 F April 2016 is portfolio questions on health and support. I will try to get as many people in as possible. I am short on succinct questions and answers. Question 1 is from Stewart Stevenson. To ask the Scottish Government what progress it is making in meeting its target to on cancer strategy to increase NHS scope capacity by an additional 2000 per annum on a sustainable basis. Fyegwn yn 2016, £6 million g份 has been released directly to NHS boards, including one million annually, since 2016-17 for scope capacity. In 2018-19 alone, that supports an additional projected 2,250 scopes through 560 endoscopy sessions. Stewart Stevenson. I'm the grateful recipient of a negative diagnosis after a scope a couple of years ago, and like others, I very much welcome that. Can the Scottish Government indicate how its monitoring is spent by individual health boards and the outcomes that that 2,250 additional scopes in the coming year in this year will deliver? I'm grateful to Mr Stewart for that supplementary. I'm sure he will recall our waiting times improvement plan, which I published in October. That plan has an operational board, which has senior health board and other expertise on it, who will monitor for me both the delivery of the plan against the trajectories that are in it, but also the individual actions of specific boards against the funding that we will release, and we release the funding against specific requests to increase either diagnostic or elective or other capacity in a particular board in order to deliver specific results. The money is allocated on that basis and the monitoring is done on that basis. I set out in the announcement of the endoscopy action plan what progress has been made in reducing the number of people waiting for an endoscopy this month alone in December by 5,000, the target was set at, and how much of that has been used in the private sector? Jeane Freeman, the exact number that I don't have to hand, I'm very happy to send that to Mr Briggs following today's session. In terms of the use of the private sector, there is use made of the private sector by some of our boards, but he will also recall that, in the waiting times improvement plan, we have a specific action here. I recall that plan as an effect in two parts. One part is to reduce immediate action to reduce the longest weights in the most clinically serious weights, which will include, for example, using mobile facilities and so on, and it will include agreement on a national contract with the private sector for a specific time-limited use on specific procedures. Once that contract is concluded, I'm very happy again to ensure that Mr Briggs is aware of its contents and what it requires. Question 2, Jamie Halcro Johnston. To ask the Scottish Government what progress it has made in implementing the recommendations from the chief medical officers, advisory group on maternity and paediatric services at Dr Gray's hospital. Jeane Freeman, NHS Grampian's phase 1 plan for the reinstatement of maternity service at Dr Gray's, includes a summary of actions that they will take against all the recommendations from the CMO's advisory group, and they are making progress against implementation of the actions in that plan, which resulted in 38 per cent of local births in Dr Gray's in November. In addition to those actions from the CMO group report, the Scottish Ambulance Service has implemented a test of change to improve local ambulance cover in Murray and has recruited additional staff to cover that service. Jamie Halcro Johnston. I thank the cabinet secretary for that answer. She will be aware that the advisory group's report pointed out that communication with women affected has been poor. Almost a month later, there is still a regular complaint from patients with cases arising of women, left not knowing who to contact if problems arise during their pregnancies, not knowing even weeks away where they will give birth and without information about how to get the support that they need. How does she have confidence that communication from NHS Grampian is working effectively? Will she encourage the chief executive of NHS Grampian to attend the Keep Mum campaigns proposed public meeting in January, and will she consider attending herself? Jeane Freeman. I accept absolutely Mr Halcro Johnston's point about communication. It has, from the earliest of days, I believe, been poor. NHS Grampian now recognises that, I most certainly do, we, as a Government, have worked very closely with NHS Grampian to improve its communication, both with mums and residents in and around the Dr Gray area and more widely. I think that improvement is there to be seen, although I accept that there are still areas where more can be done. I read earlier today an email exchange in terms of a forthcoming meeting between Keep Mum campaign and the senior member of the board, the executive manager from the board, who is currently taking a lead role in and around Dr Gray's and delivering that plan. In terms of the meeting in January, it is, of course, for the chief executive of NHS Grampian to determine what the priorities are for her diary, but I would hope that she would consider that to be a priority. Question 3, Gail Ross. To ask the Scottish Government what steps it has taken to improve addiction support services in the Highlands. Jo FitzPatrick. NHS Highlands recently redesigned parts of its drug and alcohol services, and NHS Service Improvement Group is leading on-going work to reduce the time that individuals wait to access drug