Good afternoon. The first item of business is portfolio questions. The first portfolio is rural affairs land reform and islands. I would remind members that, if they are seeking to ask a supplementary, they should press the request to speak button during the relevant question or enter the letter's RTS under the chat function during the relevant question. TO ASK THE SCOTISH GOVERNMENT WEN THE REMainING 46 MILLION OF DEEFERD FUNDAN FROM THE AGRICULTURAL BUDGET WILL BE RETURNED? The 2024-25 budget returns £15 million in capital to provide important support to our rural communities, and the Deputy First Minister has committed to the returning of the remaining £46 million in full in future years. The remaining ring-fence funds will be returned in full at the right time for specific measures that will help to reform the transformation of Scotland's farming and food production industry. It does not impact on the existing commitments or schemes, and the appropriate profile for returning the remaining £46 million of ring-fence funding will be considered as part of future budget process. Thank you, Presiding Officer. At some time, it gives no comfort to all our farmers. At the NFUS conference, the First Minister could not say when the £46 million would be returned to the agriculture budget. Since then, the Scottish Government has had an extra £295 million in Barnett consequentials from Westminster. Can the minister tell us how much of this extra money will be going to repay the £46 million taken from our farmers? Presiding Officer, it never ceases to amaze me that the Tory party can come here and make comments about the £293 million, which is almost a couple of hundred million pounds of what there should have been for national health service consequentials. £230 million of that money will go to the NHS in order to counter the cuts that we have already faced. Members, let the minister respond, please. The phrase ring-fence money has already been allocated or will be allocated in the future. £15 million has been returned to the budget and the other £46 million will be coming in future budgets once the Scottish Government can work out its priorities after the savage cuts that have been made by the UK Tory Government. Will the minister agree that capital investment is absolutely vital if we are to transform how we support farming and food production in Scotland so that we help farmers and crofters to invest in improved slurry storage and to take action to tackle climate-related issues such as water scarcity and flooding? How does the failure of the Westminster Tory Government to provide any additional capital for Scotland in the budget affect her plans to become a global leader in sustainable and regenerative agriculture? The UK Government failed to provide any additional capital funding for Scotland or our rural communities. Indeed, our capital budget, as we expected to fall by nearly 9 per cent in real terms, is a cumulative loss of more than £1.3 billion to £27.28 billion. In contrast, the EU cap provided a multi-annual programme budget over a seven-year period with flexibility to use capital or resource spend. The UK Government offers only yearly allocations that fail to provide adequate EU replacement funding or commitment on future spend on agriculture support, which requires long-term certainty. We need clarity and certainty from the UK Government about future rural funding after 25 right now, because right now we have no idea whether it will be Tories or Labour. None of them are committing to supporting rural Scotland. The Minister will be well aware how appalled those in the farming industry will be at the fact that he is unable to say when the money will be returned to the budget. Is the Minister aware of any other budget being raided in this way within the Government's budget? Liam McArthur is absolutely well aware that every budget has been under pressure because of the savage cuts that have come from the UK Government and every cabinet secretary right across the Government are all trying to find ways to pull their horns in to make sure that we can deliver a balanced budget as has been done every year since the SNP took government balancing our budget every single year so everybody's budget is under strain. Before I call the next question, can I just say that this is a kind of question and answer so when the question is asked, we do listen to what the answer is. Thank you very much indeed. Question number two, Ashrigan. Thank you, Presiding Officer. To ask the Scottish Government in relation to its rural delivery plan, what discussions the rural affairs secretary has had with ministerial colleagues regarding the impact of its housing strategies, including the rural housing action plan on local rural economies? The Scottish Government's rural delivery plan will set out in all parts of the Scottish Government deliver for Scotland's rural and island communities. The Cabinet Secretary for Rural Affairs, Land Reform and Islands courtiers and ministerial working group for the rural delivery plan which has been established to drive activity and ensure cohesive delivery on which I am a member. I thank the minister for that response but I'm not sure that this action plan is in fact delivering for local communities right across Scotland and if I raise the issue of some hotspot areas in the highlands, some areas are experiencing extreme pressure due to the levels of second homes. In some areas that are actually approaching a level of 60 per cent, 60 per cent are now second homes. That's creating a number of difficulties, as I'm sure members of the chamber will understand, difficulty recruiting into public services like teaching and the NHS is quite literally no accommodation for those people. I don't think that the current policies are working so perhaps it is time for the Government to consider giving communities the power to decide when the level of second homes is getting to be too high. Minister. I think that there's a number of initiatives under way and the member will be aware of the recent legislation that gave local authorities the ability to look at doubling council tax and also in the second homes discount. I think that the short-term let's control area is also an option that's available to each local authority to look at and they can be specific in terms of what they're doing in terms of that. There's a £25 million key workers fund that's available as well and Richard Lockhart and I had a round table with various local authorities and employers a few months ago and we've got a follow-up coming to that to talk about the support around that area. There are also economic development opportunities around about the renewables hubs, around about discussions with the SCN and SPEN, for example, around about, first of all, temporary accommodation units but how we can provide legacy units beyond that as well. So there's a lot of work that's going on. We're also working very closely with HIE, for example, on SOZE in the south of Scotland in terms of looking at combining economic development growth with looking at housing opportunities. As I said, one of the key things is looking at the short-term let's control areas which each local authority has the ability to bring forward and be specific in some of these areas. I've had requests from three members. I hope to take all three if we could have reasonably brief questions and answers. I call, firstly, for supplementary Richard Hamilton. Thank you, Presiding Officer. All talk from Minister McClellan. The house building record of this SNP Government has been dreadful with rural areas away from the central belt bearing the brunt of their failures. Over the course of the 2016 Parliament, the Scottish Government promised to spend 25 million on rural house building, which it failed