 SAFN? To ask the Scottish Government what action it is taking to improve the condition of the road network in the highlands and islands. Since 2007, the Scottish Government has spent, in excess of £336 million to maintain and improve trunk roads in the highlands and islands. Local roads, although they are a matter for local authorities. Llywodraeth gwybodol, dechougwyr sydd yn siarad eich gwneud o'r dwybod yn ar hunain, a bwysig oherwydd roedd y Cynllun Pothol i ddech chi i ddiwethaf o mynd amwysig o gyllidau i Llywodraeth ac i chi ddim yn gwych ar gael o'i ddefnyddio'r cystafoli ac yn arwag y mynd i ddim yn gofyn eu bwysigol. Felly os ydych chi'n gwybodol yn dechrau eu llwyffordd a'i doddysgol o'i ddodd wni ar hyn o hefyd doedd i'w dwylo chi'n i'n fath i'n ei ddweud o weithwyr ar gyfer dfynebu gwyllwyd pam oed. Glockorau y Ffwrdd rydw i'n mynd i, ac mae'n dweud yn fawr, credu ddweud o dweud o gyfer y Llywodraethau Llywodraethau, ac mae'n dweud o gymorth o'r rhaid i teimlo gyda'r lleiol mewn rhaid i lleid i Llywodraethau, ac mae'n dweud o ond maen nhw i gyflawni rogi i leiru hwn. Felly, mae'n dweud o byddau i eich dweud o gweithborth i leiru rhaid i programmes. We have had around a 26 per cent cut, for example, to the Scottish Government's capital budget, and of course there is pressure on public finances, which is bound to work through in relation to this. The discussions that the member asked about, we would include discussions that we have had, for example, with Argyll and Bute local authority. We have agreed to trunk the 83-road from Kenny Craig to Campbelltown. Those discussions are on-going and are going well, and we expect to have a transfer of responsibility from that road from the local authority to the Scottish Government in July this year or thereabouts. I would say that in relation to the resources that are at the root of all this, we have pressured public finances, and certainly it has not helped, of course, by voting for around £776 million to spend on trams in Edinburgh rather than the roadworks around the whole country. 2. Jim Eadie To ask the Scottish Government what recent discussions the Cabinet Secretary for Health and Well-being has had with NHS boards regarding the operation of private finance initiative contracts. 2. Alex Neil The Scottish Government is committed to the non-profit distributing model as its preferred procurement option for revenue finance projects. Unlike under PFI, the level of private sector returns is capped under NPD. In addition, services provided as part of NPD contracts are limited to those that relate to the maintenance and fabric of the buildings. However, there remain 28 historical PFI agreements in NHS Scotland. The NHS in Scotland pays £215 million in unity charges under PFI, and of that £86 million relates to service charges. A NHS Scotland group, including all boards with PFI contracts, the Scottish Government and the Scottish Futures Trust, has been working to improve contract management and deliver savings on those contracts. This work has already achieved £1.3 million worth of annual savings, which will save £20 million over the remaining life of the contracts. By the end of 2014-15, savings over the remaining life of the contracts will rise to £26 million. Those savings will be reinvested in NHS services. 2. Jim Eadie I thank the Cabinet Secretary for that answer. Is he aware that the PFI contract is not withstanding the savings that the Government is negotiating? The PFI contract for the Edinburgh Royal Infirmary stipulates that, if the health board does not walk away after 25 years of the 30-year contract, it is bound to pay consort an annual management fee for the next 25-year period. Can he confirm the net value of the management fee that would apply in this circumstance? Does he agree with me that those golden handcuffs shackle the NHS to a land deal and a contract that is against the public interest? I am aware that an on-going payment made during the secondary payment is for facility services to be provided by the contractor rather than a management fee if the board does not walk away. The precise cost of those services cannot be precisely defined at this point, but are determined by provisions within the contract that basis calculation on all expenditure on the facilities over the previous five-year period, which was approved by the then Labour Government at that time. Clearly, those on-going obligations are not helpful, which is why contracts signed from around 2000 onwards either use leases that end with contract or more recently, including the NPD and hub projects grant only licence to service provider and therefore do not face the same issues. To ask the Scottish Government what progress is being made to resolve the environmental issues arising from the abandonment of opencast coal sites in East Ayrshire? The Scottish Government consultation entitled Opencast Coal Restoration Effective Regulation closed in February this year, and subgroups on financial instruments and compliance monitoring will report back in due course. The restoration of sites is a long process, however active restoration is now under way on sites in Dumfries and Galloway, in Fife, in South Lanarkshire and in East Ayrshire. My officials and the Scottish Mines Restorations Trust continued to work closely with relevant local authorities to assist them in their restoration planning. Adam Ingram, I thank the minister for that answer. Can he also provide an update on discussions with the UK Government about returning Scotland's share of the coal levy payments to assist with the restoration of opencast coal sites? Yes, I can. I did write to the UK Government on 17 September last year and the 20 November requesting that the royalties collected by the UK Coal Authority for Coal produced in Scotland amounting to more than £15 million being made available to help fund the restoration of legacy opencast sites across Scotland. A holding response was received from Michael Fallon, the UK Energy Minister, on 8 January this year, to say that the request is being actively pursued with the UK Treasury at this time. We have received no further