 yn wel accommodate'r cwysbeth o leyryn dangos ac sgwais eu bod wedyn ei fwyadwyr i dyddol iawn. Final yDyw… Mae'r First Minister hwnna i chi'w cyfeilio amser erioedd wide'r gweithiau. Mwys gehtd y gallwn cyfreith Joe Scott bron gilydd fathorol gyfahrig gyda'r cyfeilio. Mae Hedd изв Consortiaeth Ysgrifennidogaeth ydyn nhw hwnna ti'w nodio mawr, fish in gör detydleadwn, ond she has been a senior Government minister for more than eight years, including five in charge of the NHF. The First Minister wants is to judge the SAP Government on its record, and today, of all days, we should do exactly that. Now, everybody in this chamber knows somebody who has been affected by cancer-it's a horrible disease. Perhaps the most commonuest thing being the elderly people. pobl yn gwyfnneidd ar y maes. Mae'r drwyysig wedi ei ffordd sig yn cael ei gael. Rhaid i ni'n uch affects i ffasgfainteriaeth ac ar y sefydledig, rhai i mae hyn yn cael ei gael. Rhaid i ni'n rhaid i ffaith gwych oedd ymlaen ni'n wlad i'i'r yswun gan ymladeg? Rhaid i ni'n rhaid i ni'n rhaid i mi gael i chi fod yma yn rhaid i chi'n rhaid i chi fod a chansof. Yr y ffordd pan fyddai errig yn rhoi'r gael ymlog yn y gwaith mae'n gweithio ychydig oedd in our most deprived communities are more likely to die younger from illnesses like cancer, from stroke, from heart disease. That didn't start when the SNP came to government, Presiding Officer. That's been something that has been true for generations. What is equally true is that this government has been working hard, as I think it's fair to say previous governments did, to close that gap. To see rates of cancer decrease, to see survival rates from cancer increase. That's why we have policies not just about getting people access to the best cancer treatment. One of the things that we've done in the last year, since I've been First Minister, is double the fund for new cancer medicines a step in the right direction. It's also why we've put such a great priority on innovative, ambitious public health measures to improve people's diets, to cut the incidence of alcohol misuse, to reduce smoking. Those are the kind of policies that, frankly, it shouldn't involve party politics. Every single member of this chamber should get behind these things so that we see far, far fewer people in all parts of our country die from cancer. Nicola Sturgeon has been responsible for our NHS in one way or another for six out of the last eight years. The reality is that, in Scotland today, the likelihood of someone getting cancer too often depends on how much money they have. Those new statistics show that people living in the poorest areas are 32 per cent more likely to have cancer than those from the wealthier areas, and they are 68 per cent more likely to die from it. That's just not right. This is 21st century Scotland, not the Victorian times. I have never doubted the First Minister's sincerity, but this job needs a bit more than that. The Government's cancer strategy was due to be published at the start of this year, but it has been repeatedly delayed. Can the First Minister confirm when her Government's cancer strategy will be published? The cancer strategy will be published in the spring of next year. We're working with stakeholders across the NHS, including some of the best cancer clinicians in the world, that we are lucky to have here in Scotland to make sure that we get that strategy right, such as the importance of this particular issue. Kizia Dugdale said that the fact that people in our poorest communities are more likely to die from cancer is not right. I absolutely agree with that. It wasn't right when Labour were in office and it isn't right now. That is why we are working so hard to reduce deaths from cancer. We saw figures published this week that show that overall cancer death rates have dropped by 11 per cent in the past 10 years. Overall cancer mortality in 2014 is the lowest and rates for cancer from breast, long stomach and colorectal cancer are dropping as well. Those are things that all of us should take great optimism from, but the job is not done. That is why we are working to lower cancer waiting times. Interestingly, Labour set some of the current cancer waiting times. It never once was met when Labour was in government. We are working to reduce cancer waiting times. We are working to make sure that we get more people into screening programmes. That is why we are investing £30 million in detect cancer early programmes so that people come forward earlier when they have symptoms and get diagnosed earlier. The earlier people get diagnosed, the more chance they have of surviving. I would say to Kezia Dugdale in all seriousness that this is far too important for party political arguments. Let all of us unite to say that we want to see an end to the situation in which people in our most deprived communities are more likely to die of cancer. I think that that is something worth uniting around. Kezia Dugdale, Mr Dugdale. There is no doubt that we welcome that progress, but the reality is that that progress is largely happening in the richer parts of Scotland, and that is why