 The first item of business today is consideration of business motion 382, in the name of Joe Fitzpatrick, on behalf of the business bureau, setting out a revision to the business programme for today. I would ask any member who wishes to speak against the motion to press their request to speak button now. I call on Joe Fitzpatrick to move motion number 382. Firmly moved. No member has asked to speak against the motion. I will therefore put the question to the chamber. The question is that motion 382, in the name of Joe Fitzpatrick, be agreed. Are we all agreed? We are all agreed. The ministerial statement will be taken at 240 after portfolio questions and decision time will be moved to 5.30 tonight as a consequence. I am conscious that members will want to hear the statement from the on the Queensbury crossing and question to Cabinet Secretary on Development. However, I am also aware that there has been very little notice of the statement for members and for the general public, and that is not the way I would necessarily want business to be planned. I would therefore ask the minister and fellow bureau members to reflect on this for the future as I will be. I move to the next item of business, which is portfolio questions on health and sport. The first question is from Elaine Smith. I ask the Scottish Government when it last met NHS Lanarkshire and what matters were discussed. Ministers and Government officials regularly meet with representatives of all health boards, including NHS Lanarkshire, to discuss matters of importance to local people. Elaine Smith. I thank the minister for her response. The minister will recall that I campaigned to stop the downgrading of Monkland's A&E, and I was pleased when her Government stepped in to instruct the health board to overturn the decision. We are now facing increasing cuts to local health services in Monkland, including closure of the dermatology ward, the CIC clinic, as well as another proposal to downgrade the A&E with the removal of orthopedic trauma. Will she step in to stop those cuts, and specifically, will she instruct the board that downgrading the A&E is as unacceptable now as it was in 2007? Elaine Smith is quite right to remember that it was, of course, this Government in 2007 that reversed the Labour plans to close the A&E department at Monkland's hospital. Since then, local people have benefited from over 500,000 attendancies at the A&E department. Local communities can be assured that this Government remains committed to a viable future for Monkland's hospital, including the A&E department. That is why we have welcomed NHS Lanarkshire's preparation of a business case for the redevelopment of Monkland's hospital. That will be a very important investment within the local area. As Elaine Smith knows, there is a trauma orthopedic review on going. No decisions have been made. I have been assured that all stakeholders will be fully involved as this process is taken forward. In reference to the dermatology services, she will be aware of the correspondence that I have sent to her. I am very happy to continue if there are any other issues arising that have not been answered in the correspondence that I have sent to her. I hope that I have been able to assure her that the number of dermatology patients that require hospital admission has dropped and more and more are being treated as outpatients. That is what lies behind that change. Kate Forbes, have you pressed your request-to-speak button for an intervention now or for later? The most recent delayed discharge figures for NHS Lanarkshire, which was released in May in excluding code 9 delays, revealed that there were 123 patients prevented for leaving hospital as an inpatient. That is the highest level for any month so far this year and almost twice the number that was compared with this time last year. Can the cabinet secretary explain what is being done to address the unacceptable increase? The cabinet secretary is quite right to highlight how important that is. Of course, discussions are going on with both the partnerships covering North Lanarkshire and South Lanarkshire. She may be aware that there is a particular issue in South Lanarkshire, which lies behind some of those delays. I can assure her that officials are engaging closely with that partnership to ensure that they take the action that we know works and has worked in other partnerships to reduce delayed discharge. She will be aware of the significant investment that is being made in both those partnership areas by the Scottish Government to tackle delayed discharge, but I am very happy to keep the member closely informed of South Lanarkshire's plans to tackle what is a very important issue. Emma Harper, are you pressing to speak now or for later? Thank you, Presiding Officer, to ask the Scottish Government what it is doing to boost GP recruitment. Sorry, Ms Harper, what I meant was that you were asking a supplementary on the first question. You are down to ask question 6, so I will call you for question 6 at that point. Just for guidance to members, if you are down on the order paper for today, you can just wait until your turn comes or press your button at that point. If you press your button during someone else's question, I will think that you want to ask a supplementary on the question that is being asked there and then. Both Kate Forbes and Emma Harper are asking for later. I am now going to come to John Lamont, number two on the