 Ie ddweud. The First Minister is General Questions. Question 1. Jeremy Walford. To ask the Scottish Government what action it is taking to encourage school peoples to study medicine at university. Minister Shirley-Anne Somerville. Our education system aims to provide young people with experiences and careers information, advice and guidance to raise awareness of opportunities and support informed choices. In addition, targeted schools programmes have been developed to encourage and support young people into careers in health and medicine in particular. Jeremy Walford. Can I thank the minister for her answer? I should declare an interest as I have a number of family members who are studying medicine at the moment and I'm sure we would all agree that the training we get at university is very good. However, figures recently published by UCAS showed a decline in Scottish study students applying for the October deadline required by medical courses. Most worrying of the figure has dropped by 11 per cent since 2013. Given the GP crisis in all parts of Scotland, particularly here in Edinburgh and the Lloviens, surely it is concerning that there is going to be less Scottish medical graduates in the future? The setting of medical student places is based on workforce planning needs of NHS Scotland. Although the Scottish Government sets the annual intake into medicine, the selection and recruitment of individual students admitted to study medicine is a matter for individual universities. As a result, the exact number of the myself Scottish students varies slightly from year to year. The evidence suggests that Scots domicile students are more likely to stay and work in NHS Scotland. For that reason, we are taking measures to increase the number of Scots domicile students. We have increased undergraduate medical school places by 50 from this year, with those places focusing on widening access criteria. The ScotGem graduate medical school will add another 40 places from 2018, and we will have a focus on general practice and rurality within that. To ask the Scottish Government what recent discussions it has had with NHS Greater Glasgow and Clyde regarding plans to close the children's ward at the Royal Alexander hospital and the birthing unit at Inverclyde Royal hospital. Cabinet Secretary, Shona Robison. Ministers and Government officials regularly discussed matters of local importance with health boards. As I confirmed in my statement to Parliament on 2 November, NHS Greater Glasgow and Clyde decided at their October board meeting to designate the paediatric proposals as major. As such, they are now subject to formal public consultation, and I would encourage all local stakeholders to take part. Any final service change proposals will be subject to my approval. The proposals affecting births at the Inverclyde Royal hospital and the Vale of Leven hospital are currently subject to public engagement, which is due to end in early December. The Scottish Health Council continues to monitor that activity and will ultimately offer a view on whether the proposals are major. I will consider that alongside the board's views and make a final decision on designation. That will inform the board's consideration of next steps, as it is meeting on 20 December. Neil Bibby. Thousands of people in Renfrewshire and Inverclyde have signed petitions against the closure of the RAH children's ward and the IRH birthing unit, yet the health secretary is ignoring local people by refusing to offer any reassurance that she will protect the children's ward or call in the decision on the birthing unit. Shona Robison needs to stop hiding in Edinburgh and start listening in Renfrewshire and Inverclyde. I have asked the health secretary before, and I will ask her again on behalf of the many concerned families, will she visit Renfrewshire and Inverclyde to listen to the public's views on the future of their local NHS services? Neil Bibby, of course, asked that I should make the final determination on the RAH paediatric service proposal changes. Of course, I have said that I will do that. He has now moved on to ask me the same thing about the Inverclyde royal hospital, and I would say the same to him as I said in my initial answer. Those are not formal proposals that have been designated as either major or not as yet, so the process should be allowed to continue as it was for the RAH. If we get to a position where that goes ahead formally and is designated major, and I may decide that it should be designated major in the light of local interest, then, of course, it will come to me. Perhaps in the end it will all come to me, and hopefully that is something that Neil Bibby will appreciate and understand, because I have said to him on a number of occasions what the process is. Ultimately, those decisions may well be my decisions, and I will make those decisions based on the very clear criteria that has to be in the interests of local patients. Does the cabinet secretary find it strange that the local Labour Party in Scotland is always talking about local decision making? I want the decision on the IRH and the Vila Levine to be made at national level, as compared to the NHS at the Glasgow and Clyde level, which, as the cabinet secretary is aware, has seven Labour councils on the board, but only political representatives on that particular health board. The actions of the Labour Party are often strange, which is probably why they are sitting in third place in this chamber. As I have said repeatedly in this chamber, there is a well-established process that we will continue to follow. I am not going to prejudge proposals that are currently subject to public engagement and consultation that might not even emerge as formal proposals and may well change. That is the right way to proceed. Members in this chamber will well understand that process, and that is the process that we will follow. To ask the Scottish Government how it will ensure all proposed service changes contribute to the Scottish Government's commitment to shift the balance of care away from acute hospitals and into primary care. As the member will be aware, the First Minister made an important announcement about the funding of primary care. That is a £500 million investment over the course of this Parliament into primary care. That will accelerate a shift in the balance of care from acute. What I would ask members of this Parliament to appreciate is that things cannot stay the same. That does not mean that every service change proposal that comes forward is the right one. That has to be tested very firmly in the light of what is best for patients. For anyone in this chamber to stand against any change