we need a cancer strategy. The English NHS has a widely recognised and welcome plan to fight the disease. We need the same here. In Scotland, we have a system that is failing those most in need. 66 per cent of eligible people in the wealthiest areas are taking up bowel cancer screening, yet the figure was just 45 per cent for people in the poorest areas. The most recent figures show a decline in the number of women in poorer communities getting screened for breast cancer. That lower rate of screening is one key reason why people from the poorest backgrounds are more likely to die from cancer. Does the First Minister agree with me that, without dramatic Government action, we could be in danger of seeing cancer as a deprivation disease in Scotland? I agree that serious Government action is needed to improve early diagnosis of cancer. That is important for anybody who has cancer. Obviously, with the statistics that Kezia Dugdale has quoted, it is even more important that we get people from our most deprived communities into a diagnosis as quickly as possible. That is why this Government is investing £39 million in our detect cancer early programme. That programme has already resulted in a 4.7 per cent increase in early stage diagnosis of cancer, alongside a 50 per cent increase in women consulting their GP with breast symptoms and increased uptake of the national bowel screening programme. That is the kind of serious concerted action that we need to see from Government. Over the year that I have been First Minister, I have said on many different occasions that if anybody in this chamber has suggestions to make about things that they think this Government should be doing to further improve, I am happy to listen. In all of what I have just heard from Kezia Dugdale, I have heard not one specific suggestion of what it is that she thinks this Government should be doing. We will continue to do the work to get people diagnosed early, to encourage people to come forward, to make sure that we are giving people access to the best technologies and the best drugs, to make sure that we are lowering cancer waiting times and to make sure that we are doing all the things that we need to do to improve the public health of people in Scotland in every single part of our country. Kezia Dugdale. Presiding Officer, with respect, Dr Richard Simpson has come into this chamber for years and pushed this Government to be more ambitious when it comes to the cancer strategy. We need an NHS that is fit for the future. That means an NHS ready to tackle the challenges of the 2040s, not the 1940s. We need that bold action, but it is just not happening. Let's look at the First Minister's record. 16 years as an MSP, eight years as a minister, seven years as Deputy First Minister, five years in charge of her NHS and this morning she had the cheek to say that she's only just getting started. Week after week, no matter what the issue, no matter the feelings of her family, the First Minister always goes to tell me about her opinion poll ratings. Clearly, she thinks that that answers the question. I actually think that it poses a question. With her opinion poll ratings, with her majority, with all her power, what exactly is she waiting for? First Minister? I'm not sure opinion polls are the strongest suit for a party that is now in a scrap for second place in Scotland with the Conservative Party. Since Kezia Dugdale has raised the question of opinion polls, opinion polls show that people trust the SNP more with the national health service than they trust the Labour Party or any other party in Scotland with the national health service. We'll continue to get on with the job. We've seen cancer death rates fall by 11 per cent. We've seen, as I've just said, an increase in early stage diagnosis of cancer. We're seeing an increase in the number of people coming forward for diagnosis by their GP and coming forward for screening. We're working hard to make sure that we've got the best cancer centres. We've got five state-of-the-art cancer centres in Scotland. We're investing in state-of-the-art radiotherapy equipment in every single one of them. We'll continue, Presiding Officer, with the consent of the Scottish people to get on with the job and will leave Labour as it has been doing for so many years now, carping on the sidelines and slowly but surely getting beaten in Scotland, not by the SNP but by the Tories. Question 2, Ruth Davidson. Thank you, Presiding Officer. I'd like to thank the First Minister for her electoral endorsement there and ask her when she'll next meet the Secondary of State for Scotland. No plans in the near future, but I've got a thank you to Ruth Davidson as well. I'd like to thank her for making sure that I got a copy this morning of the internal Tory lines to take for the day. We've got nothing to say about David Cameron's new taxpayer-funded private jet, but nevertheless they were very helpful. I'll take it as a wee anniversary present. On Tuesday, a parents group called Fair Funding for Our Kids met the education secretary to ask for some basic details on how the SNP Government plans