question 4. To ask the Scottish Government what it is doing to ensure that operations scheduled by NHS boards go ahead as planned. The Scottish Government continues to work to support health boards to manage their capacity planning to keep cancelled operations to a minimum. Decisions to cancel a patient's operation is never taken lightly. Any postponed operations will be rescheduled at the earliest opportunity. The latest figures for cancelled operations, published by ISD on 7 June, show that, for the month of April 2016, only 1.6 per cent of operations were cancelled by the hospital due to capacity or non-clinical reasons. That is a reduction on the month before. I thank the cabinet secretary for that response. I think that we all agree that cancelled operations are a waste of resources and an inconvenience to patients. In NHS Borders, half of all operations that were cancelled in the latest month were cancelled due to capacity or non-clinical reasons. The figure is regularly twice the national average. Given that NHS Borders is having to cancel such a large percentage of operations due to a lack of resources, will the Scottish Government look closely at whether rural health boards are being sufficiently resourced to help with issues such as recruitment? The member raises a very important point. As I said in my initial answer, progress is being made. If you look at the figures, there is a tiny number of operations that are cancelled due to non-clinical reasons. The vast majority of operations that are cancelled are due to either patient choice or clinical reasons. However, he highlights, obviously, that within NHS Borders it is at a higher rate than we would like. There is a lot of work under way to try to improve the level of cancellations by, for example, a weekly review of orthopedic theatre lists, six weeks in advance, planning for staffing, theatre time and equipment, booking on the basis of average time per consultant to carry out procedures for orthopedics, reviewing admissions per ward, area per day and smoothing surgical flow, reviewing data for orthopedics, looking at implementing a process to review lists every week to develop a standard operating procedure. I can write to the member with more detail around that, but please be assured that we are working very closely with NHS Borders to make those improvements. To ask the minister how many procedures have been referred to private hospitals because of a lack of capacity in our NHS and if there is a cost for doing this. The member will be aware that the use of the independent sector is only used at the margins, where that is required because there is no capacity available within the locality, but it is very much at the margins. If you look at the level of spending in the private sector, that is a matter that is reducing. Importantly, the elective centres that we are investing £200 million in over the next few years are an important way of dramatically reducing that independent sector spend, which is contained to a very small number of boards. The vast majority of boards hardly use the independent sector at all. There are probably one or two boards who use it more than others. With those elective centres, particularly in the east, two of those centres will be located within the Lothian area. That will make a big difference in growing that capacity so that its reliance on the independent sector is reduced further. I am happy to write to the member with further details about that. Government, what action is it taking to support the PAMIS campaign changing places toilets? The Scottish Government actively supports the PAMIS campaign to increase the number of changing places toilets in Scotland. We congratulate PAMIS on its substantial achievements in developing the campaign, which has so far resulted in 136 changing places toilets being installed throughout Scotland. The Scottish Government will continue to work in partnership with PAMIS as it develops a network of changing places and accessible toilets throughout Scotland, enabling those with the most complex needs to have access to their communities. Mr Lyle? Thank you, minister. I share with the chamber how inspired I was in meeting one of my constituents, Sheila Johnson and her son, Mason, who opened my eyes to the issue of changing places toilets. In response to the minister's answer, what action the Scottish Government can take to support places of interest or tourist attractions to installing changing places toilets to help to allow disabled or physically challenged visitors to access their services fully? I thank Richard Lyle for raising this important issue. I would be pleased to know the thoughts and views of Sheila and Mason and invite the member to write to me with them. In 2015, the Scottish Government published our draft delivery plan for 2016 to 2020 in response to the United Nations Convention on the Rights of Persons with Disabilities, which sets out our aims to ensure that disabled people in Scotland have the same freedom, dignity, choice and control over their lives as everybody else. Regarding tourism, Visit Scotland is currently running an accessible tourism project that aims to work with the tourism industry to boost accessibility for all disabled people. Through this project, tourist businesses are now able to showcase their accessibility credentials via access statements. Those statements can be used to feature changing places toilets where those facilities already exist. The