and alcohol treatment services, with a specific focus on reducing waiting times for those who require opioid substitution therapy. Furthermore, our new alcohol and drug strategy writes, respect and recovery outlines how £20 million of additional investment per annum will be available to support the quality and provision of local services in order to better meet the needs of those at risk. Gail Ross. To ask the minister for that answer. Having been contacted by a number of my constituents recently and given the online petition about increasing addiction services in Caithness, can the minister tell me how the additional funding recently announced within new drug and alcohol strategy will be distributed to rural areas where the problem is sometimes not as visible? Jo FitzPatrick. The additional funding recently announced within the strategy that has been allocated across three funds. A total of £20 million has been made available to support service redesign and system change in this financial year, so the three funds are local improvement fund of £17 million made directly available to alcohol and drug partnerships, also the challenge fund and the national development project fund. Over £1 million of that additional investment will go directly to the Highlands to support efforts to make services more accessible and attractive to people seeking help. I have two short supplementaries. John Finnie, followed by David Stewart. The minister will be aware of the statistics show that there were 19 drug-related deaths in the Highlands in 2016. That was an increase of five. The minister will also know that police officers are often frequently the first on the scene of such incidents. Could the minister engage with the cabinet secretary for justice regarding police officers routinely carrying naloxone, please? Jo FitzPatrick. I thank the member for the question, which is a very important one. He is absolutely right that right across Scotland and probably particularly in rural areas, police will be the first person that will come across someone who is experiencing an overdose. I know that discussions are on-going and I understand that there has been positive noises coming in relation to the proposal that Mr Finnie, the suggestion that Mr Finnie makes and so on. I hope that there will be a positive announcement on that soon, because naloxone is something that Scotland is ahead of the curve in making it routinely available. I have personally undergone the training that is required to be able to administer naloxone. I have two of the members of my office, so we have a naloxone kit in the office that is in the town centre in Dundee. I encourage anybody else who thinks that their office is in the right location to consider to service managers to see if they might extend that as well. Police are a very good point. David Stewart. Thank you, Presiding Officer. Does the minister share the view of alcohol-focused Scotland that a new public health supplement provides substantial additional funding for addictive support services in the Highlands and the rest of Scotland? Parliaments have already approved that by passing the Alcohol Accenture Scotland Act of 2010. Surely the time is right to provide additional funds to help to offset the significant cost to the public sector of dealing with the consequences of alcohol harm. Joe FitzPatrick. The member makes this point almost on a weekly basis in the chamber, and he is right. That is something that the Government and certainly myself personally are very sympathetic to. The argument is that, with the introduction of minimum unit pricing, there may be a potential windfall. I think that the point that I have made to the member before is that we need to see what that windfall is. I hope that there is not a windfall because I actually hope that alcohol consumption goes down so that there is not that windfall. However, if there is, I think that that would be the point when we have that assessment to consider what any further movement should be. Mark McDonald. Mark McDonald. I ask the Scottish Government what steps it is taking to improve adult oral health. Joe FitzPatrick. In January this year, we published the Oral Health Improvement Plan. The plan sets out the strategic direction for NHS dentistry, building on the considerable achievements that were made around child oral health and access to NHS dentistry. We will be introducing a new programme of preventative care and we will, over time, be introducing an oral health risk assessment for adults. We also have a programme for government commitment to provide new oral health domiciliary care services, which will be rolled out next year. Mark McDonald. I thank the minister for his answer. Mouth cancer deaths in NHS Grampian rose in 2017 from 21 to 28. Late presentation is often a factor. My father ignored an ulcer in his mouth as something that could be dealt with later. Later turned out to be too late. What steps can the Scottish Government take to encourage people to check their mouths regularly and to seek medical advice at the earliest possible opportunity if they notice anything at all unusual? Joe FitzPatrick. I recognise the member's personal interest in this subject. The early detection of oral cancer lies at the centre of our proposals. The focus on the Oral Health Improvement Plan for adult patients is to introduce a more preventative-based system for NHS dental care. That means that, over time, we will be introducing the oral health risk assessment that I mentioned in my first answer. We