to meet its pledge to double nursery entitlement. They left that meeting so frustrated that they decided to speak out as Angela Constance was unable to provide even ballpark figures on how that pledge could possibly be met. They wanted to know that if this Government is to double child care by 2020, how many extra places that will take, how many extra staff need to be hired, how many apprenticeships to train new staff, how many more nurseries need to be built, how much money will this cost, and where is it going to come from? They say that Angela Constance could not answer a single one of those questions. It will cost £880 million where that will come from and will be set out in our budgets. It will take 20,000 additional staff. That will be a mixture of college places and apprenticeships. We're currently working with local authorities to determine the expansion of capacity that will be required. That will be a mixture of new build and extension of current local authority capacity. I noted with interest the pressure lease at fair funding for Our Kids put out yesterday a group of parents that I think are to be commended for their determination around this issue, but they say that there aren't enough places now to deliver our policy of doubling child care. That, I have to say, is the case. That's why it's a commitment that we've made to double child care over the next five years and to invest more than £800 million in delivering that. I think that that is a commitment parents in Scotland will want to get behind. We know where the SNP stands. We're going to double free child care over the next Parliament. The question is, what's the Tory policy? Ruth Davidson? More flexibility, and we'd love you to take it up now. I'd like to thank the First Minister. Arddur, Arddur, Arddur, Ms Davidson. I'd like to thank the First Minister for giving everyone the answers that her education secretary seemed unable to find yesterday. There's a reason that the mums were asking her these questions. It was this. It's because they've gone to potentially the biggest of the childcare providers, Glasgow City Council, and they've been told that the Scottish Government's plans are, and I quote, impossible. The First Minister knows this because the mums wrote to her on 23 September telling her, I have the letter here. We spoke to this parents group yesterday. They believed the Government a year ago when it said it wanted to help, but they now feel utterly disillusioned and have lost all trust. For the last year, the First Minister has enjoyed the headlines, but eventually she's going to have to start delivering. These parents no longer believe that she will, so what is the First Minister going to physically do to restore that trust? Physically do is invest £800 million to build the capacity in our system to double the provision of free childcare. Ruth Davidson is going to give more flexibility. She might have heard me a few weeks ago say that flexibility will be built into our policy so that parents can take their eligible hours, not just during term time but during school holidays as well. There can be more flexible ability to fit that in with the working patterns that parents have. That's the ambitious plans that this Government has. Let me tell Ruth Davidson what the chief executive—no, she might want to listen to this—the chief executive of early years Scotland has to say about it this very day. They welcome the Scottish Government's commitment. Yes, they say that there are challenges, but they say that they know that they are sure that with our exceptionally dedicated workforce and downright determination to give every child the best start in life, we will work together to ensure that this laudable ambition becomes an everyday reality. Double childcare provision, that's the everyday reality that this Government is going to deliver. To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. Matters of importance to the people of Scotland. Willie Rennie The timetable for the Government's national testing for schools has slipped. The Government now expects MSPs to scrap the existing system before details for the new tests are even published. We have seen a cost estimate of £12.5 million. That could be used for 400 teachers instead. The First Minister told us that she was against crude league tables, but the EIS warned this week that if she carries on, league tables will be back. For a flagship policy, all that's a shambles, isn't it? The First Minister No, it's not. I think that there is a disagreement between myself and Willie Rennie, and there's disagreements between myself and Willie Rennie on many things. However, I want to make sure that we are raising standards in our schools. I want to make sure that we continue to close the attainment gap in our schools between children in our least deprived areas and those in our most deprived areas. I want to make sure that parents have the information that they want about their children's progress, and I want to make sure that I've got the information that I need, First Minister, to assure the country that we're making progress on those aims. I'm