member should also visit the changing places UK map, which shows the full list of changing places toilets throughout Scotland, including several in his constituency. To ask the Scottish Government when it will review the referral pathways that results in cancer patients in Stranraer having to travel to Edinburgh via Dumfries, rather than cancer services in Glasgow. The role of the Scottish Government is to provide policies, frameworks and resources to NHS boards in order that they can deliver services that meet the needs of their local population. Within that context, the actual planning and provision of healthcare services is the responsibility of local health boards taking into account national guidance, local service needs and priorities for investment. However, I am aware that NHS Dumfries and Galloway has confirmed that they are currently reviewing their cancer referral pathways to ensure that people with cancer do not have to travel unnecessarily for treatment. It is also my understanding that it is only patients' transport that goes via Dumfries to Edinburgh and car users can actually go to Glasgow. Would the minister agree that the Government should seek the health boards and providers to develop the pathways to stop this inequality, particularly those that affect clinical outcomes, but in this case travel? I would expect health boards wherever they are to deliver as many of their cancer services as locally as possible. However, it is important to recognise that some complex treatments can only be delivered via specialist centres. That is obviously a clinical decision on where best the person goes, and that would be determined in close discussion with the consultant and the clinical team. On the transport issues that he raises, I am sure that NHS Dumfries and Galloway is more than aware of those issues. Essentially, it is important that people with cancer do not have to travel unnecessarily for treatment wherever that is to. It is important, though, when they do have to travel, it is to the place that is most appropriate for them. However, I am very happy to keep in contact with the member as Dumfries and Galloway take those issues forward. I am sure that Dumfries will be feeding in his views to the local health board through Mr Jeff Ace, the chief exec, and I would encourage him to do so. To ask the Scottish Government what measures it is taking to help to reduce waiting times at GP surgeries. The Scottish Government is fully committed to reducing waiting times at GP surgeries. We have increased the primary care fund in the draft 1617 budget, which will now deliver £85 million of investment over three years. That will include £20.5 million on the primary care transformation programme, as allocated to boards to support work at practice and wider multidisciplinary team level, £6 million to develop digital services, including helping online appointment booking, £16.2 million to recruit 140 new pharmacists to work directly with practices and support the care of patients with long-term conditions. Of course, we are working closely with the BMA and the Royal College of GPs to reduce GP workload. That includes our pioneering agreement to abolish the bureaucratic system of GP payments in order to free up more GP time to spend with patients. The cabinet secretary may be aware that many surgeries in my constituency of Midlothian North and Musselborough are closed to new patients, yet house building continues apace. Would the cabinet secretary agree that there is a need to balance infrastructure against development to ensure that constituent medical needs can be met? Colin Beattie makes an important point. Since 2007, the Scottish Government has invested over £170 million of capital in projects that are delivering new or refurbished GP premises across Scotland. In addition, the Government's hub programme is delivering over £500 million of community healthcare infrastructure. Planning should take into account current infrastructure capacity and, indeed, future requirements. That applies to all types of infrastructure, including primary healthcare provision. The delivery of more high-quality homes is a key priority. To that end, we published draft guidance on planning for housing and infrastructure delivery earlier this year, and the recent independent review of the Scottish planning system has made a number of recommendations that aim to strengthen planning for infrastructure, which are currently under consideration. To ask the Scottish Government what it is doing to boost GP recruitment. The number of GPs in Scotland has increased by 7 per cent under this Government, and we want to go further and faster to boost GP numbers as part of building a strong multidisciplinary community health service. We are funding support to GP returners, provided by NHS Education for Scotland. We have increased the number of GP training places from 300 to 400. I will soon be in a position to announce the details of the latest package of funding being distributed under the £2.5 million GP recruitment and retention fund, which will include a range of innovative projects to tackle recruitment issues, including those that are faced by rural and remote areas. In the longer term, we are committed to delivering a national workforce plan that will set out how we will address workload and capacity by building those multidisciplinary teams, including boosting GP numbers and, of course, our £3 million commitment to train 500 