have envisaged in the Oral Health Improvement Plan a new system of preventative care at the centre of which is that assessment of adults. That is a considerable enhancement on the current check-up regime where patients will receive tailored services on how to manage and look after their oral health, including advice on lifestyle factors such as smoking and drinking, which are clear risk factors associated with oral cancer. As well as maintaining the free NHS dental checks for patients, we have also taken the lead on public health measures such as being the first country in the UK to announce our intention to implement, as soon as practically possible, an HPV vaccination programme for adolescent boys. Question 5. Neil Bibby. To ask the Scottish Government when it last met NHS Greater Glasgow and Clyde and what issues were discussed. Ministers and Scottish Government officials regularly meet with representatives of all health boards, including NHS Greater Glasgow and Clyde, to discuss matters of importance to local people. On Monday, I met the chair of that board. Neil Bibby. A young constituent of mine in Paisley, who is suffering from a severe ear infection, has had an operation planned for later this month, cancelled due to the closure of the central decontamination unit in Glasgow. She now faces an extra month of agony when she should be studying for her prelims. Another Renfrewshire woman has been told that she will have to wait for an ear, nose and throat appointment as an outpatient for 52 weeks. The target is 12 weeks. An FOI passed to me shows that only once have Greater Glasgow and Clyde managed to see more than 70 per cent of patients within 12 weeks. In August, the target was only met in 41 per cent of cases. Does the health secretary believe that any of that is acceptable? What will she do to ensure that patients in Renfrewshire and the west of Scotland get the treatment for ear, nose and throat conditions that they are entitled to? Jeane Freeman. Thank you, Mr Bibby, for that supplementary answer. As he will know, I have put on record many times in the chamber and elsewhere that I find such long waits completely unacceptable. I am very sorry personally for the distress that it causes his constituents while any other patient who is waiting longer than they should for the treatment that they require. The waiting times improvement plan is precisely designed to try and address, with effective action, targeted action, as we touched on earlier, backed by significant additional resources to reduce those long waits and to tackle the areas where we have particular challenge, either in terms of capacity, in terms of physical capacity but also in terms of workforce capacity where we may need to do additional work in order to secure the specialisms that we need. I believe that, when I introduced that plan, I undertook to report to this Parliament against the trajectories that it sets out, and I will continue to do that. Of course, I am very happy to keep individual members up-to-date on the relevant propositions that are coming from boards in their area and which the operating board that I mentioned earlier is approving. I finally do approve them myself, which are very specific actions that are designed to produce specific results and backed by a particular amount of money and monitored, as I described. If supplementaries are fairly short, we can get through more, anywhere else. Thank you, Deputy Presiding Officer. Last week, I was contacted by Anne Hughes, a 75-year-old lady who was unable to visit the out-of-hours GP services at Glasgow's Queen Elizabeth hospital due to staff and shortage in 1 December. I am trying to rush now. Instead of being able to access the A&E services at the hospital, she was told that she had to go to the Royal Alexander in Paisley or the new Victoria hospital and not arriving home until 10 hours after first seeking medical assistance. Can the cabinet secretary confirm that action is being taken to guarantee out-of-hours care as available at all times to patients in her country's largest health boat? Jeane Freeman, I am grateful to Ms Wells for that question. As it happens, I came before this session from a longer discussion with Professor Lewis Ritchie, who, as you know, has undertaken work on out-of-hours services to be updated by him on where we are at the moment. Our out-of-hours services across the country undoubtedly are displaying some degree of fragility and we need to be taking action that we are doing and planning more in order to strengthen that, but it is part of the whole system. It links very strongly to accident and emergency, but it also links very strongly to where we are in terms of our integration of health and social care. It is that whole system approach that we are trying to drive forward very fast. In the case of A&E, A&E most recently across the country, all our sites have seen a significant increase over what is expected at this time of year in the number of those who are attending. Part of that might be because of out-of-hours services. Part of that is to do simply with the nature of the weather and we are doing some investigative work to try to understand who are those additional attendees and what might be done, but I completely appreciate the point that she makes. For that individual who contacted her, she is absolutely right that that length of time and that further additional travel is completely unacceptable. I can assure her that we are looking in detail at what we might do, and I am very happy to discuss