not interested in the return of league tables. I'm not interested in high stakes testing that has teachers teaching to the test, but I don't think that it is acceptable that we can't have that information in primary schools and in early secondary schools to know whether the action that we are taking, such as the £100 million attainment challenge, is working to deliver the objectives that we've set. Willie Rennie and I will continue, no doubt, to debate this, but I'm on the side of making sure not only that we're driving upstanders in our schools and closing the attainment gap, but that we're able to evidence the fact that we're doing so, and I make no apology for that. She repeatedly says that she's not interested in crude league tables, but she's not going to do a single thing to stop them happening. Information requests gathered by common space have shown that the Scottish Government only had four emails with advice on national testing from only two people, and they each had reservations. That's why I think that it's quite right to say that this is a shambles. Poorly informed, badly led, set to divert money from teaching, bringing back crude league tables. There's growing opposition from parents, teachers and unions. She says that she's consulting, but are there any circumstances that the First Minister would abandon those plans? No, I'm not going to abandon those plans, because I think that those plans are right. I want to see her raise standards, close the attainment gap and have the ability to evidence that we're doing that. Yes, we're talking to teachers and to parents as we develop the national improvement framework, and Willie Rennie, if he's taken the time to read it, will know that the proposal for assessments that are already carried out in 30 out of 32 local authorities are part of that national improvement framework. We're talking to teachers and others about the timing of the assessments to avoid the high stakes teach-to-the-test approach that many people, including me, are against. We're talking carefully about how we use the information so that we can avoid league tables that nobody wants to see a return to. I will not apologise for wanting to make sure that I'm able to stand up in the chamber and tell other members and tell the country at large what is happening in our schools and for giving parents access to the information about the progress of their children in schools. Those are assessments not to replace teacher judgment, which is at the core of curriculum for excellence. Those are assessments about informing teacher judgment. It's the right thing to do. We'll continue to talk to others about it, but we'll get on with the job of making sure that we are raising standards in our school, which is what people across the country expect us to do. To ask the First Minister what steps the Scottish Government is taking to promote early HIV testing. It's vitally important that those who are at risk of having contracted HIV are tested promptly. That's why we have reiterated our commitment to promote early HIV testing in the revised framework that was published in September. The Government is providing more than £28 million this year to support NHS boards and third sector organisations to deliver that framework across Scotland. Importantly, the framework includes funding to tackle the stigma associated with HIV infection, because that stigma is still one of the greatest barriers to people getting tested early. I thank the First Minister for that answer. She will be aware that Waverly Care, HIV Scotland and the Terence Higgins Trust have stated that the barriers to HIV testing do indeed include stigma, fear and lack of awareness. Looking ahead to European HIV hepatitis testing week, does the First Minister agree with me that having postal testing initiatives, like the fast test service from the Terence Higgins Trust, can help to overcome those barriers, raise awareness of early HIV testing, ensure those who have tested positive receive the treatment that they need as soon as possible and ultimately help to prevent needless deaths? Yes, I agree with that. I hope that people across the chamber will agree with that. HIV postal tests are available to any adult living in Scotland through the Terence Higgins Trust website. Confidential testing is also provided by Waverly Care in some parts of the country, and we have changed the law so that the sale of instant results and self-testing kits is now legal. Those arrangements complement NHS provision, but they can be particularly helpful for individuals who are nervous about approaching their GP or sexual health clinic for a test. It is absolutely vital, and Jim Eadie is right to raise that as an issue, that we do everything that we can to deal with and allay the stigma associated with HIV so that people are encouraged to come forward for prompt testing. To ask the First Minister what discussions the Scottish Government has had with the UK Government regarding using the new welfare top-up powers that are being devolved. Scottish Governments continue to have regular discussions with the UK Government about the devolution