to do so. Can the minister confirm if the SNP Government has finally met this pledge eight years later? And what further steps will he do to scale up rural house building? Minister? Again, it comes back. It's a bare-faced cheek, I think, of the Conservatives. First of all, the capital budget was cut. The budget? Members, we must hear the minister who has the floor. Minister, please resume. I feel it may answer. First of all, I think that there's a bit of context. Minister, please resume. We're not going to make much progress with this. The net result of this will be that I will be able to call fewer members to ask supplementaries and indeed may not even get to all the questions on the business bulletin. Minister, please resume. A couple of things. The capital budget has been cut by 10 per cent as well. There's been financial transactions cut of 62 per cent in one year. 62 per cent. 40 per cent more homes are delivered per head of population than England and 70 per cent more than Wales. The figure that the Scottish Government has got has delivered 10,000 houses over a number of years in rural areas. I touched about some of the areas that we're looking at around short-term and key workers. I touched about economic development opportunities, around about SSCN and SPEN and how we developed that. Scotland's got a proud record. It's outstanding in terms of the delivery record against England as of Wales. The quickest way to build more houses would be for the UK Government to restore that capital budget cut. Thank you, Presiding Officer. The Scottish Government announced a £205 million cut in real terms to the affordable housing supply budget. However, the lack of affordable housing is consistently raised as a top concern in rural areas and is consistently considered as a cause for depopulation. The minister knows that it's more expensive to build in rural areas. Therefore, can I ask him to reassure me and the Parliament that the promise outlined in the rural housing action plan to deliver 11,000 affordable homes by 2032 will be truly in rural areas and will be delivered? Minister. I think that that's a very important point and the point that the member mentioned is roughly on average 20 per cent more in terms of delivering more in rural areas. We've already seen construction inflation of 20 per cent just in the last year or so. I think that we've talked about this in previous debates around about that 10 per cent, which creates to 11,000 in terms of that. I think that that's the really important part of it and 10 per cent being the minimum. I think that we've clarified that 10 per cent being the minimum. There was action set out in the rural housing action plan just in last year. First, those actions were about nine months, then it goes beyond to the medium and longer term. That objective is still there. We're working very closely, for example, around about the opportunities with SSEN and spend around about the economic, the renewable development opportunities. Then again, coming back to looking at the short-term accommodation requirements, but longer-term legacy in terms of that. So there's work going on with high in terms of how we look at that as well. As part of the rural delivery plan, that also is a really important part of it. The economic development drives the house and so they've got to work very closely together. I'm very happy to meet the member to discuss that and specific issues in terms of that. Thank you. I very much agree with Ash Regan in terms of the importance of community groups in resolving the housing crisis. So many communities have delivered excellent housing developments across the Highlands, proving that. A number of others have approached me in recent days, not least Elgal. I wonder if the minister would be open to engaging with those communities in terms of progressing such developments. I think that the member raises a very important point in the community's housing trust. It was awarded nearly £1 million to work capacity for local communities. I've already met a number of communities in Cape Forbes area and will continue to do so. So I'm very happy to take up with the member and meet the group that she just mentioned. Question 3, Liam Kerr. To ask the Scottish Government what its response is to reports of rising wildlife crime across Scotland. Minister Jim Fairlie. Thank you, Presiding Officer. The Scottish Government has always been clear that wildlife crime is unacceptable. We have implemented a number of important changes in years to tackle wildlife crime, including increasing the maximum penalties for the most serious wildlife crimes and strengthening the laws around hunting with dogs. Our wildlife management and mure burn bill contains a number of key changes to help to tackle incidents of wildlife crime, and that includes the persecution of raptors occurring on some grouse mures. I would also encourage anyone with information relating to any wildlife crime to please report it to the police. Liam Kerr. Yes, with the Scottish Government set to grant additional powers to the SSPCA in the bill that was referenced to investigate wildlife crime, rural communities will still nevertheless expect Police Scotland to have a role. Can I ask the minister what research has the Scottish Government done on the impact of outsourcing policing on evidence and convictions, and what impact is this projected to have on the SSPCA's other duties and purposes? Minister. The member is talking about part of the bill that will be decided here on Tuesday. I'm actually delighted that he's taken such an interest because the bill that we're actually producing has been right across the chamber. There's been a lot of discussion, a lot of debate, and we're getting to the heart of where this bill's going to be which is right in the proper place. So I very much welcome and I look forward to seeing them voting for the bill. As far as the SSPCA powers are concerned, they're very limited and they'll be done and concord that with the police so that they're working together to make sure that they can be progressed slightly further than where the SSPCA have been in the past, but it will still be the police who will do the final investigations. Question 4, John Mason. Thank you. To ask the Scottish Government what cross-government action it is taking to improve island connectivity in order to support measures to increase the population of Scotland's islands. Minister Jim Fairlie. The very first strategic objective in the national islands plan commits the Scottish Government to addressing population decline to ensure a balanced population profile for our islands and the recent addressing de-population action plan sets out how we will work with regional, local and community partners to deliver a sustainable solution to these challenges. Our recently published draft islands connectivity plan, strategic approach paper proposes a vision that Scotland's ferry services supported by other transport modes should be safe, reliable, affordable and inclusive for residents, businesses and visitors, enabling transport connectivity, sustainability and growth of islands and peninsula communities and populations. The draft strategic approach paper is open for public consultation until 3 May and I would encourage responses. John Mason. I wonder if he would agree with me that the population of Scotland's islands is not just a challenge for the people on the islands, it's a challenge for the whole country and for people even in the cities like myself. Would he encourage young people as they think about their careers to at least consider spending some of their time working and living on the islands? Minister. I would absolutely agree with that sentiment. The islands are profoundly important and positively contribute to our cultural heritage, our