with Ms Wells the specific actions around out-of-hours that we are taking. Shorter answers would be helpful too. To ask the Scottish Government what progress it is making with its plan to equip an additional 500,000 people with CPR skills by 2020. Joe FitzPatrick. The Scottish Government is working in partnership with Save a Life for Scotland. It has provided CPR for learning for approaching 300,000 people since the launch of the out-of-hospital cardiac arrest strategy in 2015. It is on target to reach the 500,000 target by the end of 2020. Last week, the Eastern Bartonshire Council committed to training all secondary pupils in life-saving CPR and is the 14th local authority in Scotland to do so. In addition, the British Heart Foundation Scotland is offering to equip every local authority school with a free CPR training kit. Will the minister join me in encouraging all remaining councils to offer this training? Joe FitzPatrick. Yes, I will. It is really encouraging that those local authorities have committed to CPR training for their secondary school pupils. I really appreciate the contribution that communities and schools are making by purchasing defibrillators. They are taking a huge step towards creating a country of lifesavers and contributing to Scotland's out-of-hospital cardiac arrest strategy. We welcome the efforts of all of our partners to help to introduce CPR to everyone, particularly our young people. We know that the British Heart Foundation is doing a great job in supporting schools with their call, push, rescue kits and heart starts training programme. Stuart McMillan. Can the minister highlight what the Scottish Government is doing to increase the number of defibrillators across the country and the need to register them with the Scottish Ambulance Service? Joe FitzPatrick. I think that we would certainly encourage the access and the roll-out of defibrillators for public access defibrillators across Scotland, but I think that the point that the member is making about knowing where they are is very important. We know that it is prompt access to defibrillators is vital. As part of our strategy, the Scottish Ambulance Service public access defibrillators register is the arrangement for defibrillators to be mapped, maintained and accessible to the public. That enables the Scottish Ambulance Service call handlers to direct a caller to the location of a cardiac arrest to a public access defibrillator when one is near. A critical element of that is for members of the public, communities, businesses and other partners responsible for public access defibrillators to register the details, so I would encourage people to do that. To ask the Scottish Government, in light of the development of new tools for HIV prevention and treatment, what action it is taking to update its 2050 to 2020 sexual health and blood-borne virus framework? Jo FitzPatrick. I am delighted at the developments that we have seen since the update was published in 2015, including Scotland being the first part of the UK to make HIV prep available through the NHS service. Work to develop a further update to the framework will begin next year with officials engaging with a wide range of stakeholders to identify areas for further action with a view to publishing an update in 2020. We will adopt a co-production approach that was taken in the past, which has supported the progress made across Scotland such as recently exceeding the United Nations 1990 target for HIV. I am happy to engage with the member and others across the chamber who have a particular interest in taking this work forward. Patrick Harvie. I am grateful to the minister for the answer. I am aware that I am asking this question well in advance of the development of a successor to the framework that runs to 2020. That is deliberate, because we now have not only prep pre-exposure prophylaxis, but also effective post-exposure prophylaxis. We have levels of treatment now that not only lead to HIV-positive people living long, healthy lives, but the level of viral load being undetectable and the virus being untransmitable. Given the developments, there are many people in the field who feel that it would be appropriate and possible to set a target of zero new HIV transmissions in Scotland. Will the Government seriously consider putting that into the next framework update? Joe FitzPatrick. First of all, it is important to re-emphasise the message of U equals U. That is a really important message for us all as politicians to spread as wide as possible because it says to anyone who is afraid of having that test because they think that it is a life sentence that there is treatment and the treatment will lead their viral load to be undetectable and that therefore makes it untransmitable. That is a really important message. It is correct for us to be ambitious in this area. The Scottish Government supports the ambition of zero new HIV infections and I am happy to work with the HIV community and the member and other stakeholders to look at what would be required to take us to the point where we would have confidence to put that into our new strategy, but I think that it is an ambition that I think that across the chamber we will all share. Short supplementaries and answers, please. Mary Fee, followed by Ruth Maguire. Thank you, Deputy Presiding Officer. HIV Scotland estimates that 13 per cent of people who have the virus are unaware of their status. What action can the Government take within the sexual health framework to raise awareness of