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I thank Ms Tweed for speaking about her own experiences. I do not take it lightly when people share their health experiences; it is a difficult thing to do, particularly when standing in a parliamentary chamber.

Our women’s health plan goes into some detail on how we will do that. However, the best thing that I can do for Ms Tweed is give her detail of what the implementation board will seek to do, because the implementation of the actions will be different in different local health board areas. One size does not always fit all, so there will be different pathways to referral. The diagnostic side of endometriosis is something that we have to concentrate on. Funding will be available for that, including through the investment that accompanies the women’s health plan.

The implementation board will be absolutely vital to that work. Ultimately, it will decide on the best way to implement each of the actions. I can promise Ms Tweed that some of them will be short-term actions, but, equally, some of them will be long-term actions. I cannot wave a magic wand to improve things overnight—I know that that is not the expectation. However, particularly with regard to endometriosis, some of those actions will be taken at speed, because we know not only just how much women suffer but how many challenges there are around the diagnostics.

I am happy to write to the committee in more detail on implementation of the women’s health plan, if that is acceptable to Ms Tweed and the committee, but it would be helpful if I could do that at a time when we have a bit more detail about the implementation board.

Forgive me, but I do not have that information to hand. I will get an update on that research and write to the committee.

My concern around cervical screening involves some of the issues that my colleague Maree Todd updated Parliament on before the summer recess. She will provide Parliament with a further update shortly. My concern is that we do not allow the issues that she addressed then, as unfortunate and regrettable as they are, to detract from the importance of women coming forward for cervical screening. We know what a positive impact the cervical screening programme has had on detecting cervical cancer early, which leads to earlier treatment and, in turn, a more positive outcome. Therefore, I do not want those issues to detract from the positive benefits of the screening programme.

As I said, I do not have the most up-to-date analysis of that research, which is still being undertaken. When we have that, I will be happy to write to update the committee.

I agree. I should have said in my response to Evelyn Tweed’s question that one of the actions in the plan is to commission endometriosis research. You are right to say that a number of people—clinicians and women—want to know more about the condition and understand it better. The research is there to develop better treatment and management, and, hopefully, a cure. That is one of the actions that are part of the women’s health plan. I hope that that gives you some comfort.

Annie Wells is right to say that the issue is not just one of physical health—it is absolutely also about mental health.

I vividly remember a conversation that I had, during a visit to a hospital, with a nurse who was quite senior and worked in the high-dependency unit. As somebody who is not a clinician, I had wrongly assumed that someone at her level of seniority in nursing would, unfortunately, have seen a number of people pass away during her career but, actually, she had not. However, at the beginning of the pandemic, the high-dependency unit was overwhelmed with so many people coming in that the amount of death that she saw at that stage was greater than she had seen in her entire career. She said that that had had a huge impact on her mental health. Maybe I am stating the obvious, but that is something that had not registered with me, as a non-clinician. I agree entirely with Ms Wells’s assessment that there is a huge mental health impact on staff.

What are we doing about it? There is £8 million going into wellbeing, across a range of initiatives. We have the 24/7 national wellbeing helpline, the national wellbeing hub, coaching for wellbeing and the workforce specialist service. All those resources are being used, and used well. We know that the national wellbeing hub has been used more than 115,000 times by health and care staff, and that the workforce specialist service—the clue is in the name—is being used as well.

With regard to protected time, I am absolutely open to that discussion. I am more than happy to take that suggestion away and discuss it not only with health boards, but with our trade unions and staff-side representatives. I am certainly open-minded on that point. It would obviously come with some challenges, given the current pressures on the health service that we have all spoken about, but if we want our NHS to recover, staff wellbeing must be at the heart of that.

The additional funding of £2 million that we allocated to support the primary care and social care workforce should help local teams to secure time for reflection and recovery to meet the identified needs. That funding could also be used for locum cover and backfilling costs. On the broader issue of protected time for wellbeing, I am happy to look at what more we can do in that regard.

If it is okay, I will pass that question over to the national clinical director. Ms Callaghan is absolutely right. When it comes to the more challenging cancer pathways, we look at the most common cancers. The largest cause of preventable death is smoking, and cancers associated with smoking, of which lung cancer is one. I will ask the national clinical director to say a little more about lung cancer specifically.

I could not have articulated the conundrum better myself. That is the challenge. Providers are weighing up incredibly difficult factors. My colleague Kevin Stewart and I have had a number of meetings with family members of people in care homes. It can be sensed from them just how difficult life has been over the past 18 months.

Nobody in the Government and—I say this with absolute confidence—nobody in the care sector wants to keep relatives from visiting a loved one. We understand the challenges of the past 18 months. That desire has to be balanced with considerations to do with what we know is a complex residential setting that involves older people, who we know are more susceptible to the most serious and severe effects of Covid. That is why our clinical director, Public Health Scotland and our other clinicians keep close to the social care sector and advise it regularly on what can be done safely.