written communication. I raised this matter again with DEC at the cross-party Scottish Coal Industry Task Force, which I chair on 7 April. I also spoke with Michael Fallon on this issue when we met in Houston, Texas last week. We continue to pursue this line of inquiry with the UK Government, and I recognise that Adam Ingram's continued campaigning efforts to ensure the return to Scotland of the money that is much needed to deal with the urgent task of restoration. How many local authorities have adapted the lookbook equipment that they provide to people with hearing loss since the introduction of digital televisions and radios? This information is not held centrally by the Scottish Government. It is a matter for individual local authorities to assess which hearing loop equipment they will provide to people with a hearing impairment. For that answer, it is hard of hearing people rely on that equipment to get any enjoyment for their TV or radio. Some local authorities have not adapted that equipment since the switch-over from analogue to digital. Is the minister willing to write to local authorities to get an understanding of the situation nationally and issue guidance to local authorities to switch over to that modernised equipment as soon as possible? I have not been encouraging local authorities to make the switch-over, but I am more than happy to write again to them to encourage them to do so. As the member rightly says, it is of a huge material benefit to the recipients. 5. Roderick Campbell To ask the Scottish Government what guidance it provides to NHS boards on prescribing blood glucose test strips. We expect clinicians to refer to sign guideline 116 on the management of diabetes, which makes it clear who would benefit the most from self-monitoring of blood glucose. According to Diabetes UK, many members of the public are concerned that the provision of test strips is patchy and inconsistent. Can the cabinet secretary assure me that the Scottish Government is taking steps to avoid that situation in Scotland and to ensure parity of access across all health boards? For clinicians to determine the treatment regime that is best for each individual patient, taking into account the relevant local and national clinical guidelines that I referred to in my previous reply, national clinical guidelines are quite clear that people with diabetes who are treated with insulin should be provided with blood glucose test strips. Current guidance suggests that for people with diabetes who are not using insulin, self-monitoring of blood glucose may lack significant benefit, with little or no effect on glycemic control and is unlikely to be clinically or cost-effective in addition to usual care. To ask the Scottish Government what assistance is being provided to deliver ophthalmology services in Shetland. It is a matter for NHS Shetland to utilise its funding in the most appropriate way to meet local health needs and priorities, including the provision of ophthalmology services. The payments made by NHS Shetland for general ophthalmic services for the years for which data is available has risen from £342,000 to £360,000 during 2012-13, and that's since 2008-9. I'm grateful to the minister for that reply. Is he aware that the eye scans that many Shetland patients need are now available in a machine through an optician in Lerwick? Would he understand that that would save the NHS money because patients would then not have to travel to Aberdeen and Aberdeen royal infirmary? Would he undertake to cut through any NHS red tape that is currently stopping that process beginning in Shetland and therefore being available at much greater convenience to patients and at a great saving to the NHS? I absolutely would like to take up that suggestion and I will do everything I possibly can to facilitate that change. If the member wants to write to me with more detail, I'll make sure to recover every possible angle on this because it's a common sense approach to dealing with this issue. I wonder if the cabinet secretary could update us on the provision of IT links between optometrists and ophthalmic departments in Shetland and, indeed, in the other parts of the country. We are making significant progress, but I will write in detail to the member to give him a detailed update. To ask the Scottish Executive what progress has been made toward meeting accident emergency waiting time targets. It's theme questions today for me. The Scottish Government is making good progress towards meeting accident emergency waiting times targets. Since the launch of the £50 million three-year national unschedule care programme in February last year, there has been a measured improvement in the overall four-hour performance target from 90.3 per cent in December 2012, increasing to 93.5 per cent in December 2013. There has also been a significant improvement in patients waiting over 12 hours. Compared to December 2012 against December 2013, there has been an 87 per cent reduction in patients waiting over 12 hours, which is very welcome. Each health board has a local unschedule care action plan, which supports improvement in A&E waiting times. Additionally, boards are implementing lessons and best practice from across the country in order to bring about improved performance. The Scottish Government continues to work closely with the health boards to ensure that A&E performance reaches a sustained level of performance, not just the interim target of 95 per cent, but continually striving towards the 98 per cent standard. I thank the cabinet secretary for that most extensive and thorough response to my question. The Audit Scotland report from last week states that 19 out of 31 A&E departments receive no referrals for admission from GPs. Is it the case that many patients are now bypassing their GP, putting additional pressure on A&E departments? I just want to ask if any work is being done by the Government to help to understand the issue. In many situations, the GPs bypass the A&E procedure rather than the other way about. Therefore, those figures reflect that, but it is all part and parcel of trying to get the