress? If not, can that be progressed? That sounds like a silly observation, but isn't it silly about it that many people fall on Icy pavements? I do recognise that, historically, there have been challenges during winter months where weather has been adverse and where there has been Icy periods where accident and emergency departments can be busy with individuals who have slipped and fallen, broken wrists, hips, ankles etc. It has been a long-standing issue. I cannot say that the winter plan is to deal with issues within the health and social care system. I need to make sure that local authorities are doing everything they can to help to provide communities with resources to allow them where necessary to be able to distribute salt within their local street or where the council are providing that as well. I certainly want to encourage local authorities to play their part in helping to make sure that we are taking the right actions to try to make sure that pavements are safe during periods of adverse weather. Tess White, to be followed by Kevin Stewart. I would also like to pray tribute to our hardworking NHS staff. Cabinet Secretary, in February this year Aberdeen Royal Infirmary declared a major incident due to a perfect storm of staffing pressures, bed blocking and ambulance stacking. Other hospitals were on the brink of doing the same. The reality is that the health care system is already at breaking point, even before the pressures of winter put greater strain on services and staff who are at rock bottom, rural and at breaking point. How can this SNP Government expect things to be different this time around when the wheels are already off the bus? Some of the challenges and pressures that we face in grampine are similar to the pressures that our NHS across the whole of Scotland is facing. In fact, similar to the pressures that our NHS is facing across the whole of the UK. The member made particular reference to the pressures on accident emergency in grampine, but if we look at the data in Scotland for accident emergency performance, it is for the last eight years that has outperformed all accident emergency provision across the whole of the UK. I know that for those who go to accident emergency and do not receive the service that they would wish to, that is called comfort to them. However, if we look at the performance relative to England, we are almost 9 per cent ahead of performance in England in A&E when it comes to four-hour waits. We are almost 10 per cent ahead of Wales and we are significantly above that for Northern Ireland. We are putting resources in to try to help to support these key services to support them where we can. Today I have announced £50 million of investment into our ambulance service, another £12 million that we have £15.6 million this year alone into hospital at home. That is the equivalent of another Aberdeen royal infirmary alone that we are providing funding for to help to support our NHS to take demand away from the front end of our hospitals, to support people in their communities, to make sure that we are seeing people seeing treatment through the ambulance service, diverter them to primary care where that is appropriate, to minor injury units where that is appropriate. We will keep taking action that is necessary to support the first-class staff that we have within our NHS and the funding and the approach that we are taking. I believe that it demonstrates that and our record over the course of the last 16 years demonstrates our commitment to making sure that we provide the best possible healthcare we can where possible. Aberdeen City Health and Social Care Partnership had intended to expand its hospital-at-home service from 37 beds to 55 beds by the end of March 2024, ensuring maximum efficient use of the current capacity, helping to provide acute care closer to home, supporting early discharge from hospital and providing alternatives to admission. I welcome the hospital-at-home announcement in the statement today. Does the cabinet secretary envisage that with this additional £12 million that expanding hospital-at-home and Aberdeen and in other places can now go further and faster for the benefit of our people? From the funding that we provided earlier on this year to partners, I know that, as Kevin Stewart mentioned, Grampian, the Elder Social Care Partnership and Aberdeen have been able to expand hospital-at-home. With this additional funding, they will be able to do further expansion of that service over the course of this winter period, providing support and care to patients at home when they require acute care in an appropriate way where it is clinically appropriate to do so. I should just point out to the member that this hospital-at-home service is larger for older people. However, there have been services in different parts of the country that have expanded into providing support to younger people and to those who have respiratory conditions as well. However, the expansion of hospital-at-home that I have announced today will allow us to provide at least an extra three hundred and eighty beds in the community, which, as I mentioned earlier on, alongside what we have already provided, is a 50 per cent increase in capacity at the present moment, which will make a significant difference to help to manage some of the challenges. Thank you, Cabinet Secretary. We are going to have to have brief responses as well as brief questions. Paul Sweeney to be followed by Evelyn Tweet. Thank you, Deputy Secretary of State. The Cabinet Secretary of State referenced the recruitment of 1,000 nurses, midwives and allied health professionals of the last two years, which is welcome. However, 7,000 vacancies in our NHS remain unfilled. Recruitment means little without a long-term retention strategy. Is he planned to ensure that those new NHS workers will stay in post, and how does the Government plan to fill the other 7,000 vacancies? I recognise the need to make sure that we not only recruit, but we also retain staff within our NHS, which is why we have the nursing and midwifery task force, which I chair, which has very specific actions on looking at how we can tackle both of those issues. We also recruit more people into our NHS, but we also help to retain staff within the NHS and work in that task force has already been taken forward, which will help to address those issues, which has partners from trade unions, educational and NHS services all across the task force, helping to support that work in order to make sure that we have a long-term plan to help to support both retention and recruitment into the NHS. Rural areas face additional challenges in winter, longer journeys and greater disruption due to poor weather. How will the Scottish Government ensure that those are accounted for? I recognise that there can be specific challenges within rural areas. Hospital at home is a very good example of a service that can be deployed within rural communities to help to support people to remain within their own home environment. The expansion of services that we have through things such as pharmacy first is a service that can be deployed within rural areas. The expansion that we have had of NHS 24 in the range of services that it is able to provide to individuals over the phone, including direct clinical support to individuals at home, can help to support people within rural communities such as everyone tweets during the winter months and throughout the course of the year.  