 Good afternoon. The first item of business today is portfolio questions. Question 1 is from Dean Lockhart. Maîur Tew Whiching Cymru whatnot is taking to lower outpatient wasting time Governor Secretary sooner Robison. We've seen a significant growth in outpatient numbers with over 140,000 extra patients now being seen on an annual basis compared to 2009. I announced last week that £10 million has been made available to health boards to to the ability to reduce long waits for a first outpatient appointment. That funding will provide an additional 40,000 outpatient appointments between now and the end of March. Yesterday, I also announced a consultative document to transform outpatients. The aim is to deliver a major shift in the way outpatient care is delivered. The modern outpatient collaborative approach sets a new strategy for managing the raising demand in outpatient appointments and aims to free-up around 400,000 hospital appointments. iawn i gael ei gweithio i gael y fathau maes ymlaen, yn gweithio i gael oedd yn gweithio i'r rhaglen i gael, a yn gweithio i'r gwymau yn ynnyddol. Dean Lockhart. I thank the cabinet secretary for that response. Further funding is, of course, welcome. However, as we have said on this side of the chamber a number of times, it's not just about the money that's spent, it's about having the necessary staffing resources available to deliver satisfactory outcomes for patients. Across Scotland, there are high vacancy rates in cardiology Cyngorlach han Where the vacancy rate for cardiology consultants is above national average and is currently standing at 16.7 per cent. In any case, that is having a direct effect on patient outcomes. In NHS 4 valley despite the hard work of the local staff, the longest reported rate for cardiologists was 202 days. That is nearly 29 weeks and is more than double the Scottish Government target of 12 weeks. Does the cabinet secretary make sure to urgently resolve high cardiology, consultant vacancy rates across Scotland and NHS Forth Valley and address unacceptable waiting times for patients? Richard Miller-Lefain Whywntooth The Member chatting to the world public health mae'n perthaw safefump mewn pomfail Во을 cael axis i gael ondoeufol ei wneud. Mor diplomatic disputes hefyd, ond mae'n gwneud ahaen eraill ar gyfer CEO i gael eu bap feeli vrij ac wyddwch gan y per 280 village todd nifer gwrs-failain o gael ei wneud effeithiol ei wneud gennym goingf trainings gyda'u holdersunig号 yn fwrdd oedd mae'n ddatuniaf hwnnodd mai mewn mewn darloethau. The number of consultants, medical and dental consultants is up 40 per cent over the last since September 2006 to June 2016. We have seen more consultants, more specialists. There are specialties where there are shortages. Cardiology is one of those challenges. Given that the member has raised specific issues about cardiologists in Forth Valley, i gael i felnau y ping emergency cyfnod y gwahanol wedi wneud o'r edrych o'r resusiau o'i ei ddysgu'i niat. Murray Todd. I welcome the Scottish Government investment in reducing outpatient waiting times. In the winter period, demand for NHS services is expected to increase. What support has been given to NHS boards in the winter to ensure that that acquired capacity is in place to manage the expected increase in demand? I can tell Marie Todd that I announced last week an additional £3 million which is being allocated to local boards to help support their preparations for winter. This £3 million of winter funding is designed to increase each local area's winter resilience. That's in addition to previously announced sums of money, including £9 million to support accident and emergency departments over winter, and £30 million specifically to reduce delayed discharges this year. Patient treatment following GP referrals at NHS Harnarn and now the Washington Scotland has been falling from acceptable levels to unacceptable levels for the last 18 months. I have been aware of that from the growing number of my constituents who have contacted me because they are unable to get hospital appointments with winter pressures still to come. I have raised those matters of unmet demand in different ways with the cabinet secretary over several years, and she has reasonably acknowledged this growing problem and I welcome her promise of extra funding. However, cabinet secretary, hand wringing over the statistics of misery and disappointment, which have a bearing on outcomes, is no longer enough notwithstanding the daily more frantic efforts of front-line staff to get through the work. What instructions or funding are you going to give directly to NHS Harnarn to encourage or force them to up their game? Certainly, we have acknowledged that John Scott has regularly raised local issues regarding NHS Harnarn's performance. I can say to John Scott that, of course, NHS Harnarn will get a share of the £10 million to improve outpatient performance, and that is important in the short term, creating those additional 40,000 outpatient appointments between now and March across Scotland. However, there is a more fundamental issue here, and that is at the moment that our outpatient system works, is that everybody ends up in the same queue to see a specialist, even if they would be better treated by someone else. If you look at orthopedics, for example, a lot of work has been done to make sure that those who were traditionally in the queue to see an orthopedic consultant—many are now seen by physiotherapists—because that is the best health professional to see them. What we need to make sure is that, through the reform of outpatients—whether that is in NHS Harnarn or anywhere else in Scotland—we get people into the right professional, which will mean that those who need to see a specialist will be able to see them far more quickly. Again, I am happy to write to John Scott with more detail about the allocation of the £10 million that will go to NHS Harnarn. I encourage members and the ministers to have shorter questions and answers. We will get through more. Presiding Officer, to ask the Scottish Government how long it will take to make a decision on the future of Lightburn hospital if this was to come to ministers. As the member knows, NHS Greater Glasgow and Clyde's proposals around Lightburn hospital may well change or indeed not be taken forward at all as a result of the public engagement process currently underway. That is part of the well-established process on service change and the NHS and why I cannot and will not prejudge the outcome. The time taken to carefully consider any major service change proposal