environment, our economy and our national identity. Despite the challenges faced, islands are great places to live for our young people and that's why I would encourage young people to stay within our rural and island communities or to move there as a priority in the addressing de-population action plan. There is a different sense, there is a different feel, it will be different to the way people normally live in a town but there is a fantastic community feel in islands and rural communities that I would really encourage people to look at. That's why we are working with Youth Scotland and Young Islanders Network to consider how to best address population decline through co-developing ideas and actions to support and encourage young people to remain on, move to Scotland. We will also work to increase participation of young people in community councils to empower young people to inform improvements to services in their area making rural communities far more attractive places for them to live and work. The exciting development of Saxiford spaceport has a vital role in the country's space industry but to get to the spaceport you've got to take two ferries from Shetland's mainland. Does the minister agree with me that cross-government action between tunnels between Shetland's islands would improve connectivity and diversity population as our Nordic neighbours have found with their tunnel projects? Minister. I have to say I wish that that was not something I've heard about but it is something I'd be very keen to engage with and I'm more than happy to meet and talk to you about it after this session. Question 5. Thank you, Presiding Officer. To ask the Scottish Government what support is available to farmers who have experienced damage to crops as a result of the activities of beavers? Minister. Beaver burrowing into flood banks can exacerbate flooding in some areas but in other circumstances beavers can reduce flood risks. I will be visiting a farm in Perthshire next week with the National Farmers Union of Scotland to discuss the flood damage and how that may have been exacerbated by beaver activity. Farm viability and livelihoods can go hand in hand with delivering for nature and climate. That is not at the expense of farm incomes. Nature Scotland has mitigation measures available and we are exploring long-term solutions to key issues such as increasing the resilience of river banks to flooding events. I thank the minister for her response and she will be aware when she visits farmers in Perthshire as the minister beside her is well aware that there are farmers alongside rivers such as the Tay, the Errin, the Erracht and the Islay who have suffered significant loss due to flooding and damage to crops due to beavers eroding traditional flood banks. It was the Scottish Government that decided against the wishes of many in the farming community to reintroduce beavers and give them protected status. Does the minister accept that this puts a moral obligation on the Government to fully compensate affected farmers for the losses that they suffer? Beavers are native to Scotland and their establishment will play an important role in restoring Scotland's natural environment. We are looking at how the Scottish Government and NatureScot can further support farmers to host beavers. There are opportunities to do this with the upcoming changes to agricultural support. In my visit to Perthshire next week we will be talking about mitigation plans and what is available for farmers. Beaver licences will continue to be available to deal with serious risks where there is no feasible or alternatives for beaver management. Of course, we also need long-term flood management that would include things like natural flood management and realignment of flood banks to help mitigate beaver issues. I welcome the recent beaver reintroductions in the Cairngorms National Park which have the dual benefit of facilitating translocation into suitable habitat and providing an alternative to lethal control. Can I ask the minister what measures are being taken by the Cairngorms National Park Authority to support farmers to mitigate any impacts to their businesses? The release of beavers in the Cairngorms National Park represents a key milestone to ensure beavers as an iconic species and ecosystem engineer can once again thrive across Scotland. The Cairngorms National Park Authority has produced a management and mitigation plan which reflects land managers' primary concerns. The park authority's commitment to fund small-scale mitigation activities and remedial works adds significant extra resource on top of the already available national mitigation scheme operated by NatureScot. The approach has been commended outside the farming sector. To ask the Scottish Government whether it will provide an update on its progress towards introducing its proposed land reform bill. As outlined by the First Minister in September, the current programme for government includes a commitment to introduce a new land reform bill. While I cannot comment on the contents of the bill ahead of its introduction to Parliament, the bill will further improve transparency of land ownership, help ensure large-scale land holdings delivered in the public interest and empower communities by providing them with more opportunities to own land and have more say in how the land in their area is used. Kevin Stewart. Minister for that answer. I recognise that many think that land reform is a rural matter, but could the minister please give us an outline of how the contents of the bill, how that will benefit people in urban settings who want to bring land and buildings into community ownership? We strongly support community ownership for all communities, which is why in 2015 the Scottish Government extended the right to buy to urban areas through the Community Empowerment Act. We have also extended eligibility for the Scottish Land Fund to groups in urban areas. Since then, there has been a steady increase in successful applications from community groups in towns and cities across Scotland. A review of the community right to buy legislation will begin this summer following introduction of the land reform bill. It will cover legislative and procedural aspects of the community right to buy and will report at the end of 2025. To ask the Scottish Government what discussions the Rural Affairs Secretary has had with the health secretary regarding implementing the commitments contained within the Good Food Nation Scotland Act 2022. The Ministerial Working Group on Food is the mechanism for cross-portfolio discussions and decision making on food-related policy at a ministerial level. Health interests are represented on that group by the Minister for Public Health and Women's Health. The Good Food Nation plan has been discussed at all the in-person meetings of this group and the group has also worked by correspondence to review and approve the consultation draft. The Good Food Nation Act sets out a vision for Scotland to be a nation where people take pride and pleasure in and benefit from the food they produce, purchase and prepare. To achieve this aim it is vital for the Rural Affairs Secretary and the health secretary to work together to support high-quality producers and address the ultra-high-processed high-fat sugar salt foods that are detrimental to health. Can the minister just reaffirm that the cross-portfolio working will continue to take place and can she comment on whether the Good Food Nation commitments will be enacted? The Good Food Nation plan reflects the importance of cross-portfolio working to achieve our vision of Scotland as a good food nation. The plan describes the key areas of focus to achieve our vision of Scotland as a good food nation and details the working mechanisms in place