and reduce this worrying statistic? The good news is that the progress that we have made means that now that figure that Mary Fee talked about that was 13 per cent is now down to 9 per cent. That puts us ahead of international targets on that, but absolutely we want to get to the point where everyone knows their status. It is not a difficult test for people to get and I think that the U equals U message is one that says to people that there is a really good reason why you should get that test because it is treatable. We just need to keep making that message to get people to encourage them to go and get the test. We also need to look at new and innovative ways to go out into communities and to identify people who may be at risk and encourage them to get the test. HIV prevention drug PREP is currently almost exclusively accessed by men. A third of all people living with HIV are women. Can I ask the Scottish Government what is being done to redress the imbalance of access to the drug? It is important to be clear that PREP is available to women and it is right that women who are high at risk of becoming HIV-positive should have access to it. The member is absolutely right that there is a lack of awareness that has resulted in a lack of uptake. There are organisations out there such as Waverley Care, the Scottish Drug Forum and organisations that receive funding from the Scottish Government that are working to raise awareness of PREP to women who may benefit from taking it. It is important that we recognise the work of the third party organisations in going out and finding communities who are at risk and making sure that they are aware of their right to PREP. To ask the Scottish Government when it last met NHS Fife and what issues were discussed. Jane Freeman I chaired the NHS Fife's annual review on 3 December and discussed a number of matters with the area clinical forum, the partnership group and patients and carers and also with the chair and chief executive concerning the board's performance and its improvement plans. On Monday, I met the chairs of all the health boards, including NHS Fife. Claire Baker Thank you. The cabinet secretary will be aware that there are currently 18 GP practices across Fife with full patient lists, including all of those in Cercodi and Loggelli and most of those in Dunfermline. According to NHS Fife, seven surgeries are experiencing recruitment difficulties with two considered to be at high risk. I recognise that we have seen a small rise in the number of GPs compared to this time last year, but yesterday it was revealed that compared to a decade ago, we still have fewer GPs but far more patients. Can I ask the cabinet secretary what guarantees she can give that the pressure on Fife GP services will ease in the interests of patients and when? Jane Freeman As Ms Baker recognises, that is an issue that is affecting GP practices in other areas as well. Since 2017, there has been a 10 per cent increase in GP recruitment fill rate. There are currently 352 doctors in GP training posts across Scotland. We have also introduced, as she knows, the £20,000 GP training bursary incentive to attract doctors to placements that have previously been hard to fill. Our new ScotGem programme for graduate entry level to medical training is located largely in Fife, co-located with the University of St Andrews and Dundee, and that is specifically focused on a GP career. We are working hard to increase the number of GPs that we have available to us and the number of GP training posts. In addition, the new GP contract looks to introduce a multidisciplinary team to those general practices in order to ensure that GPs are freed from some of the bureaucratic work that they have in the past and up-to-date have to endure, but that they are freed in terms of their time to deal with the complex issues that we need them to deal with as the local clinical leader that they are. Willie Rennie The health secretary will be aware that I oppose the proposals to close the GP out-of-hours facility in St Andrews. The decision on that will be made by the Fife health and social care partnership on 20 December. Does the health secretary agree that it would be sensible to give further time to consider new options for the provision of the service in North East Fife? Jeane Freeman Mr Rennie and I have discussed that on previous occasions. Indeed, he has a member's debate tomorrow that I am looking forward to taking part in. I absolutely understand the concerns that have been expressed by a significant number of people in North East Fife. I think that it would be wise to wait for the proposals that are taken to that meeting on 20 December before we jump to conclusions as to what might happen in that area. Brian Whittle To ask the Scottish Government what it is doing to ensure that sport and physical activity are available to all irrespective of background or personal circumstances. Jo FitzPatrick The Scottish Government believes that there should be no barriers to participating in sport. Everyone should be able to participate in and enjoy sport whoever they are and whatever their background. In July, we published Active Scotland delivery plan that sets out our aims to enable people in Scotland to be more active with a key objective to decrease inactivity in adults and teenagers by 15 per cent by 2030. Brian Whittle Thank you. We have some magnificent national stadium venues in Scotland's cities. However, with so many local venues closing their doors, access to special and rural communities