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Patient confidentiality is clearly working very well, because I was not told that.

I was seeing Dr Shackles and some of the rest of the team at the Taymount surgery, and they have done exceptionally well. They are part of a group that also has a surgery in Scone, as Murdo Fraser will know. They told me that they have had challenges even though their surgery is a relatively large one. Other surgeries are much smaller, such as my medical practice, and their ability to see people face to face has been even more constrained. As we recover from the pandemic—we are recovering and will recover—we will need to look at a hybrid model, of which telephone consultations, video consultations and increasing face-to-face consultations must all be parts.

Dentistry has been hit really hard because of the nature of the aerosol-generating procedures that are undertaken and the infection prevention and control measures around that. Again, it is recovering, but that will take time, particularly as we continue to have the IPC measures in place.

Many of the patient pathways give me concern, but the one that gives me the most concern—I suspect that I am not alone in this among those who are round the table—is probably the cancer pathway. You heard, again, compelling evidence from a range of organisations that represent those with a variety of cancers. We have evidence that there are some 5,000 so-called missing cancer patients from 2020. During the first nine months of the pandemic, 2,681 patients were diagnosed with breast cancer, 1,958 patients were diagnosed with colorectal cancer and 3,287 patients were diagnosed with lung cancer. Those numbers are, respectively, 19 per cent, 25 per cent and 9 per cent lower than would have been expected in that period if Covid had not happened.

There are a range of pathways that I am concerned about, but cancer causes genuine concern, and that is why it is such a priority for the Government.

They would say the same, I think.

First of all, convener, I apologise for being slightly late. In view of the fact that I am slightly late, I am more than happy to pass back to you and go straight to questions and answers so that we have as much time as possible for that.

I will say a few things about that. First and foremost, I welcome the committee’s inquiry into the matter and its detailed analysis. I have had time to read over and, when I have been able, listen to the evidence that you have taken. It has been a reminder for every person around the table of how sobering the data is and how every person in Scotland has been touched in some way by tragedy involving Covid. That could be anything from an individual in a family who has suffered from long Covid right through to people who have been bereaved by Covid. People talk a lot about statistics and numbers in the committee, and with good cause, but I remind everyone that, behind each of those statistics, there is a human tragedy.

We know that, since the start of the pandemic, there have been 12,140 excess deaths from all causes. That figure is 11 per cent higher than the five-year average, which demonstrates Covid-19’s impact. Over the same period, there were 13,429 deaths involving Covid, and Covid was the underlying cause of 11,443 of them—85 per cent of all the deaths involving Covid. Therefore, the excess death measure during the pandemic clearly demonstrates Covid’s impact.

On how the pattern changed in the latter half of 2021, I strongly associate myself with remarks that you heard in previous evidence sessions such as those by Dr Lynda Fenton, who is a public health medicine consultant at Public Health Scotland. She recognised that, in view of the breadth of the situation, it is likely that there will have been health service factors—I am certain that we will get into that in the committee discussion—as well as factors that are related to the determinants of health. Peter Hastie from Macmillan Cancer Support—I have a lot of time for him as an individual and for Macmillan Cancer Support—made the undebatable point that people with cancer are being diagnosed later than they were before the pandemic. That is also a factor in the figures.

In the latter half of 2021, the vaccination programme was well into its stride, and there is no doubt that vaccines have played an important role against the severest impacts of Covid and, of course, Covid mortality. That might be demonstrated in the figures, too.

Professor Leitch might want to add something to that, given his clinical expertise in the area.

You will remember that one of the things that the First Minister made clear in her announcement is that testing for health and social care staff will remain, including the testing of asymptomatic individuals; that will not change.

As we move from the transition phase to the steady state, might that have an impact on staff absences? Potentially, but the biggest impact will be if we can control transmission. The more that we can control community transmission, the more impact that will have on staff absences.

The general number of staff absences sometimes masks the detail. If we look at staff absences that are not just related to Covid but related to those who are testing positive themselves, we find that we have unfortunately seen rises in the past few weeks—that is the case in the community, too—which have exacerbated the pressure that we were already feeling.