to support this. The final version of the plan is due to be published in 2025. However, work continuing to the outcomes is already ongoing. For example, the open consultation on proposed regulations to restrict promotions of food and drink high in fat, sugar and salt is in line with our public health priority to create a Scotland where everyone eats well. To ask the Scottish Government what steps it is taking to support Scotland's fishing industry. Minister Jim Fairlie. Thank you, Presiding Officer. As set out in the answers to previous questions in the subject, the Scottish Government continues to support and manage Scotland's vital fishing industry in a number of ways. We continue to deliver the actions in our 10-year fisheries managing strategy with an update to the strategy delivery plan to the production later this year. That is underpinned by the funding that we continue to provide through the Marine Fund Scotland and the various functions that we deliver to ensure that our fishing industry can operate sustainably and effectively. Last year, the Scottish Government was asked by the fishing sector to consider a derogation to the North Sea card avoidance plan to allow fishing for squid inside 12 nautical miles. As the Scottish Government officials themselves recognised in their correspondence with the Fisheries Management and Conservation Group that this is a lucrative fishery and one that can take pressure off netfrog grounds. However, no derogation was granted last year and the industry still hasn't been advised whether a derogation will be granted this year, something that they ideally need to know by the end of this month. Can the minister confirm that a derogation is being considered? Also, when a decision on that derogation will be made? The Scottish Government wants to restore marine habitats in Scotland's intro waters and provide a higher chance to recover it in sustainable fisheries in the future. However, I understand that this is a complex issue with strong views on both sides and that the decision to remove exemptions was not taken lightly. However, the answer to that specific question would have to come for the cabinet secretary and I will ask her to respond to the member directly. Does the minister agree with me that we would be far better able to support all of Scotland's fishing industry had the Westminster Tory Government to keep their much-repeated breaks and promise to fully replace all EU marine funding? Minister. I absolutely agree with that sentiment and the figures, I don't have figures right in front of me just now, but what I do know is that the EU funding has grossly been cut by the UK Government and the Scottish fishers were far better off when we were actually part of the EU. Minister, that concludes portfolio questions on rural affairs, land reform and islands. There will be a very brief pause before we move on to the next item of business in the front-bench teams to change positions. Should they so wish? The next item of business is portfolio questions on NHS recovery, health and social care. Again, I would remind all members should they wish to seek to ask a supplementary they should please press the request-to-speak button during the relevant question or enter the letters RTS in the chat function during the relevant question. Question number one, I call Kate Forbes. To ask the Scottish Government what it has had with NHS Highland about progressing planning and design work for the new Belford hospital in Fort William. Officials met with NHS Highland in January to discuss the development of new projects, including the new Belford hospital. As colleagues will be aware, the Chancellor ignored the Deputy First Minister's call to increase capital funding for our NHS, so we are still facing nearly an 8.7 per cent real terms cut in capital funding over the medium term to 7.7.28. We will continue to work with NHS Highland to progress where we can in the face of this lack of capital from the UK Government budget, but Kate Forbes will understand the challenge that is before us. I absolutely understand the challenge that the health secretary is dealing with and indeed the whole Government and he will be aware that at a time of constrained public finances it is all the more important to use funding that progresses work as far as possible without wasting the funding and the effort that has gone in to bringing the project to this point. Does that end? How much money the NHS health board has asked the Scottish Government for in order to continue that design work on the new Belford hospital? Cabinet Secretary. Discussions are on going. It is essential that NHS boards continue to plan for how they will improve and reform services and we remain committed to supporting them in that process by exploring all funding options available to progress projects. As capital projects like the Belford will clearly assist with patient outcomes, productivity and thereby assist our recovery. The UK Government cuts to our capital budget have resulted in new health capital projects being paused so we know this remains challenging as Kate Forbes has alluded to as many projects around the country are under review and we are working through this challenge both myself and the Deputy First Minister. However, the colleagues will appreciate this may take some time as we look at all options and I will do what I can to keep Kate Forbes updated given her understandable interest and concern. supplementary to Migo Thank you, Presiding Officer. Fford William is the outdoor capital of the UK and yet a helicopter taking a casualty from the hills cannot land at their hospital. The people of Lochaber have been promised a new hospital for over two decades. Will the Scottish Government make good on that promise? Cabinet Secretary. I thank Rhoda Grant for that question and understand the concern that she comes forward with as Kate Forbes has articulated the need for a new hospital has been set out and made. The issue that we have is the financial reality that we face where the costs of these projects have risen with spiralling UK inflation of which this is not the fault of NHS boards or indeed this Government and a constrained capital budget where we are seeing £1.3 billion removed from our capital budget up until 2728. The financial reality is that these projects must be reviewed in order that we take forward as many as possible through the review that is under way both by the Deputy First Minister and myself. Rona Mackay. To ask the Scottish Government whether it will provide an update on the availability of ADHD medication supplies in Scotland. Minister Jenny Minter. Various ADHD medicines a number manufactured by Takeda pharmaceuticals continue to experience limited and intermittent supplies with market data indicating that supplies will stabilise between March and the end of May 2024. The shortages are caused by a combination of manufacturing issues and increase in demand. The pricing and supply of medicines is a reserved matter for the UK Government and we continue to engage with them on this. The Scottish Government recognises the impact of these global shortages on people living with ADHD and their families. NHS Scotland has robust systems in place to manage medicine shortages when they arise. Anyone affected by this issue should speak to their clinical team. Rona Mackay. I thank the minister for her response. During a recent event I sponsored in the Scottish Parliament, I had the opportunity to meet a young girl with ADHD who expressed concerns about her medication. She shared her experience of having to skip medication days. Can the minister advise on measures to ensure that no child with ADHD needs to skip their medication days? Minister. I thank Rona Mackay for raising this in the chamber and I'm sorry to hear about the