is largely dependent on the nature, context and complexity of those proposals. If those proposals are designated major and come to me, I will take sufficient time to carefully consider all the available evidence and representations. Former MSP Paul Martin highlighted in January this year that there was a plan to close Lightburn hospital by referring to a health board minute in which it stated that Lightburn hospital was up for closure for what she was called a liar. In April, local MP Anne McLaughlin wrote to constituents saying that she has received an unequivocal assurance that Lightburn will not close. Given that—that is an assurance that I do not think that anyone can give, given what the minister has said—she is deliberating on the matter, so I would like to know where Anne McLaughlin got that assurance from. Is the minister concerned that the service is clearly being run down while that decision is being taken? Will she not accept an appeal from me that the people of Glasgow north-east need a third hospital to serve older people? If she is considering an option to reduce the service by closing Lightburn hospital and transferring beds to Stop Hill and Glasgow royal, it will not be an adequate solution for the people of north-east Glasgow. What I would say to Pauline McNeill on stress is that nothing has come to me. I will have to wait until Greater Glasgow and Clyde have taken through their proper public engagement process. That may or may not result in any formal change proposal, but what I would want to see and to make sure that if anything did come to me—and I was considering that as a major service change proposal—is that I would need to be convinced that it addressed some of those concerns that Pauline McNeill and others have raised, that it would be fully consistent with national policy and would improve the patient experience. I would expect any proposal, if they were to come to me to address all those issues. I would hope that Pauline McNeill and others would certainly fully partake in any consultation around those. Ivan McKee The Scottish Government's national clinical strategy calls for a shift to community-based services and to person-centred care and homeless settings. For example, a local community-based hospital in familiar surroundings and it calls to address health inequalities by moving resources into areas of high deprivation and not away from them. Can the cabinet secretary reiterate her support for those principles and that any proposal for changes to health services in the east end of Glasgow and including local community hospitals, such as Lightburn, would have to be consistent with those principles? Obviously, what I can say is that when Nicola Sturgeon rejected proposals to close Lightburn hospital as self-secretary in 2011, because she had consistently heard from both patients and clinicians that the hospital provided high-quality services and were greatly valued, but, as I said to Pauline McNeill, I would need to be convinced that any final proposals, if they do indeed emerge, effectively address concerns raised by Ivan McKee and others, that any proposals are fully consistent with national policy and, importantly, would improve the patient experience. That is the challenge to Greater Glasgow and Clyde when looking at the future of Lightburn hospital. However, as the stress has come to me at the moment, it is a very early stage of the process and I would expect Greater Glasgow and Clyde to take on board the need for them to address all of those issues. Let's be clear, days before the election, Paul Martin was called a liar for suggesting that there were plans to close Lightburn hospital. An SNP MP used parliamentary resources to write to every constituent to say that she got assurances from this cabinet secretary that there were no plans to close Lightburn hospital. It seems that the cabinet secretary is denying that that was the case. Six months later, those proposals are in black and white and that same MP, as well as the local SNP MSP, is now holding public meetings in the area claiming that they are the ones that will try to save Lightburn hospital. That is a betrayal of people in the east end of Glasgow. The cabinet secretary should be honest with Parliament today and say that those proposals are real and that she will accept the will of this Parliament to call those proposals in. We believe that those proposals should be to reject the closure of Lightburn hospital. I am surprised that Anna Sarwar is criticising MPs or MSPs for listening to their constituents. I would expect any MPs or MSPs to listen to the views of their local constituents, whether it is on the future of Lightburn hospital or any other issue. As I have said in response to two questions, there are no formal proposals. What there is is a consultation public engagement process that is currently under way. That is a very early stage. Proposals may or may not emerge from that. Nothing has come to me in formal service change proposals. However, if they do, I have set out clearly the criteria that would need to be met in those proposals. It would need to improve the patient experience. It would need to be fully consistent with national policy. It would need to address those local concerns that have been raised. I do not think that I could be clearer. I take this opportunity to remind members to be careful about the language that they use in the chamber. I urge all questioners yet again to be brief in their questions. 3. Willie Coffey Thank you to ask the Scottish Government when it last met the NHS Ayrshire and Arran and what matters were discussed. Ministers and Scottish Government officials regularly meet with representatives of all health boards, including NHS Ayrshire and Arran, to discuss the matters of importance to local people. I thank the cabinet secretary for that answer. As part of the independent review that he announced last week into the baby death at Crosshouse hospital, he could ask that the parents of maybe Elijah Kennedy, who died in 2011, and Joseph Campbell, who died in 2012 could ask that both their sets of parents be included in that review so that their story may be heard and that any lessons will be learned and acted upon. I certainly wish to put on record my condolences to any family who lose a baby. I think that we all want to make sure that, in taking forward the review that Healthcare Improvement Scotland has been asked to carry out, that the views of families are very much at the centre of that. I have asked his to look into whether the processes and procedures within Ayrshire and Arran