Yes. That goes back to what I said. I am happy to state on the record that, in the conversations that health boards have had with me and my officials this week, they have said to us that this feels as though it could be the worst week of the pandemic—or, if not the worst, certainly among the worst weeks. There is an accumulation of factors that I have already spoken about.

Yesterday, I met Pauline Howie and Tom Steele, the chief executive and chair of the Scottish Ambulance Service, and they said again that they are under severe pressure. We know the knock-on effects—I will not go into detail on them. In fact, from my reading of previous evidence sessions, I know that Murdo Fraser has previously raised the issue of ambulance waiting times and turnaround times at hospitals.

We are seeing those pressures play out this week. My hope—it is not just a hope; we are working to do this—is that we will alleviate as much of that pressure as we possibly can while realising that, as Professor Leitch says, we will get through the peak that we are currently at. The question is how we will insulate our health services, including emergency medicine, when we have a future peak. We are working as hard as we possibly can on that. However, it is a challenging time at the moment.

There have been some positives on the redesign of urgent care. If any programme has been needed during the pandemic and is needed into recovery, it is the redesign of urgent care. It is not unusual for the Government to take feedback on what areas of any programme can be improved and to take advice on whether it needs to be readjusted.

We are implementing the redesign of urgent care programme, which is supported by significant investment. For example, a hub has been established in every health board to directly receive referrals from NHS 24, offering rapid access to senior clinicians and using telephone or video consultation, where possible, which minimises the need for people to attend A and E.

There has been good innovation, but we are never against seeing how we can improve programmes, including the redesign of urgent care.

We have certainly seen a positive impact, although it is difficult to judge that during the pandemic. The redesign of urgent care programme will be vital to our recovery, as we will have to reduce the demand on acute care. The redesign of urgent care will help with that, as will the hospital at home work that we are doing. Addressing the issues on social care that Alex Rowley raised will also help with it.

We will have to reduce the demand. The redesign of urgent care programme has helped to an extent, but I have no doubt that we should consider what additional improvements could be made to it.

I can give you a very brief reassurance that the cabinet secretary and I discussed the national care service and that very issue. I return to my point that such matters should not be seen as a bolt-on. We are much better to include consideration of the arts and culture and the health and wellbeing benefits that people get from them at the inception stage rather than towards the end.

On social care, Angus Robertson was absolutely right to reference the point about local authorities. Right across the country, our integration authorities are already doing this work, and many of them are doing it very well. The challenge for us is that sometimes there is inconsistency across the country, and the national care service might be able to help with that. However, it goes to the very core of the original question about the preventative space. By way of reassurance, I can say that that is absolutely being considered as part of the national care service.

I thank Jenni Minto for a very important question. I think that there is a lot in this space. Our approach thus far to using culture and the arts as a very important social prescribing tool has been largely through grant funding local initiatives, and it is working very well. Part of the learning—and it is part of the challenge that the deputy convener put to me—is how we do it in a more systemic way. That is where the conversations between Angus Robertson and me are very important.

Where the public can get significant benefit is in the mental health space, particularly but not exclusively among young people. We know the challenges that we are facing with child and adolescent mental health services and the backlog. I would be the first to say that there were issues pre-pandemic that have been exacerbated by the pandemic.

Going back again to the points about Christie that you and the deputy convener have raised, we want to look at the preventative; we want to look at how we can stop people getting to the crisis point. When they get to the crisis point, of course CAMHS will be there to assist, and we have to clear that backlog, but—this goes back to Angus Robertson’s point—where we can scale up good initiatives, such as some of the work that we have funded, we should do that.

Again, I hold my hands up and say that the Government can sometimes suffer from pilotitis. We need to be able to scale up some of those good initiatives and do that in good time. If the pandemic has taught me anything—it has taught me a number of things, frankly—it is that, if there is a will to move quickly, we can move quickly. That might mean that we do not quite get it 100 per cent perfect first time, but in the benefit risk analysis, going quickly and scaling up quickly can have real benefits. I definitely think that there is a lot in the mental health space. I could talk to many other areas, but I am conscious of time. I think a particular focus for us in this space will absolutely be mental health and, in particular, young people’s mental health.