situation that the young girl that she spoke to finds herself in. A UK-wide national patient safety alert is currently in place for medicines used for the treatment of ADHD, advising healthcare professionals of the shortage and providing information on alternative suitable medication when appropriate. Restrictions have been introduced which prohibit a number of medicines for the treatment of ADHD from being exported from the UK or stockpiled in order to protect supplies. The chief pharmaceutical officer for Scotland is a member of a UK-wide medicines shortage response group that is set up to identify and co-ordinate responses to medicine shortages, providing advice to clinicians on alternative therapeutic options. The shortage of ADHD medication supplies is causing distress for people who have advocated tirelessly to get a diagnosis in the first place. One constituent of mine first sought a diagnosis in 2008 and was finally diagnosed privately with ADHD in 2023. It will shortly run out of the medications that she needs. What consideration has the Scottish Government given to exploring new procurement options for drugs, like listexamphetamine, given the production issues faced by the current supplier? I thank Paul Sweeney for that question. As I mentioned in my first question, the UK Government remains responsible for medicine supply. However, the Scottish Government keeps in close dialogue with all health boards to manage the shortage and provide support where necessary. 3. Liz Smith To ask the Scottish Government what its response is to a recent report from the Institute of Physical Studies which states that the 2024-25 budget implied a real-terms reduction in health spending. The Scottish budget shows year-on-year real-terms growth in health funding when we compare the opening position. The budget documents states the opening budget position for each financial year and allows direct comparison with the two previous years. This provides a point of reference for the Parliament and stakeholders. In fact, the IFS report also notes the real-terms increase when comparing on a budget-to-budget basis. The report clearly underlines how important additional in-year funding is to maintaining real-terms growth. Funding that has directly dependent on the UK Government prioritising additional health investment over the year is something that we did not see prioritising in this budget. Liz Smith, thank you to the Cabinet Secretary for that. I recognise that there are comparisons that can be made on previous years but the Institute of Physical Studies was making the point that the Scottish Government's claim that health spending had increased by 1.3 per cent for 2024-25 did not include the top-up figures for the previous health budget in 23-24. Does he recognise that there is some inconsistency in that which makes it more difficult to scrutinise budgets? Cabinet Secretary. In my earlier answer we provide budget-to-budget consistency so that there can be clear scrutiny. I understand and more than understand given the pressures that we're currently under how important in-year consequentials are and would encourage the UK Government to continue to consider the call from international organisations to see investment in public services instead of tax cuts being a priority for this Government because that would then allow us to take forward further increased spending on our health service which is much needed. Liz Smith and the Conservatives seem to imply that somehow money could appear out the magic money tree to fund the NHS in Scotland. Can the cabinet secretary clarify if the NHS in England is much better funded? It has a direct consequence on the budget that we have in Scotland, the decisions that are taken in the UK Government for the NHS in England and the UK Government's own figures so that the Department for Health and Social Care for 24, 25 is 0.2 per cent less in real terms than 23, 24. The figures there stand in contrast, our 24, 25 budget provides a real terms increase of almost 3 per cent for the NHS in Scotland as we continue to prioritise front-line public services. Jackie Baillie Patients and staff have been promised state-of-the-art national treatment centres for many years now specifically to increase capacity and tackle the waiting list backlog. As a result of the real terms reduction in health spending in the forthcoming financial year the cabinet secretary has instructed health boards to halt all project plans. Can the cabinet secretary tell the chamber now that the NHS recovery plan is in tatters how he intends to clear this backlog? I do not accept the premise of Jackie Baillie's question because she is suggesting that it is decisions that we are making around the capital investment in our NHS that is to the detriment of those national treatment centres. That is not the case. It is a direct consequence of the decisions that have been taken elsewhere where we have seen nothing in terms of a capital increase to our budget from the spring statement or indeed from the autumn statement. That is why those national treatment centres are absolutely important. They are critical to seeing our continued recovery. I want to see them happening but, as I said in answer to previous question from Rhoda Grant, there is a financial reality around a diminishing budget coming from the UK Government and increased costs. That means that we have to put those projects under review and wishing it to be otherwise is not enough. We have to get on with looking at how we can fund these centres which I am committed to looking at as far as possible. What assessment has the Scottish Government made on health spending and the impact of front-line services and patients in rural and island areas given the higher costs of delivering services to those areas? That is something that not just myself as somebody who grew up in an island community but also this Government recognises. We will obviously have negotiations with health boards to look at what we can do to provide on-going support for the fact that they have disproportionate costs in the delivery of their service and that remains under constant review on a budget-to-budget basis. To ask the Scottish Government whether it will provide an update on the availability of NHS dentistry for the residents of Denun and its surrounding communities. Minister Jenny Minter. NHS Highland has recently been successful in recruiting to post within the public dental service in Denun, which is currently providing NHS dental care for priority groups as well as emergency dental care. I also understand that the board has procured funding to establish a peripatetic service which is expected to be in operation around Argyll and Bute this summer. The board has a dedicated dental help line for patients in Argyll and Bute which can provide advice on which practices are accepting new NHS patients in Highland and surrounding health boards as well as further advice and support. Tim Eagle. Thank you very much for that. I do appreciate that there has been some work on going. In response to a previous written question on this the Government noted the opening of a new dental practice in Inverness. While that may be welcome for residents there it is hardly of comfort to residents in Denun which are 174 miles four and a half hours away. Several residents are still contacting me about this though they are deeply concerned. So whilst I appreciate that there has been something that's happened now, some other incentives that can help the Scottish Government to offer existing local practices more support so that they can increase their capacity and meet demand. Minister. I thank Tim Eagle for that question and actually on Friday I had conversations with a number of my constituents about dentistry in Denun and Cowell. Unfortunately