They are being put in a situation by the Scottish Government that is as desperate as it is dangerous. The BMA says already exhausted staff find it, and I quote, demoralising and incredibly insulting to listen to Government assurances on staffing. The latest statistics bear that out, with 5,600 vacancies in nursing and midwifery and consultant vacancies also sky-high. Any plan to recover NHS to tackle horrendous waiting lists to get people treatment will fall flat without enough staff. Does the cabinet secretary recognise that there simply aren't enough staff to meet the challenge of the winter ahead? I recognise that we have staffing challenges within NHS here in Scotland, as is the case across the whole of the UK. He will be aware of that, but there are a variety of reasons as to why that is the case. What are we doing to try to address those things? We have increased our training provision in order to help to recruit more people into NHS staff training programmes, whether it be in HPEs or whether it be in nursing or whether it be in medical courses, in order to help to ensure that we have a sufficient throughput of training places to support the NHS going forward, and we will continue to work with the professional groups to make sure that we get that training balance right in order to try to recruit as many as we can into the NHS and to support our staff as well. I will finish on this point. One of the things that I think underscores the difference in the approach that we have taken here in Scotland around retention and recruitment of staff is through pay. NHS staff in Scotland are paid higher than any other part of the UK. We have avoided industrial action because of that. Our direct interaction with trade unions in order to pay our staff the right wages that they deserve in order to make sure that they can continue to provide the first class services that they do right across the country. We have four members wishing to ask a question. Four minutes to go. I am intending to get everybody in, but they will need to be brief. Following the First Minister's recent announcement of additional investment to tackle waiting lists, can the cabinet secretary outline how this £100 million annual package will improve services in East Kilbride and across Scotland while benefiting patients and staff and helping to ensure the NHS' resilience over the often challenging winter period? I recognise that there are patients who are waiting too long for the treatment that they require, which is why the additional £100 million and the £300 million over the next three years will be new investment that will tackle the issues that we have around waiting lists. That will allow us to treat an additional 100,000 patients through over the course of the next three years. It is a demonstration of this Government's determination to make sure that people receive the treatment that they require at the earliest possible point in the appropriate setting. Gillian Mackay, to be followed by Sue Webber. NHS Forth Valley in my region has faced extreme pressure on their A&A department in previous winters, affecting patients and staff alike. What action can the Government take to provide targeted support to those health boards that are facing particularly acute pressures? For those health board or health and social care partnerships where there are particular challenges, we work in partnership, directly in partnership with the health and social care partnership to make sure that they are taking forward a range of actions in order to address the pressures and the challenges that they are facing. I mentioned in my statement the winter preparedness checklist that has been issued. That has allowed us to draw in a lot of information on preparations that are in place in areas such as Forth Valley that cover my own constituency to look at the state of preparation and to then address areas where further actions need to be taken. That is the type of action that we are taking with health boards such as NHS Forth Valley and its partners to try to make sure that they are doing everything they can to be prepared for the winter pressures that they will face. Cabinet Secretary, substantial and sustained improvement on delayed discharge depends significantly on addressing social work and social care workforce issues. In response to the winter planning 2324 Scottish Parliament inquiry, Social Work Scotland highlighted the issue with non-recurring funding and the detrimental impact that it has on recruitment and retention of staff. There is difficulty filling posts due to short-term nature of the contract, leading to unintended consequences of gender of greater insecurity in the sector. What action will the cabinet secretary take to stop the ongoing deterioration of this workforce situation? We have gathered a range of work that we are taking forward in order to help to improve social work services, including additional funding that we have made available in order to increase recruitment of social workers. Alongside that, the work that we are taking forward in order to help to encourage people into the social care setting to make it an attractive place for people to pursue their caring career. That is a piece of work that will take time, but it is already work that is in action in order to help to try to address the challenges that we face within the social care setting. The additional funding for the Scottish Ambulance Service this year to support increased demand is very welcome. Can the cabinet secretary say some more about how this investment will be directed to improve things for patients and to reduce winter pressures on our health services? A key part of the £50 million investment that we are putting into the Scottish Ambulance Service is to allow them to recruit an extra 317 front-line staff to help to increase emergency response capacity. Alongside that, to provide 18 additional clinicians who work in their call centre hubs who will be able to provide additional triage services and to help to provide patients with advice and information where it is not time critical and where it does not require emergency response. What actions can they take in order to make sure that they deal with their condition or circumstances appropriately? That concludes the item of business. There will be a brief pause while the front bench changes and we move on to the next item of business.