more advanced nurse practitioners. I thank the cabinet secretary for her response. Does she agree with me that the Scottish Government's measures to boost GP recruitment will bring enormous benefits to the healthcare provision in rural parts of Scotland, including my area of Dumfries and Galloway? Yes, I agree with that. We are taking a number of actions, but there is more to be done. Of course, one of the key components of transforming primary care is the new models that we are testing in primary care along the lines of the community health hubs, multidisciplinary working. What we will underpin is the new GP contract that will take place from 2017 onwards. That is being negotiated, as we speak, with the BMA. Discussions are going well, and that has to be a contract that will help to deliver a radically different model of primary care, which will benefit remote and rural Scotland as well as urban Scotland. Kate Forbes. The cabinet secretary will be aware that, in rural Highlands, it can be difficult for an increasingly ageing and scattered population to get to GP appointments. What progress is the Scottish Government making to increase home-based options such as telecare that is currently used by more than 2,000 people in NHS Highlands without replacing contact time with healthcare workers? As part of the Scottish Government's technology-enabled care programme, over £1 million is being made available to NHS Highland and its partners over the next two years. The funding is to drive forward the uptake of technology-enabled care services, which includes telecare across the Highland and Argyll and Bute partnership areas. That is in addition to the £973,000 that was awarded to Highland and Argyll and Bute during 2015-16, as well as the significant funding that has been provided to both areas over the past few years to develop livingitup.scot as part of their local strategy to raise public awareness of the benefits of technology-enabled care. Colin Smyth. Given that we have clinics closing now due to the immediate crisis and hospitals such as Lockhearts and Lanark not taking new patients and it takes several years to train a GP, what action is being taken now to deal with the immediate short-term crisis? The member may be aware that I recently, just a few weeks ago, just before the election, announced a £20 million package for this financial year, which covered many of the workload issues that GPs themselves said could help to relieve some of the pressures. That was very well received by the profession and it was intended to address some of the short-term issues, but it is without doubt the medium to long-term that will make the biggest transformation, because although, yes, that resource investment is important to tackle workload issues, the new contract and the new model of primary care is fundamental to changing primary care and making it a more attractive proposition for medical undergraduates. Not enough medical undergraduates are choosing primary care as their specialist option once they qualify and that is an issue that has to be changed and the new model of primary care and the new contract will help make that more attractive and we are working very closely with the profession to deliver that. Kenneth Gibson Thank you, Presiding Officer. One of the issues is that Scotland is excellent in training doctors, but that means that Canada, Australia and New Zealand often try to poach some of those newly trained doctors. What can we do to mitigate against that, given that those people are offering a different lifestyle perhaps than the folk who are born and educated and trained here would enjoy if they stayed in Scotland? Fiona Hyslund What I can say to Kenneth Gibson is that, through our recruitment campaign for junior doctors, that has had a very, very positive response across a number of specialties. The numbers are well up on last year. Obviously, we need that to translate through to appointments, but indications are that Scotland is being seen as an attractive place by junior doctors to come and train here. There still is an issue with general practice and that is mirrored across these islands. Of course, we are in an international competitive environment, so part of the solution is to make sure that our training environment is internationally recognised and is somewhere where junior doctors want to come and train and there is evidence of some success of that. We also want to grow more of our own doctors, which is why, of course, we are taking forward the first graduate entry programme for medicine here in Scotland. I hope to be in a position to say something more about that over the next few weeks. Donald Cameron Already in this Parliament, we have heard much about the crisis in GP staffing, but what plans does the Scottish Government have to boost recruitment by reducing in particular stress levels and the workload of GPs? As I said in my earlier answer, the £20 million that I announced a few months ago for this financial year was new money intended to help with some of those short-term workload issues. Those were things that were called for by the profession that could help to reduce some of that workload. Getting rid of the co-off, of course, was a major step forward because it was seen as a bureaucratic system that was a tick-box system and took a lot of GP time. That was very warmly welcomed when we took the decision to get rid of the co-off system. As I have said to others in this chamber, those