I had hoped that a new dental practice was going to open in Denun because there had been interest in one of the Government's SDAI grants which gives £100,000 for a new practice to be opened but unfortunately the dentist that previously expressed an interest in purchasing the practice via the grant has advised that they're no longer progressing that. I mentioned the peripatetic unit which I think is going to make a difference but the board has also advised me that they continue to seek expressions of interest for the grant and continue to engage regularly with local dental practice owners and dental corporate bodies regarding the provision of NHS dental services for communities in Denun and Cowell. Question number five, Keith Brown. To ask the Scottish Government when it last received an update on NHS Forth Valley's Assurance and Improvement Plan. Thank you, Presiding Officer. The Scottish Government receives regular updates on NHS Forth Valley's Assurance and Improvement Plan through the NHS Forth Valley Assurance Board which last met on Friday 8 March. Good progress has been made by leadership, culture and governance and with a strong focus of evidencing the improvements that are now being made I'm hopeful and confident that this will lead to de-escalation. Minutes from the NHS Forth Valley Assurance Board meetings are published and can be viewed on the Gov.Scot website and a copy of the improvement plan is available on NHS Forth Valley's website. Keith Brown. I acknowledge that progress is being made and that Forth Valley hospital performs well in areas such as elective care and, for my part, local MSP, I continue to get a series stream of very positive messages about the care that people are receiving and I think that we should acknowledge the work of the staff in relation to that. The cabinet secretary will be aware of the challenges faced by the smaller health boards like Forth Valley and can he outline any further measures that the Scottish Government is taking to address that? Thank you, Keith Brown, for that question and his interest. I'd also for the information that he's been able to pass on there in relation to that information experience, which I think is incredibly important. That is indeed a challenging time for us all. I recognise, as Keith Brown has, that the progress that has been made in elective care, the continued difficulties that there are in areas in unscheduled care, for instance, and indeed those challenges being faced on a wider basis by other smaller boards. The Government is continuing close dialogue with boards to maximise performance and delivery locally. That is supported by strategic collaboration on financial and workforce planning. Practical measures from an NHS Scotland perspective include mobilising tailored improvement support from the national centre for sustainable delivery, creating additional capacity through the new national treatment centres and targeting both regional and national approaches where appropriate to support pressurised services. By recognising in Forth Valley's case improvements have been made, there is more to do and I'm committed to providing as much support as I can in order to see that continue to happen. It is unclear how required improvements at urgent and unscheduled care at NHS Forth Valley would take place. The picture around psychological therapies and children's mental health was extremely challenging to what improvements have been made and what action can be put in place to ensure that those patients are given the care that they require. I have set it. I thank Alexander Stewart for that question and I recognise the points that he has made. I reiterate the points that I have made in response to Keith Brown around where we have provided support and intervention on those areas. He is right to point to unscheduled care to be a particular area of concern. That is an area of concern that there has been for a long period of time. I'm hoping that in the figures that we see come through on the weekly A&E statistics that we will see some improvements coming from Forth Valley but that is coming from a very long period of time. We need to see a much greater improvement going forward. My commitment is to continue to support them in that progress being made. Question 6, Willie Coffey. To ask the Scottish Government how it will develop its e-health strategy in the coming years. Thank you, Presiding Officer. I can confirm the Scottish Government's e-health strategy was replaced by a digital health and care strategy that was published jointly with COSLA in 2018 and 2021. The strategy is accompanied by an annual delivery plan with the delivery plan for 24-25 scheduled to be published in April 2024. However, there are no plans to further develop the strategy in the immediate future. Willie Coffey. One of the few benefits of Covid was that we were able to embrace digital technology much more and which basically came to the rescue in many fields, not least in telehealth. Does the cabinet secretary agree that we must continue to develop and exploit the power of digital technology within our health service to help us to improve things like GP appointment systems, e-health digital consultations and general telehealth services that are crucial, especially for people living in rural parts of Scotland but are just as valuable as a means of improving general access to all of our NHS services? Yes, I am grateful to Willie Coffey for that question. I do agree. It is going to be a central point of where we can see reform in health and social care going forward as to further utilise innovation and technology. I agree that we should be exploring more opportunities for greater use of digital solutions. Some of this is about maximising the capabilities of our existing investments. For example, the new GPIT system that we are in the process of rolling out has the ability for GPs to offer online booking services. We have already rolled out near me for online consultations and some of this, of course, is about exploring the art of the possible. Through the Scottish Funding Council, we have recently confirmed 10-year funding for the digital healthcare innovation centre to continue leading our efforts to explore where those opportunities are. I am grateful for Willie Coffey because this is an area where we are going to need much greater time and resource. As we attempt to tackle significant issues within our health service, I hear time and time again from an answer that their outdated IT systems are a block to progress. A modern collaboration and communication platform is essential to begin to bring our health service back into a better state, especially in data-gathering and the development of our eHealth. The chancellor committed, in excess of £3 billion, to develop healthcare tech. Would the cabinet secretary consider working with the United Government to help bring Scotland's NHS IT systems? I agree fundamentally with the points that he is raising about the need for that investment. I would gently point out to him that the investment that was announced by the chancellor is not money that is arriving this year. It is money that is going to be arriving in years to come, where I believe that we need that investment much earlier. Of course, we would seek to collaborate where that is possible to ensure that we are able to do that. We need to collaborate where that is possible to ensure that there is effective communications between systems or, indeed, in Scotland, between the likes of GP services, the acute settings and social care. That is exactly what the reform discussions that I am embarking upon will be about trying to direct. In terms of where the capital comes from to invest in that, I would encourage Brian Whittle to encourage his colleagues to see that investment front-loaded