improvements rolled out in A&E right across the country. Essentially, the key issue here is patient flow. Therefore, rather than clog up A&E, there are many health boards who have the arrangement whereby, if the GP wishes to make an admission, they can do so directly into the ward rather than having the patient needing to go through the A&E department. I ask the cabinet secretary what progress the current Scottish Government has made in increasing the number of A&E consultants since taking office and what further progress is being made through the £50 million unscheduled care action plan. Since taking office, we have increased the number of A&E consultants by 86.5 full-time equivalent from 75.8 to 162.3. That is an increase of 114 per cent under this Government. The unscheduled care action plan has supported recruitment of an additional 18 A&E consultants. In year 2 of the three-year action plan, we will maintain a focus on achieving the A&E target, as well as focusing on sustaining improvements and on whole system approaches, creating local community partnerships where hospitals and primary community care services are aligned and focused on patients getting seen by the right member of the multidisciplinary team at the right time. John Scott. Thank you, Presiding Officer. Does the cabinet secretary share my concerns about A&E waiting times in NHS A&E and targets that have not been met? A problem that is exacerbated as he will know by a lack of available beds and what can the Scottish Government do to help to resolve that problem? Presiding Officer, although A&E has not met the 95 per cent target consistently, they are much better than what they used to be in their averaging just over 93 per cent. The issue is not actually lack of bed capacity in A&E, it is the flow of patients. A too-low percentage of the daily discharges are made in the morning or early afternoon. That means that beds are not being freed up during the day in the wards to receive incoming patients from A&E and indeed from normal admissions. It is that flow that is really at the core of many of those issues. That is why we are rolling out—for example, we are doing many things, but we are rolling out the electronic white board across the country, because that improves the management of beds and patients and staffing right through the hospital. John Wilson To ask the Scottish Government how many cataract operations the NHS performs each year. The latest available information shows that activity has risen from 31,892 in 2008-9 to a provisional figure of 36,340 cataract procedures being carried out in NHS Scotland during 2012-13, an increase of 13.9 per cent. John Wilson I thank the cabinet secretary for his response. Could he outline to me what additional follow-up procedures are in place in terms of patient treatment plans after cataract operations that have led to complications? How elderly patients can be reassured about the procedures, particularly when they may not have had a good experience the first time round, particularly if they are waiting on a second operation? John Wilson I would give a two-prong reply to that. First of all, in terms of every patient who gets a cataract operation, there is a standard follow-up procedure laid out in clinical guidelines and protocols whereby the consulted and related services follow up with the patient to check progress and check in particular that the operation has been successful and to deal with any side effects that may arise. Secondly, if a patient has had an unsatisfactory experience, they should use the complaints procedure within that health board to register their complaint or concern and make sure that that is dealt with. One of the changes that we are making across the national health service in Scotland is to use complaints, not just for dealing with specific complaints, but to use them to provide management intelligence on where things are not running as smoothly as they could and should. Indeed, in a number of health boards already, every complaint is treated as an adverse event. Again, that is why I would encourage every patient to use the complaints procedure. To ask the Scottish Government what assessment it has made of the payment of the state pension in an independent Scotland. The different Cabinet Secretary, John Swinney. The Scottish Government this week published updated research on the state pension and its impact in Scotland. It showed that men and women who have the same pension entitlement will get less in Scotland than in the UK if we stay tied to the Westminster pension and welfare system. In terms of our assessment of the payment of the state pension in Scotland, we are well placed afford a decent social security system with welfare, including pensions, being consistently more affordable in Scotland than in the United Kingdom. We are also well served in having much of the infrastructure in place to deliver a strong social security system. Annabelle Ewing. I thank the cabinet secretary for his answer. Given the less than inspiring comments that we have had from Labour over the last couple of days, does the cabinet secretary agree with me that it is an absolute disgrace that Labour party politicians are more interested in towing the Tory line on the state pension age rather than standing up for their constituents? I think that Annabelle Ewing highlights an issue of fairness. It cannot be fair that a 65-year-old can expect the lifetime value of the state pension to be about £11,000 for women or £10,000 for men less in Scotland than in the UK as a whole, based on the same entitlement. It is worth remembering that previous UK Governments do not have a strong record when it comes to protecting the state pension. They reduced the long-term value of the state pension when they abolished the link between the state pension and earnings, and that was not restored by the Labour Government. In an independent Scotland, we have already said that it is right and proper that we look again at raising the state pension age. We will do what we always do, act in the best interests of the people of Scotland. We now move to 1st Minister's Questions.