short-term measures are important, but it is the new models of primary care and the new contract that I believe will make the biggest difference to being able to recruit, retain and, importantly, get young doctors to choose general practice as their choice of specialism. That is work that we are undertaking with the profession, and if we get the new contract right, I think that we will be able to do that. To ask the Scottish Government what timetable it is working to and its pledge to examine extending the minor ailment service. As I am sure Jamie Giemmel will appreciate considerations about extending the minor ailment service are at an early stage, following the First Minister's statement on 25 May, taking Scotland forward. Detailed scoping work needs to be undertaken first, all taking into account, for example, the cost of an extended service, the capacity within community pharmacies, the wider primary care transformation agenda, and how to better support self-care as a core part of the service going forward. Over the coming weeks, we are going to engage with NHS boards, community pharmacies Scotland and other stakeholders on the options and associated timeframes. I am happy to keep the member informed of the progress that is being made. I thank the cabinet secretary for her answer and also welcome her commitment to extending the minor ailment service, as set out in our manifesto, and ask what extra funding will be allocated in the first instance. First of all, we invest a significant amount of resource in community pharmacy already. The community pharmacy rumination global sum is just over £178 million. That is our £1 million increase on the previous year. In addition, community pharmacy contractors will earn a minimum of £93.5 million in reimbursement from the purchase of drugs on behalf of NHS Scotland as part of the overall funding settlement. He will appreciate that negotiations with the community pharmacy Scotland about the extension of the minor ailment service will have a resource component to it. I think that it would be more appropriate to have those discussions rather than to put out arbitrary figures in the chamber, so he will appreciate that that would be part of the discussions going forward. I would say to the member that what we are doing here with community pharmacy is in stark contrast to that south of the border, where pharmacies in England face a potential reduction of up to 6 per cent—some £170 million reduction. If that happens, what pharmacies are saying in England is that there will be far-reaching consequences for that, with many of them saying that there will be the potential closure of pharmacies in many areas. I hope that the members reassured that we are not taking that action here in Scotland. To ask the Scottish Government what the average weight was for child and adolescent mental health services in the NHS fourth valley region for patients who started their treatment in the last quarter of 2015. The average weight waiting time for the quarter ending December 2015 in NHS fourth valley was 22 weeks. I am disappointed that the board is still to achieve the waiting time standard for CAMHS. However, month on month, the average waiting time decreased throughout the quarter and was down by seven weeks by December 2015. In the most recent Scotland-wide data for the quarter ending March 2016, which was published on yesterday, the percentage of children and young people seen within the waiting time standard increased on the previous quarter, with half of patients seen within eight weeks. NHS fourth valley's performance against the standard increased by 10 per cent. I welcome that progress, however, is still far from good enough. I expect the board to increase their efforts to meet the waiting time standards. I will be paying close attention to that and to ensure that all boards are meeting the waiting time standard sustainably. Dean Lockhart Thank you minister for that response. We also welcome those small recent improvements in performance, but we would highlight that further progress is required with regard to the performance of the NHS board in fourth valley. The fact that our youngest and most vulnerable people in this area have to wait approximately four or five months for treatment for mental health issues is clearly unacceptable, especially considering that early diagnosis and treatment are critical for successful outcomes. Given those disappointing overall figures, and in particular for the fourth valley NHS, will the minister and the Government follow the advice that was published yesterday by the Scottish Children's Services Coalition to put in place an urgent action plan not only for this NHS fourth valley region, but across Scotland to increase investment in mental health and to put additional resources in this area? Of course, the member will be aware that the Scottish Government is putting in extra resources £150 million. Of course, the strategy will take into account the requirements not only of those in fourth valley but throughout Scotland. However, I can see that the service, the CAMHS service in fourth valley has gone through a significant period of redesign in the last year. There has been investment in the CAMHS service with new nursing and psychology posts. A new management structure has been established with clear lines of responsibility and accountability. There is now a dedicated manager for the service and lead roles have been established for