so that we can see that investment now. Thank you, Presiding Officer. The roll-out of e-health and digital technology is going at quite a slow pace. Recording of patient data still differs from one health board to another, which hinders progress and some prescriptions are still being written by hand. If we are to develop a e-health strategy fit for the future, we must see rapid advancement in terms of streamlining, recording practices across the country and we must ensure that staff and patients alike are clear on what that progress looks like. Could the Cabinet Secretary outline in any future e-health strategies how we might address those concerns? I agree with the premise of her question. I think that she is absolutely right for us to have a productive health service, one that is responsive to patient need and ensures that our clinicians are able to communicate effectively with boards in some cases where that is necessary or indeed between different settings, primary, social care for instance, then that cohesion and coherence is necessary. We are already making investments and I take the point that Carl Malkin is making about the pace of that. We want to go faster. We look at interest with the capital investment that is to come in future years from the UK Government. We would want to see investment come sooner and I will continue to collaborate with boards, with colleagues on how we can develop the digitisation of our health services in a faster process. Question 7 is from Monica Lennon who is joining us remotely. To ask the Scottish Government whether it will provide an update on NHS Lanarkshire's recovery plans. Cabinet Secretary I thank Monica Lennon for that question. I thank all boards for their updated delivery plans sitting out how they are addressing the challenges set out on our NHS recovery plan. Boards are currently in the process of developing their updated plans for 24-25 and once finalised NHS Lanarkshire's will be published via their website. Those plans set out how the board continues to address significant on-going pressures with Covid backlogs, delayed discharge and Brexit related staff shortages compounding the pressures on already a number of my continued thanks to NHS Lanarkshire and their staff for their on-going dedicated effort during those challenging times. Monica Lennon I thank the Cabinet Secretary for his response and also put my thanks to staff on the record. Can he advise whether the downgrading of wish-aws neonatal intensive care unit will help or hinder NHS Lanarkshire's performance and whether in his assessment the plan will be good or bad for the baby's children and families of Lanarkshire? To be clear this is not a downgrading of Wisher General Hospitals' neonatal unit. This is about ensuring that we are providing the specialist services that those particularly sick babies need in a safe way. My colleague Jenny Minto visited Wisher General Hospital recently and was able to see the progress that is being made there and we will continue to engage with staff and with patients to ensure that the understanding of why this is necessary which has been led by clinical advice and evidence can be taken forward and I will ensure that Monica Lennon has that advice to her either from myself or Ms Minto. To ask the Scottish Government whether it will provide further details on fulfilling its 2017 commitment to increase the number of GPs by 800 within a decade. I remain fully committed to increasing the number of GPs in Scotland by 800 by 2027. I welcome the fact that the GP headcount has increased by 271 since 2017 and is now consistently over 5,000. Training new GPs is key to our approach, this takes time but we have expanded GP specialty training, adding 35 places this academic year and a further 35 places next year and there are currently just over 1200 trainee GPs in Scotland. We are also investing over a million pounds each year in recruitment and retention initiatives and I will set out my plans to further increase GP numbers in due course. I thank the cabinet secretary for that answer but I was very concerned when I met a constituent who worked part-time as a GP and his view that, because GP services are not given financial support to have trainees working with them who are future doctors that this means that those GPs potentially are missing out because those trainee doctors don't see the fantastic contribution that GPs make to our health service and he wanted me to highlight directly to the Scottish Government that lack of funding which doesn't apply to hospitals so I wonder if the cabinet secretary would do that issue and consider whether it could make a big impact. Cabinet secretary. In principle, yes. Serobioac will be well aware of the financial pressures under which we are operating but in principle I am more than happy to look at that I am more than happy to hear more from Serobioac's constituent to hear about how we are able to see the resource going into primary care being increased and part of the reform consideration about ensuring that people are using primary care in a much more effective way and so I'd be happy to meet Serobioac and our constituent to hear that directly. Supplementary standards go honey. GP shortages are particularly acute in Scotland's highland, island and rural areas and doctors are quitting and we now have some rural practices wholly staffed by temporary locum doctors. This is worsening health inequalities and depopulation in these areas. GP shortages have been described as critical by the BMA and they have called for special measures to be put into place to reverse the crisis. Golden hollows clearly aren't enough to address the issues and current schemes are also not delivering enough GPs. We need urgent action to properly tackle the root problems of the failure to recruit and retain GPs. What urgent action is the Scottish Government doing to address this crisis in rural and island communities in Scotland? I've already set out in response to Serobioac's question the work that we're doing both in investing in recruitment and retention worth a million pounds a year and what we're doing to provide increased numbers of people GPs in training. We're currently sitting at 1200 GPs in training and we'll look obviously I'm looking forward to meeting with the BMA and hearing more about their suggestions to continue to facilitate that recruitment and retention but doing so within a financially constrained environment where decisions taken for us both in terms of workforce the impact that Brexit has had but also the impact that diminishing resources coming from the UK Government clearly have an impact in terms of our ability to invest in the reform that we need. We know that training new GPs will play an important part in increasing the number of GPs in Scotland but can the cabinet secretary provide any update regarding what further steps it's taken to support people to train like the unique ScotGem programme which does have a focus on rural recruitment? Yes, I did a good point there from Emma Harper she's absolutely right and recruitment into general practice specialty training programmes in Scotland has improved drastically in recent years of all the GPST for example 99 per cent were filled successfully up from 64 per cent in 2016 100 per cent fill rate has been achieved in Scotland for the first time this year based on data that was published in July 2023 and end year results will be published shortly and will confirm the final position for 2023 and we are funding on-going expansion in GPST with 35 additional posts created last year and another 35 being added this year in addition to increasing training numbers we recently submitted and committed to investing £1 million into targeted enhanced recruitment scheme bursaries for GP trainees who agree to undertake training in traditionally hard to fill areas including remote and rural parts of Scotland Thank you cabinet secretary that concludes portfolio questions on point of order from Dr Cahane I apologise Dr Cahane that will be duly noted obviously the expectation is that any declaration and then the register of interest is made before and prefaces a member's contribution in the chamber that concludes the portfolio questions on NHS recovery health and social care there will be a short pause before we move on to the next item of business