of social security. Those discussions happen through the joint ministerial working group on welfare and a key element of discussions at the joint exchequer committee. There are also regular discussions between officials. Deputy First Minister has also written to the UK Government to ask for confirmation that any additional or increased benefits provided by the Scottish Government will not result in the UK Government simply reducing reserve benefits and effectively clawing back the funds provided. I hope that the First Minister will eventually agree with Labour on restoring cuts to tax credits and that she will raise that in face-to-face meetings. In the meantime, there are other new powers coming to the Scottish Parliament. The cold weather payment is worth £25 a week and, of course, winter fuel payments are worth £100 to £300 for pensioner households, together with decisions about the implementation of the energy company obligation. I hope that she agrees with me that with fuel poverty at a staggering 940,000 households affecting some 2 million people in Scotland that this is a national scandal. Can I ask the First Minister, with all due respect, when will she get on with her job, fuel poverty increased on her watch and will the First Minister admit that she will not meet the pledge of ending fuel poverty by November 2016 and tell us what she will do with those new powers to help families and pensioners having to choose between heating and eating this winter? I will and we will bring forward plans to use all of our new powers in the interests of people in Scotland. Some of the powers that Jackie Baillie has listed there, for example, over the winter fuel payments, give us the opportunity to look at overall what we do to try to tackle fuel poverty. Jackie Baillie is standing there as the representative of the party that, two weeks ago, when they had the opportunity not just to vote for sticking plaster powers, but to vote for the devolution of tax credits and the devolution of the budget with tax credits, did they vote with the SNP for that? No. They trooped through the lobbies of the House of Commons with the Tories to keep those powers in the hands of Conservatives. That is the action of Labour politicians that people in Scotland are judging day in and day out. Let us also not forget that while others, to their credit, on her benches were voting for £167 billion to be spent on things that matter, not on nuclear weapons, Jackie Baillie was voting with the Tories to renew the Trident nuclear weapons programme. Jackie Baillie's credibility on the issues before today, I thought, was pretty ropey, but I think that yesterday she probably ended any credibility that she had absolutely completely. When she went to the finance committee and said, and I quote, my maths are shaky, I think that sums it up. I draw the First Minister's attention to comments made by the STUC General Secretary yesterday when he recognised the importance of the financial framework for any additional powers. To quote him, he said, it would be completely wrong for the Deputy First Minister to sign up to a mechanism for block grant adjustment, which would structurally disadvantage Scotland. Does the First Minister agree with me that Jackie Baillie and her group should heed the advice of the STUC, stop mouthing some of the UK Tory party's words and stand up for Scotland? I think that Jackie Baillie and Labour stopped listening to the STUC the day they decided to go into an alliance with the Tory party in Scotland in the referendum. Yes, I did see the comments of the STUC yesterday. Indeed, I saw the comments today of Professor Anton Muscatelli, the principal of Glasgow University, who is also warning about the dangers of an unfair fiscal framework. Those are credible, independent voices that should be listened to not just by Labour but right across this chamber. Indeed, Professor Muscatelli was a member of the Kalman commission. For our part, we have made clear that we will only support a legislative consent motion on the Scotland Bill if there is a satisfactory and fair fiscal framework agreed between the Scottish and UK Governments. Nobody, absolutely nobody, not even Labour could reasonably expect any Government to say anything else. Patrick Harvie. Thank you. If the new welfare powers are to be used successfully to tackle fuel poverty, as Jackie Baillie was asking for, they are going to have to work in concert with the money that the Government is spending on energy efficiency in the home. And yet, committee witnesses working in this sector do not appear to have had any opportunity to discuss ahead of the budget or ahead of the national infrastructure project with Government how that is going to work. Why haven't they, and when will we hear any of the details involved? First Minister. We will discuss these things as these powers are implemented now. I know that Patrick Harvie is a supporter of this, and we agree on many of those issues. Even Patrick Harvie must concede that those new powers over winter fuel payments, for example, are not going to be in place in the next financial year. We