each specialty. A new CAMHS website went live on 1 June with a range of self-help material. Of course, NHS fourth valley will have to do more to meet those standards. To ask the Scottish Government when it will announce the final 2016-17 budgets for health boards and integrated joint boards. On 26 February, the Scottish Government announced 2016-17 budgets for NHS boards, taking health spending to a record level of almost £13 billion. Additional funding of more than £500 million for health boards enables investment of the additional £250 million to support the integration of health and social care and build the capacity of community-based services. The Scottish Government does not set the budgets for integrated joint boards. Rather, budgets are delegated to integrated joint boards by health boards and councils. Budgets were agreed for integrated joint boards by the first of April as plans, subject in some areas to final decisions regarding health efficiencies as part of the NHS boards local delivery plans. The Scottish Government is working to the 30th of June as a date for conclusion of local delivery plans and is providing support for this process. I thank the cabinet secretary for that response, but I ask the cabinet secretary to outline to what extent those budgets reflect needs and the disproportionate levels of social and health challenges in and within Glasgow and whether the process for defining needs and budgets is under review. Further, I could ask the cabinet secretary to indicate what work has been done in particular to address the inverse care law, which means that those GP practices—very many of them in Glasgow, which are dealing with patients with the most complex needs—are also the most poorly funded, perhaps creating the levels of stress and pressure that has been discussed in the chamber today. I think that Johann Lamont makes an important point here. I have made it very clear on a number of occasions in this chamber that, particularly when it comes to the resourcing of primary care, there needs to be more of a direct correlation with the Scottish allocation formula between deprivation and need and the budget that follows. I am very clear as part of the new GP contract and the negotiations on going there that that is an issue that has to be addressed as part of those discussions. I am very happy to keep Johann Lamont informed of how those discussions go forward. She will obviously understand that those discussions are quite sensitive and there is a lot of detail to be gone through. However, I can assure her that that is a very important issue for me, as cabinet secretary, to make sure that the resources that go into our deprived communities, particularly through primary care, monies better reflect the levels of need that are within those areas. Alex Rowley. NHS Fife has announced that it has to make a £30 million cut in its budget. The health and social care partnership in Fife has said that it has a £11 million deficit. Will the minister agree to meet me to discuss the massive challenges that NHS Fife faces in social care in Fife? Cabinet secretary. What is important to reiterate is that, as well as the additional funding of more than £500 million, as I said in my earlier answer, half of that is going to support the integration of health and social care. Of course, where efficiency savings are required to be made, which is the case for all the public sector, within those territorial boards, all savings are retained locally by territorial boards for reinvestment and front-line services. I am very happy to meet Alex Rowley. I have met recently with David Ross, the leader of the council, and I have met recently with health board representatives as well. What is important within NHS Fife and Fife council, though, is as much about getting on with building up the relationships and ways of working to change the way things are done. If you look at partnerships across Scotland, many of them are making very good progress in tackling delayed discharge and getting on with changing the way services are delivered to the benefit of service users and patients. All areas need to do that. There is more progress that needs to be made in a number of areas. Fife is one of those areas. I am very happy to work with Alex Rowley if he thinks that, by working together, we can encourage both of those parties to get on with the job of improving those local services. I am very happy to take him up on that. To ask the Scottish Government what consideration it is given to using the new medicines fund to ensure access to the cystic fibrosis medicine, I have a catheter for 2 to 5-year-olds with the G551D gene. The new medicines fund can be used by NHS Borsas to support the cost of this treatment. The peer-approved clinical system pilot provides a route for clinicians who want to prescribe the treatment. I will be happy to meet the member to discuss further. While the Scottish Government has taken action to put in place improvements in access to new medicines, including our new medicines fund investment, pharmaceutical companies also need to take action on the prices that they are charging. It would be in the best interests of people in Scotland for the manufacturer of the drug to put forward a resubmission to the Scottish Medicines Consortium at a reduced price. I thank the minister for that answer, but I will also put on record my thanks to Duncan McNeill, the departing chair of the Health and Sport Committee, who