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Any form of industrial action is hugely disruptive to our NHS, not only to staff and to the management process but to patients. To see that, we only have to look at England, where there has been repeated industrial action and where I believe that more than 7.5 million patients are on waiting lists and that almost a million procedures and appointments have been cancelled as a result. That is the immediate impact, and there will be a cumulative impact caused by backlogs in the system.

The system and staff are already under enormous pressure and adding persistent industrial action to that demoralises staff even further and makes them feel undervalued, bringing all the challenges that go with that. My deal with the junior doctors involved acknowledging and recognising the real challenges that they face because of pay erosion, and we managed to negotiate an agreement with them to avoid industrial action.

My big concern with industrial action is that it is not only disruptive to patients but demoralises people who work in the system even further, which has consequent challenges, and puts people off working in the NHS as a result of the disruption and difficulties.

There is a monetary cost to settling those matters. However, we would create even bigger challenges for ourselves if we did not try to address the issues. The challenges that we would have faced from industrial action would have been even greater—they would have been worse—than dealing with the financial challenges arising from the pay settlement.

I know the 218 service from my time in the justice portfolio. It is not funded under the health portfolio; if I recall correctly, it is funded directly through the community justice programme. I know that the Cabinet Secretary for Justice and Home Affairs has been engaged on that matter. I think that the issue was raised in Parliament and that she said that she would engage on it. That was in relation to community justice funding that was having an impact.

Christine McLaughlin can say a bit more about that.

CAMHS have expanded enormously over a number of years, but demand for them has also increased significantly. I recognise the concerns that Paul Sweeney has raised about children’s and families’ unnecessary waits to access some of those services. The intention behind our delivery plan is to ensure that there is a much more consistent approach to how services are delivered across the country. Members will be aware that some boards are performing better than others on service delivery, but there is a need to achieve greater consistency.

I cannot give a commitment on the funding aspect at this stage because we are going into the budget round for next year and we will need to see what the budget settlement is. However, we need to continue to expand and develop our CAMHS as a priority. I know that the Minister for Social Care, Mental Wellbeing and Sport, Maree Todd, spends a lot of time trying to ensure that we are taking the right approach to getting greater consistency of service delivery across the country, because variation of service provision is one of the biggest challenges that we face around CAMHS. The objective behind the delivery plan is to ensure that there is greater consistency of approach.

It is still a priority for us, but it is a challenging area of policy to take forward in the existing financial climate. Our options for making more progress on it are limited, largely because of the financial consequences and our not being in a budgetary position where we could actually advance it. It is still a priority and we will progress it should finances become available to allow us to do so, but at present we do not have the financial provision to be able to take it forward.

The plan was to have 10 NTCs across the country, and we are moving towards phase 2 of that work. The work is being considered in our capital programme, which is being reviewed because of the cuts to our capital budget, and is primarily focused on elective procedures—predominantly around orthopaedics, ophthalmology, endoscopies in some cases, and so on—rather than acute care. Caroline Lamb can say whether anything has been considered around cancer care with NTCs—I do not know off the top of my head.

It is difficult to assess the number of people who have long Covid. Some of the patients whom I have met who are experiencing long Covid have seen a detrimental impact on their employment. In some cases, they have had to give up their employment because they are no longer able to continue with the job that they were in. Others have been able to adapt their working environment so that they can accommodate their issues with long Covid, and others still have been able to continue with their employment.

The situation is therefore variable, and, at this stage, I could not give you a figure for the economic impact of long Covid and we have not carried out an assessment to enable us to do so. Again, it will have an impact on individuals in different ways and it will depend upon employers being prepared, as they should be, to make reasonable adaptations for employees who have a long-term condition so that they can continue with their employment. It is important that employers do that while it is necessary.

The national treatment centre in your area of Fife is helping to deliver on-going improvements in the delivery of orthopaedic and ophthalmology services, which will help to reduce the waits. I do not know the exact data for Fife, but I know that the Highland NTC is ahead of schedule with its programme, which is helping to reduce waits for patients in that health board area and will support NHS Grampian, too, because its patients will go to Highland NTC as well. Once we bring on phase 2, the NTCs at the NHS Golden Jubilee and at the Forth Valley hospital will give us additional capacity, which will help to reduce waiting times in those individual board areas. However, that work is taking place in the wider context of the increase in demand that we are facing.

On the impact that NTCs will have on unscheduled care, one of the challenges that one always has is that acute priorities can often displace elective work. The benefit of having NTCs is that they are a protected environment and are for elective purposes, which gives greater certainty around the amount of elective work that can be taken forward, as it can otherwise be buffeted around in the general setting of acute priorities, where unscheduled work is having to take priority over elective procedures for clinical reasons. The NTC environment gives us a level of protection in the system, which will assist boards much more effectively with their planning not just over months but over a whole year.

NHS Education for Scotland will take forward work on the centre, which was announced last week. Given some of the specific challenges that we have in rural areas around the delivery and sustainability of primary care, as Tess White talked about this morning, the first two years of the programme will focus on primary care, which will be the centre’s initial priority. The centre will start that work as of October.

Is this in relation to people with long Covid not having access to—

Do you mean for long Covid?