is a little more difficult. Does the minister agree with me that the most viable route to access in sport and activity is by utilising the Scottish School of State more efficiently? Jo FitzPatrick I think that the member makes a good point, and the member knows that I agree with him on this point. I think that community access to sporting facilities are very important, which is why there has been significant investment from sport Scotland in our community sports hubs up and down the country, making sure that sport is accessible at that community level, particularly targeting that resource at the more deprived communities, at people from sections of the communities who are less inclined to participate in support. We are also looking at targeting resources to encourage more women and girls to be involved in support. However, it is a partnership. We do not run schools, so the partnership with the Scottish Government, Sport Scotland and our local authorities and community groups all need to work together to get it right. If we get it right, we can make a real difference in terms of the health of our nation. I think that that is a goal worth aiming for. Question 11, Richard Lyle. To ask the Scottish Government what authority the NHS has to stop family members from visiting a patient in hospital. People should normally be able to see the friends and family members who are important to them while they are in hospital. The NHS has authority to stop family members visiting someone in hospital when this is the expressed wish of the person, when the family member has been abusive or is presenting a risk to staff or other patients or for sound clinical reasons. Richard Lyle. I thank the minister for that answer. One of my constituents have tried to see their daughter in hospital for several months but have been stopped at the entrance of the ward after being told that there was a police investigation. They spoke to Police Scotland who said that there was no investigation. I have written to the local health board regarding the case and recognise the limitations of the minister's response. However, could I ask the minister to ask health boards to ensure that families of patients are treated correctly in future and that information is up-to-date as this is causing severe distress to my constituents? As Richard Lyle acknowledged in his question, I am limited in what I can say and I cannot comment on that individual case. I would normally expect staff to take that decision at the request of the patient but there may be some small number of cases where a family member is prevented from visiting for other reasons. Health boards should always ensure that patients and their families are treated correctly and if your constituent feels that this has not been the case then I would encourage them to raise this directly with the board. The Patients Rights Scotland Act 2011 provides a specific right for people to make complaints and raise concerns, make comments and give feedback about the care that they or a family member has received from the NHS and that the patient advice and support service exists to help them. The act also places a duty on NHS boards to thoroughly investigate the issue and to take improvement actions where appropriate. Question 12, Jeremy Balfour. To ask the Scottish Government, in light of the recent figures, we are reportedly showing that the number of doctors in training in Scotland is at a five-time low how it plans to address issues with GP recruitment. Jane Freeman. I am grateful to Mr Balfour for the question. I think that the figures that he is referring to come from the most recently issued figures from ISD. I would make the point to him that, he needs to look at two lines in that particular set of figures, both doctors in training and other grades. If he looks at both of those lines between 2013 and September 2018, he will see an overall increase in that. The reason why I am asking him to look at both is because, under other grades, it is where we have doctors in training, but they are doctors who are also clinical fellows and they are doctors who are locums as well as in training. You need to take both of those figures together in order to understand what the real picture is. Of course, Mr Balfour will know that I am not the least bit complacent about our workforce numbers and about the work that we need to do to increase the accessibility and the capacity that we have across our whole health and social care workforce. Without repeating myself, because I know that you are keen that we move on, I would make the point that Scottish GP recruitment has seen a 10 per cent increase. We have other measures that I talked about in terms of the bursary, the ScotGem course, the increase in the number of medical undergraduates and the specific focus in some of those programmes on GP training, particularly in the remote and rural areas. In terms of the further detail on that, again, I am very happy to talk to Mr Balfour outside of this session to take him through the specific measures. I thank the cabinet secretary for answering questions for my members by having a number of close family members who are doctors and also training to be doctors. The cabinet secretary makes some interesting points, but the programmes that were created in 2015 and 2017, and in the summer of this year's, are overall simply not working. Would the cabinet secretary not agree that a radical new action is needed to get more doctors and more GPs working here in Scotland? It is an interesting