in acute services anywhere will get in the way of that important shift in the balance of care. I hope that that is not something that any member of this Parliament would do. Jackie Baillie The cabinet secretary will of course be aware that only seven members of the health board are Labour councillors. The other 20 or so are appointed by herself. That was a nonsense argument, frankly, from Stuart McMillan. The cabinet secretary has been invited to my area to discuss proposals to close the Vale of Leven maternity unit, but she has refused. Given that she has not given any guarantee that she will take the final decision, if it is the case that it is not a major service change, will she visit to explain the decision to my local community? Jackie Baillie Jackie Baillie is getting ahead of herself. Just for the record, I have been a regular visitor to the Vale of Leven hospital. Of course, a hospital would not be open if it had been left to the previous administration. It was this administration that saved the Vale of Leven hospital, something that Jackie Baillie does not like to talk about very often. I have made very clear what the process is. Jackie Baillie and other members of the Labour benches continue to try to cut across that process. It is a very well-established process. The proposals may not end up being formal proposals or, indeed, they may change. It is right and proper that anything that comes to me is the final proposal that is formally put forward by the board. As I said to Neil Bibby, in the light of local interest, quite often things will be designated major in the light of local interest, but that is not the position that we are at as yet. Should that decision come to me, I will, of course, regard and deal with that decision in the same way that I would with any decision. That is looking at the impact on local patients in that area. Angus MacDonald To ask the Scottish Government what progress it is making with its Nordic Baltic strategy. Minister Alasdair Allan I refer to my entry in the register of members' interests as a member of the Norwegian Scottish Association. Exchanging knowledge and experience with our Nordic and Baltic partners is of great benefit to Scotland, as those countries are recognised as world leaders in many areas of prime importance to this Government. There is much to be gained in learning from the positive examples that they set. The Scottish Government's commitment was formalised in 2014 with the publication of the Nordic Baltic policy statement. Since then, Scottish ministers have had a number of engagements with Government representatives of the Nordic and Baltic countries to promote diplomatic business and cultural ties. I have just returned from a visit to Tallinn in Estonia, and a few weeks ago the First Minister visited Reykjavik, where she met Icelandic Government representatives, as well as the Foreign Minister of Finland on the margins of the Arctic Circle Assembly. On a very practical level, there have been a number of policy exchanges between Scotland and the Nordic and Baltic countries, one of the most notable being the development of our policy to provide expectant parents with a baby box containing vital items to help them look after their babies in the earliest days. The policy is based on the tried and tested finish model, and we have worked closely with Finnish colleagues on its development. Such policy exchanges have been encouraged and supported by the work of the Nordic horizons group, which the Scottish Government has funded over the last five years and which it continues to support. The most recent Nordic policy event on 29 October examined the different relationships that the Nordic countries have with the European Union, providing valuable lessons for Scotland as we explore possible options for our own relationship with the EU. I thank the minister for his detailed reply. It is good to know that such progress has been made. Does the minister agree with me that, given the turmoil Brexit is creating, the Scottish Government should be taking every step to further develop and expand our economic, cultural and social links? I will be brief for this time and say that we should be encouraging all those bilateral relationships. Jenny Gilruth, question number four. To ask the Scottish Government when it last met with Fife Council. Minister Kevin Stewart. Minister and officials regularly meet the leaders and chief executives of all Scottish local authorities, including Fife Council, to discuss a wide range of issues as part of our commitment to working in partnership with local government to improve outcomes for the people of Scotland. Jenny Gilruth. I thank the minister for that response. I was recently contacted by a number of constituents who work as adult social care workers for Fife Council. The company Fife Council contract this work out to real life options, wrote to all its implications. They claim that, despite a number of requests to local authorities, we have not yet received confirmation that any additional funding will be provided to support the implementation of the new Scottish living wage. Can I therefore ask that, if the minister thinks that it is acceptable that Fife Council is getting around delivering the Scottish living wage to its employees via contracted employers such as real life options? The Scottish Government is absolutely committed to seeing all adult care workers paid the living wage from October 1, 2016, and we have provided significant investment to meet that commitment. We provided an extra £250 million this year to support the integration of health and social care, of which Fife health and social care partnership were allocated £16.83 million. Of that spend, £8.42 million was available to support additional spend on expanding social care to support the objectives of integration. The other £8.42 million was provided to help to meet a range of costs faced by the local authorities in the delivery of effective and high-quality health and social care, and to enable the living wage to be paid to care workers supporting adults in the independent and third sector. That commitment allows councils to commission adult social care on the basis that care workers are paid the real living wage, giving up to 40,000 people, mainly women, doing some of the most valuable work in Scotland, a very well-deserved pay rise. We have been working closely with health and social care partnerships and providers to make delivery of that commitment successful. Where that does not happen, as in the case of Fife here it seems, pay will be backdated to October 1, and that should be done within a reasonable timeframe. I spoke to the leader of Fife council