Question is from Laura Andrews, 1989. Do you have any advice for someone trying to put on muscle but is struggling with eating extra calories? If I eat much more than what I'm currently eating, it makes me feel sick. Yeah, this is a good one. Because most of my life I've tried to put on muscle, I know exactly what this feels like. And it took me a long time to kind of work around it. So there are a couple of things you can do to increase the amount of calories that you eat. But before I get into that, in terms of how you eat your food and whatnot, I do want to say this. Force feeding yourself too often, probably not good for you. Your body is sending you a signal that's saying that you're getting enough food. Now unless you're ill or overtrained, like if you beat yourself up, you're overtrained, super fatigued, sometimes that'll cause you to not want to eat as well. But if you're otherwise healthy, you want to kind of listen to your body. And maybe what you want to do to start with is send a louder muscle building signal that then will amp up your appetite a little bit. So sometimes to get your appetite to increase, you got to change your programming. Your workout may be, you may be doing too much in your workout, or you may not be working out in a way that's building muscle effectively. One of the first signs of an effective resistance training workout is an increased appetite. Absolutely. So if you lift properly and you're starting to get stronger, you'll notice that your appetite starts to boost kind of naturally. Now that being said, there are a couple of things that you can do. I would say increase the amount of hyper-palatable foods that you eat. Yes. Throw some novelty in there so that way you get that contrast that maybe that'll help in terms of helping, you feel like you couldn't eat more just because it is a different flavor. It is something that's like a new stimulus. Stay away from foods that make you feel bloated. That's an appetite killer, because I didn't learn this until later, but I would stuff myself with certain foods and I, because I thought they were supposed to be good for muscle building and I'd get bloated and then forget it. That's like I couldn't eat for the rest of the day. So easily digestible food, this is a huge one for being able to eat more calories. If your digestion starts to go off, it's easy to not eat food when your digestion is off.  So I would say focus on that. And then the last one would be drink some calories. This is probably the easiest possible thing you could do. If you're not dairy intolerant, a glass of milk with each meal, one glass of milk with each meal, boom, 300 calories, right there. If you are dairy intolerant, you could try full fat coconut milk or protein powders that you mix with the coconut milk and then drink that with a meal or in between meals. That's the old school approach. You know, old school bodybuilders used to do that. They would eat three big meals and then in between they'd have like a big shake but again, you have to digest it well because if you start to get bloated, you're gonna be totally screwed. A couple other little tips too. This is where I do see value in the six meals a day or whatever where you're breaking it up. Sometimes it's hard and I don't know where your caloric intake is at currently and where you're trying to get up to. But I definitely know that for when I was pushing four, 5,000 plus calories a day, it was extremely hard to do that. And even like four or five meals. Like this is, it required me to do six plus meals a day. And it's just easier. It's easier to put down a, you know, for me a four or 500 calorie meal, maybe for you it's a, you know, two, 300 calorie meal versus you trying to put down 700 calories in a single sitting. So that's one thing that helped me was breaking the meals up and smaller, more frequent meals instead of the big, large meals. And the difference as far as health wise and all that is we're splitting hairs on that. So I don't think it's a big deal for you to do that. The other thing that helped me was eating more high glycemic carbohydrates early and lower in like saturated fats early on in my day and then allowing that later on in the evening. So I chose leaner meats early on and things that were lower in fat. And then I piled that on in the evening time.  I did that later on in the evening when I was like my last meal or my last two meals. And earlier in the day, I kept things like oatmeal and rice and fruit. This all seemed to stimulate my appetite and keep me wanting the next, you know, small meal that was coming up in an hour or two. That really helped me push the calories in.  The problem with that is it would keep me so satiated that I didn't want to eat for another three, four plus hours versus when I had like oatmeal, blueberries and whey protein, I'm hungry an hour later, I'm ready to eat again. So those strategies helped me.  It doesn't have to be that way. Something that I would do, because I used to be able to do this. I could, if I was kind of full, I could still eat a bowl of carbs. So what I would do is a breakfast, lunch and dinner or my proteins, fats and veggies, meals in between were bowl of rice or, you know, bowl of cereal or my carbs. Those were really easy. And then, and then because I'd go through them so quickly in terms of digestion or whatever, an hour or two later, I was ready for my protein and fat, you know, main meal. So your meals don't all have to look like, you know, I have my starches, I have my proteins, I have my fats. You can split them up however you want and eat them up, eat them throughout the whole day or whatever to get those extra calories in. But number one, like get your, your body needs to want to build muscle. And once it wants to build muscle, your appetite will naturally go up. The whole force feeding yourself thing, I get it sometimes, but if this is you all the time, you got to ask yourself why your body doesn't want to eat these, these calories. What's going on? Is it your digestion? Is it your workout? Because it's like starving yourself all the time. It's the same, although it's on the opposite end of the spectrum, it's not good for you. Well, I was just gonna bring up how interesting that is to me too. Like you ever noticed like it's so hard to cut extremely hard. It's so hard to like aggressively bulk. I mean, your body has these, this natural calorie range that it wants to be in and anything left of it and anything right of it is so hard, but finding that like- That's a big stretch. It is, it's so, when you're, when you are pushing your limits like this, and I think what you said at first Sal was so important that that wasn't something that I probably noticed until later on and really piece that together, how important it was to switch my programming up. Sometimes just that in itself, I mean, if you haven't trained certain lifts or you've been following the same similar type of routine and just completely throwing a curve ball at the body it does tend to stimulate the appetite.


Not only has Sketch taken over the football world, he's taken over all of sports and he now made his way to baseball, specifically with the Cleveland Guardians, because when they hit a home run, this is their celebration.