proposition. It falls down by not telling me what that radical new action might be, so I am a bit stuck to say whether or not I agree that there is a radical new action. I think that we are taking a number of steps. I would remind the member that you do not produce GPs quickly—quite rightly, you do not produce them quickly—because you want them to undergo extensive training both as undergraduates and then as graduate medical doctors in training to go through all those measures. However, I would also remind him that we are talking about a health and social care workforce across a whole system. The GP contract is specifically designed, negotiated with and agreed with the BMA GP group in order to ensure that our GPs in particular can come forward as the local clinical leaders that they are with that multidisciplinary team so that we can focus their highly specialised and important skills on the patients who need them most. In the absence of detail on a radical action, my answer to that is no, I do not. Does the cabinet secretary agree that the biggest threat to our NHS workforce is the danger that Brexit poses to the staffing of Scotland's NHS, as reported in the new survey of EAA doctors by the British Medical Association? Yes, I absolutely do. I am sorry that the members to my left here—purely in the geography of this chamber—are grown about that matter, because it is self-evidently the case. When the UK Government will not assist this Scottish Government in meeting our objective of paying the resettlement fees—a ridiculous proposition for people who live and contribute to our country—who will not assist us in meeting those resettlement fees in order to demonstrate, in the practical way that we can, in the absence of any other half-decent powers, that those individuals working in our health service are welcomed and valued and we want them to stay. To ask the Scottish Government what progress has been made in repatriating ophthalmology services from NHS Grampian to island health boards. Jeane Freeman, as the member will know, NHS Grampian provides a visiting ophthalmology service to NHS Shetland every two months. The multidisciplinary team provides four clinical sessions over two days, but some treatments, however, require patients to travel to Aberdeen to receive their care. A meeting has been scheduled between NHS Shetland and NHS Grampian for January 2019 to discuss the provision of those services on Shetland and actions to progress this, including whether services can be sustainably delivered in Shetland in the future and associated timelines will be agreed at that meeting. I am grateful to the cabinet secretary for that reply. Will she recognise that there are now some older people in the islands in Shetland who now do not travel to Aberdeen for essential eye injection simply because of the disruption, the travel and the difficulties that that means for people undertaking that visit? Will she therefore redouble those efforts to make sure that, when that meeting happens, it makes decisions about ensuring that this essential services service can take place in Shetland to the great benefit of those elderly people in particular? Jeane Freeman, I recognise the issues that the member raises and I will take a personal interest in how that meeting progresses and what actions it agrees to and the timelines that it sets and ensure that Mr Scott is made aware of those. To ask the Scottish Government what assessment it has made of the effectiveness of the power of a ternian health cases. Claire Hawke We recently undertook a consultation on making changes to the adults with incapacity legislation. We know from that work that using powers of attorney can encourage people to think through how they might want their health, welfare and financial affairs to be managed in the future if they are unable to make decisions themselves on those matters. That means that adults who use powers of attorney are better placed to be as involved as possible in decisions about their lives even if their circumstances change. John Finnie I thank the minister for that reply. Does the minister believe that their sufficient checks and balances are in place for all parties when a public body seeks to take over a power of attorney? Claire Hawke As I alluded to in my previous answer, there certainly is a review of the adults with incapacity act on going. I am sure that that will be a subject that will be reviewed during that. Bill Bowman I will take question 15, because I know that it can be a short answer. To ask the Scottish Government what progress it is making with its plan to equip an additional 500,000 people with CPR skills by 2020. Jo FitzPatrick I refer the member to my previous answer to Rona Mackay. As we heard earlier, British Heart Foundation Scotland is offering to equip every local authority school with free CPR training kit, and training takes less than 30 minutes to complete. The Scottish Government has now made LGBTI education compulsory on the curriculum. Will it not do the same for life-safing CPR when international evidence shows that doing so has the potential to triple survival rates from out-of-hospital cardiac arrest? Jo FitzPatrick It is fantastic what the British Heart Foundation is doing. It is great the work that schools up and down the country are making, but ultimately it is for schools to decide when it is appropriate for them to provide this support. Jo FitzPatrick That concludes portfolio questions on health and sport, and we will move on to the next item of business.