worked very collaboratively with the Scottish Government, as we all did as members of that committee in relation to developing new models for access to medicines in a collegiate fashion. Access to medicines has dramatically improved right across Scotland as a result. However, minister, this case raises further issues over access, and I will be delighted to meet the minister to discuss it further. However, I also ask whether the minister will ensure that the new independent Montgomery review on access to new medicines takes account of how SMC structures handle submissions such as IVACAFTA and also when access to new medicines fund would indeed be triggered. I thank the member for raising the issue, and I also note my thanks to the work that Duncan McNeill did in the previous session. Of course, the member knows that the cabinet secretary has asked Dr Brian Montgomery to lead an independent review on access to new medicines, and the review will report to the cabinet secretary later on this year. Both the First Minister and the cabinet secretary have also been very clear that there has been real progress made to improve the access, but more can be done and more should be done. For example, again, to reiterate the point that I made in my reply to Bob Dorris's first question, we do not always get to affirm a pharmaceutical company's best offering on price early enough or at all, so there is clearly a lot more that we want to do. That is why the medicine independent review has been taking place. Again, I am happy to meet the member to discuss that and other interests that he may have on this issue. Question 11, Maurice Corry. Thank you, Presiding Officer. It is to ask the Scottish Government whether it will retain the current level of services at the Vale of Eden hospital. Of course, it was this Government that ended a decade of damaging uncertainty for the hospital by approving the vision for the Vale in 2009. Local people can be assured that we remain committed to maintaining and improving services at the Vale of Eden hospital, which includes sustaining emergency services. I thank the cabinet secretary for her answer. Also, would the Scottish Government work to reintroduce full accident emergency services so that the west of the Bartonshire area has the services on the north side of the river Clyde in view of the fact that the Royal Navy will be increasing its personnel first lane by some 2,000 personnel? The member will no doubt be aware that there has not been a full A&E department at the Vale since 2002, when it was closed under the previous administration. Of course, you cannot just stick an A&E department at a hospital. It is what lies behind that A&E department that is crucially important. The Royal College of Emergency Medicine specifies that a full 24-7 A&E service has to be supported by on-site 24-7 anaesthetic surgical critical care cover, which is not available at the Vale of Eden hospital. What we need to ensure at the Vale of Eden is the sustainability of the services that are there. That is why, of course, we have fully supported the minor injury unit at the Vale, which is open from 8 o'clock in the morning to 9 pm every day and deals with up to 70 per cent of local unscheduled care. So 70 per cent of people who need unscheduled care get their care at the Vale of Eden hospital. What I can assure the member is that that unit is doing well. It has experienced a 4 per cent increase in attendances between November 2014 and November 2015. I want to make sure that the vision for the Vale is delivered, because that is what has got a hospital that was on its knees into a position of actually doing it very well indeed. I hope that the local member will support us in what our efforts to do so. Thank you, Presiding Officer. My question is to ask the Scottish Government what discussions it has had or plans to have with NHS boards and local authorities regarding disabled access in and around hospitals and other health facilities. Scottish Government officials regularly meet with NHS boards to discuss a range of issues involving finance, performance and management of health care facilities. I thank the minister for that answer. I have a further question, which is, does the Scottish Government agree that specific steps should be taken to require local authorities to ensure the state of repair and suitability of pavements for disabled people, particularly those in wheelchairs near hospitals such as the Edinburgh royal infirmary, where the royal hospital for sick children is due to be relocated? We absolutely take very seriously, and so does the NHS boards across the country about making sure that there is access to health care facilities across the country. I am happy in the time that we have left perhaps to follow up some of the issues that the member has, particular issues that he wants to raise in more depth, but I know that there is an access audit checklist that uses inclusive design to ensure that new buildings are accessible and that it will take a whole host of different vulnerabilities into consideration when designing new facilities, and that goes for older buildings, which the NHS has a number of, to make sure that they are as accessible as they possibly can be. Not everything is perfect, but certainly there are a range of tools in place to make sure that new buildings and the existing infrastructure is as accessible as it can possibly be. On that end is the session of portfolio questions.