However, I will be honest—the circumstances that we find ourselves in at the moment, with high levels of community transmission, are having an impact on our care sector. At the last count, yesterday, I saw that more than 120 care homes have an outbreak of Covid in them. That is not an insignificant number. Therefore, difficult decisions have to be made. I can promise you that Kevin Stewart and I are looking at the situation on a daily basis in an effort to ensure that the rights of relatives of care home residents are paramount, while considering the complex safety issues that are involved in care homes. In addition, of course, we have made a commitment to introduce Anne’s law in the first year of the parliamentary session.

That is a core element of our NHS recovery plan. We have been up front and honest about the situation. We have increased the number of graduate places for medics year on year and we have increased training places for certain parts of the workforce. We are doing all that to increase recruitment as far as possible. However, that will not be enough. We have said in the plan that we will look to conduct ethical international recruitment—I emphasise the word “ethical”, because we cannot drain resources from parts of the world that need those resources.

For example, I have had a good conversation with the Academy of Medical Royal Colleges and Faculties in Scotland, which is helping us and will no doubt be a help in relation to ethical international recruitment. The plan also shows that retention is a hugely important part of what we are looking to do. In my conversations with the British Medical Association and the Royal College of General Practitioners, for example, they have stressed the point about retention.

Some of that is within our gift and we are, of course, working hard to see what we can do, but some of it is not within our gift. I have already had exchanges of letters and conversations with the Secretary of State for Health and Social Care, Sajid Javid, with whom I have a good relationship. As members would imagine, it is a frank relationship, but it is a good one. I have already mentioned the fact that pension changes that have been made by the UK Government are an adverse disincentive for those in the medical professions, particularly doctors and GPs. As I said, some of that is within my gift, and we will work hard on that, but some of it is not.

Recruitment and retention are important, and domestic recruitment and ethical international recruitment will be part of our plans.

Forgive me, I do not have a note of all those countries in front of me. However, it is not uncommon—a number of European countries have vaccination certification schemes. I will not stray into the politics too much, but they are often countries that have Governments that are centre-left or left-of-centre, or have liberal parties in power. As the convener rightly said, there has been some worry about the encroachment on people’s civil liberties, but a number of the countries that have brought in certification schemes have politics that I would say are more left or left of centre.

It is not an unusual step to take, and I also say to Emma Harper that, across the European continent and in other countries far beyond Europe, we have seen certification schemes incentivising vaccination. In France, as soon as the certification scheme was announced, there was a huge spike in the number of people looking to get vaccinated. Therefore, I am hoping that we will see something similar here.

I am more than happy to examine the issue. At my meeting with representatives of the BMA, they raised a number of issues on which they thought the Scottish Government could take action, one of which was the issue that Dr Gulhane mentioned. All of these things undoubtedly come with a cost. There are a number of issues that the BMA and the Royal College of General Practitioners have raised where they think that the Scottish Government could help with retention. We are working closely with the BMA, the RCGP, the Academy of Medical Royal Colleges and Faculties in Scotland and others. Where we can, we will do that. Where those powers exist elsewhere, we will of course work constructively with the UK Government.

I have mentioned that my relationship with the Secretary of State for Health and Social Care is a constructive one. He has promised to consider the issue and to come back to me on it. Where we can take action, we will look to do that. If that involves an additional financial ask, of course that is a decision that we must weigh up in among the other recruitment and retention issues.

This answer will be slightly unhelpful, but I hope to be able to give a little bit more detail on that next week. We were due to have our debate on the NHS and social care this week but, because of the need to have a parliamentary debate on the certification scheme, which was rightly brought forward, we will be having that debate on the NHS next week. I hope to say more next week about our strategy on long Covid and about what we are considering doing to bolster the local response to the long-term effects of Covid.

We are currently trying to ensure that the pathways that we have provide care as close to home as possible. That does not rule out the possibility of setting up long Covid clinics—health boards could do that tomorrow if they wanted—but the model of long Covid clinics does not necessarily work everywhere. In NHS Highland, for example, there may be challenges in having a long Covid clinic in one part of the Highlands given the travel and the distances that require to be covered, which could cause problems for people suffering the long-term effects of Covid in other parts of the Highlands. That one model does not always fit, although that does not mean that it does not have merit. I reiterate that, if a health board wanted to create a specialist clinic, it could do so.

The point is that there is a current referral pathway, and there is an implementation note with GPs on the long-term effects of Covid. Essentially, using existing services, we are trying to get people the best treatment that they can get in the long term, and as close to their home as possible. We are also trying to understand more about long Covid, which is why we are investing in research. Our understanding of long Covid and of the long-term effects of Covid is evolving day by day.