will work with stakeholders as we take over those powers to look at how we use them effectively. Patrick Harvie is absolutely right to say that it is vital, as all those powers come to Scotland, that we integrate them effectively with powers and resources that we already have. I look forward to Patrick Harvie being a key member of that discussion as we take forward those plans in the months and years to come. To ask the First Minister what discussions the Scottish Government has had with NHS 24 regarding the provision of winter resilience measures. NHS 24 published its winter plans last month. Those build on the excellent service provided to patients last winter, when more than 75,000 calls were received during the festive period, and more than 9 in 10 of those calls were answered within 30 seconds. To ensure the integrity of their winter plan, NHS 24 took the decision last week to pause the introduction of their new patient contact system. A full review is under way into the issues with the new system. I expect an initial report in December and a full detailed report in January. I thank the First Minister for that. Last month, in its update on the management of the IT contract for NHS 24, Audit Scotland said that the total cost of the future programme had risen by 55 per cent on the original cost predicted over two years ago. That increase was mainly due to the cost of delayed implementation. As the First Minister has just said, there is a further delay to the new IT system that was announced last Friday. Can the First Minister tell this Parliament what will now be the cost to the taxpayer of this mismanaged project? Can she give a categorical assurance that patient care will not be put in jeopardy this winter? Can I say to Liz Smith that she raises very important issues, and I think that it is right that they are raised in this Parliament. I think that it was very disappointing that this decision had to be taken last week, but it was taken in the interests of patient safety, which is the issue that Liz Smith is raising. Clearly, it was the right one to take in line with that. The new system has not been abandoned. I think that it is important to stress that. The implementation has been paused to allow issues to be resolved. The full review that I referred to in my earlier answer is under way, which will in itself answer many of the questions that Liz Smith has raised today. We will get the initial report of that review in December, and the full report in January. In addition to that, the health secretary has asked the chief nursing officer to provide reassurance about the plans for reintroduction. I think that it is important to say in terms of cost. The issues with the cost being higher than originally projected have already been discussed in detail in the public domain, but over time NHS 24 still considers that the new system will allow them to save costs every year. I think that it is important to bear that in mind, but I will be very happy and indeed it is incumbent on us to make sure that as this review takes place and as we get the findings of that, those findings are shared and filled with Parliament. I thank the First Minister for her detailed reply on that issue. I am slightly surprised that a large project of this sort was not—the problems were not solved at the beta testing level, but I welcome the fact that, in the interests of patient safety, it has been suspended. However, we have now had two reports from Audit Scotland, 2012 and 2015, highly critical of the Government's management of large ICT projects. The new structure is set up by the Government. I would ask the First Minister to look at very carefully, because they are the most shambolic system that I have ever seen. No business would run its IT systems on the system that the Government has set up in response to the Audit Scotland report. I ask her now to undertake to re-look at that structure. I think that Richard Simpson will have heard me say that a full review is under way. Those are serious issues, Presiding Officer. Detail plans were in place to manage the transition to the new system, including the contingency of reverting to the legacy system if that was required. Some issues impacting on performance were initially some of the issues impacting on performance. We are outwith the control of NHS 24, including issues with the wider telecommunications network. NHS 24 have apologised to patients who were affected by delays, and it is a priority to make sure that this new system is in place and working as quickly as possible. However, that must be done in a way that is consistent with patient safety, particularly given that we are going into the winter and the festive period. NHS 24 has taken the right decision here in the circumstances, but all the issues that have been raised, both by Liz Smith and by Richard Simpson, will be looked at in terms of this review. The findings, of course, as I have already said, share with Parliament. Thank you. That ends First Minister's questions. We are now going to move to members' business, so members who leave the chamber should do so quickly and quietly.