this morning, and he tells me that, despite repeated requests to meet with the education secretary, the council is finding it difficult to get even a response. Would the minister use his good offices to urge Mr Swinney to respond to Fife council? Does he want to discuss issues of education while he uses his office to ensure that they respond and that they can get a meeting? All I can say is that I met the leader of Fife council recently in Kelty, and that certainly was not raised with me. I met the deputy leader of Fife council only yesterday in Kirkcaldy at the Scottish Times partnership meeting. Again, that was not raised with me. There are multiple opportunities for the leaders of Fife council to engage with ministers. It seems strange to me that none of those subjects have been raised when I have met them. To ask the Scottish Government what action it is taking to address the reported £42.7 million funding gap in the Scottish Fire and Rescue Service. The challenge of bringing together eight legacy fire services represented one of the biggest public sector reforms in a generation. Audit Scotland confirmed that the fire reform process had been a success. The Scottish Fire and Rescue Service's revenue budget for 2016-17 was protected in cash terms, and that protection supports the range of excellent work that the Scottish Fire and Rescue Service continues to undertake to protect our communities. Audit Scotland also confirmed that the reform process had no adverse effect on the public and reported savings to the public purse to date, which puts the service on track to exceed expected savings of £328 million to the public purse by 2027-2028. I thank the minister for our response. We were told that the move to a single fire and rescue service would protect front-line outcomes, but year on year we have seen an erosion of those outcomes. Surely it will be the public who will pay the price for those in forced centralisation. I would say to the member that the figure to which he referred in his first part of his question, of course, is a prediction by Audit Scotland. Whilst it is based on certain knowns, that is current known costs, it is also based on certain unknowns. That is predicted, not actual future costs and OBR forecasts of UK public spending. We will need to see what the Chancellor's autumn statement holds for Scotland, but I would add, of course, that if the member could get behind the Scottish Fire and Rescue Service, he would be calling on his Westminster colleagues to give our firemen and women their vat back £10 million per annum, the member should do the maths. To ask the Scottish Government what action it takes to tackle any age discrimination against 17 and 18-year-olds. Our overarching responsibility for legislation on equal opportunities is reserved to the United Kingdom Government. The Equality Act 2010 provides the legal framework to protect individuals aged 18 and over in the UK from discrimination because of age by those providing services or exercising public functions. The provisions do not apply to children and young people aged 17 or younger. Within our devolved powers, the Scottish Government works with other public authorities to eliminate all forms of unlawful discrimination, advance equality of opportunity and to foster good relations. I thank the cabinet secretary for that answer. He will be aware that under 18-year-olds, national minimum wage is £4 and £3.40. In fact, if you are at school, you may have no earnings at all. I wonder if he agrees with me that it is not really fair that 16 and 17-year-olds pay adult fares on public transport when they reach their 16th birthday. Would he consider supporting me in my campaign to extend child fares to age 18? Would he consider the possibility that something like putting into a future ScotRail contract would be an important step for many 16 and 17-year-olds to have that flexibility of independence? I certainly think that the issues that Pauline McNeill raises are valid issues to be considered. Obviously, there are different provisions in Scotland in relation to supportive young people in terms of the availability of education maintenance allowances, for example, which are an important contribution for young people in the age group that she has raised. I am sure that transport ministers will have heard her point in relation to the ScotRail contract and to the issue of classification for fares. Of course, there are legitimate issues with which Pauline McNeill will be familiar with the different thresholds at which different age considerations apply, and ministers will certainly reflect on the issues that have been raised by Pauline McNeill. John Lamont To ask the Scottish Government where ministers last met representatives of NHS Borders and what issues were discussed. Cabinet Secretary, Shona Robison Scottish ministers and officials meet regularly with NHS Borders to discuss matters of interest to the people of the Borders. John Lamont I thank the cabinet secretary for that answer. The cabinet secretary will be aware of the recent Audit Scotland report and the worrying conclusion that NHS Borders was the least likely to balance its books this year with 55 per cent of planned savings classified as high risk. She will also be aware that the same report noted that NHS Borders had the largest increase on internal bank nurses and midwives and was spending twice as much as a previous year on external agency staff. Can I ask the cabinet secretary what specifically the Scottish Government is doing to support NHS Borders and the staff through these challenges? Cabinet Secretary In 2016-17, NHS Borders resource budget has increased by 5.3 per cent to £193.9 million. The NHS Borders uplift includes £5.3 million for investment in social care as part of the integration of health and social care. I should point out also that NHS Borders funding for 2016-17 is over £4 million above its NRAC target share. However, within that we understand the pressures that with growing demand for services and what that brings. In terms of the agency staff question that the member raises, that of course is a key element of the national programme of work that is under way to reduce agency spend. Part of that is about helping boards to recruit to substantive posts where that makes sense but also to look at other options to reduce that. I am very happy to write to the member with more detail specifically of what Borders are doing to reduce their agency spend as part of that programme. Before we move to the next item of business, members may wish to join me in welcoming to the gallery Mr Asad Kaisar, NPA, speaker of the Pakistan Provincial Assembly of Khyber Pakhtunkhwa.