were properly followed in the cases that have been highlighted. I have asked that his meet with the affected families as part of the review, and that his report back to me with their findings at the earliest opportunity. I will certainly ask his to make contact with the families raised here by Willie Coffey, but I would expect Healthcare Improvement Scotland to meet with any families who would wish to discuss their concerns with Healthcare Improvement Scotland, and that is the indication that I have given to them in taking forward this very important review. Jamie Greene NHS Ayrshire and Arran has, unfortunately, been in the news an awful lot recently. We have heard numerous reports of understaffing, lengthy waiting times and unfillable vacancies, a case of a 19-month wait to see a consultant that was only resolved after we brought it up with the First Minister in this chamber, and, of course, the tragic cases of avoidable stillbirth deaths at Crosshouse hospital. Can I ask the cabinet secretary what steps she is planning to take to restore public trust and confidence, not just in NHS Ayrshire and Arran, but across the entire Scottish health service? The member raises a number of issues, but first of all let me deal with the issue of maternity and neonatal care. It is important to stress that, despite some of the serious issues that have been raised about Ayrshire and Arran, Ayrshire and Arran, along with all the other maternity and neonatal units, have seen a marked improvement in the number of stillbirths. Stillbirths are down in 2015, the lowest on record, and neonatal deaths and maternal deaths are also down. It is important that we give that public reassurance that, despite some of those very real issues that Health Care Improvement Scotland has been asked to look into, overall the units are safer now than they were previously. Those figures are something that we should welcome. However, the member raises issues around the general performance of Ayrshire and Arran, issues that were raised previously by John Scott around schedule care performance. I am very clear with Ayrshire and Arran, as I would be with any other board, that we expect, through their share of £10 million, to see marked improvement in outpatient performance and, indeed, in schedule care performance. We also expect improvements in the performance of A and E at Ayr hospital. We have seen significant improvement at Crosshouse hospital in the A and E department performance there. There is improvement in performance in some areas in Ayrshire and Arran, but there is still room for improvement in others. Again, I am happy to write to the member with more details if he would find that help. Christina McKelvie Thank you very much, Presiding Officer, to ask the Scottish Government what discussions it has had with NHS Lanarkshire regarding the implementation of the mental health strategy. Thank you, Presiding Officer. During the implementation of the previous mental health strategy 2012-2015, review visits by Scottish Government officials to NHS Lanarkshire took place in May and November 2012, May and November 2013, May and November 2014 and May 2015. In the engagement process for the forthcoming 10-year mental health strategy, the Scottish Government received a written response to its engagement paper, Mental Health in Scotland, a 10-year vision, from the Lanarkshire planning partnerships north and south. The written response was the result of a collaboration between North and South Lanarkshire health and social care partnerships, NHS Lanarkshire, North and South Lanarkshire councils and the local voluntary sector. The Scottish Government has carefully considered its response, along with the other 597 responses that were received in developing the final strategy. Christina McKelvie I thank the minister for all that information. The minister will know the value of working closely with community-based organisations, along with the NHS and other organisations, and I draw her attention to the work of an organisation in my constituency called FAMS, Families and Friends Affected by Murder and Suicide. I ask the minister if she will ensure that organisations like FAMS will be invited to contribute and work with NHS Lanarkshire to roll out the mental health strategy in my local area. Christina McKelvie I think that organisations like FAMS in the member's constituency absolutely have a key role to play and the prevention and reduction of suicides in Scotland is a key priority area for the Scottish Government and engagement in developing the next suicide prevention strategy will take place in spring 2017. During this period, we would expect input to this important area from a range of agencies, including organisations like FAMS and Friends Affected by Murder and Suicide. It is the role of NHS boards to draw on the knowledge, ability and resources of local groups like those to develop solutions that reflect the needs of their population. Monica Lennon The draft mental health strategy, the 10-year strategy, states that there will be actions to improve perinatal mental health. NHS Lanarkshire perinatal mental health services did not begin until November 2014, and NHS Lanarkshire does not have in-patient specialist perinatal mental health services, instead relies on NHS Greater Glasgow and Clyde. I note from the previous reply that the minister perhaps has not met NHS Lanarkshire recently, but is this something that her officials have discussed or that she might discuss in the near future, and does she find that situation to be acceptable? Of course, it is up to NHS boards to decide how best to provide that services, and co-operation across health boards is absolutely vital in taking forward health in Scotland in the future. In terms of perinatal mental health specifically, the mental health strategy will dovetail with the review that Jane Grant from Forth Fally has been undertaking into neonatal and maternal health services. Emma Harper To ask the Scottish Government what its position is on the establishment of a respiratory task force to help tackle lung disease in Scotland. We are already working closely with the national advisory group to support local improvement in respiratory care through the development of respiratory health quality improvement plan. The plan will aim to support NHS boards and respiratory managed clinical networks in making local improvements in respiratory diagnosis, treatment and care. Emma Harper Thank you for that answer. Does the minister agree that charities such as Chest Heart Stroke Scotland, British Lung Foundation and Asthma UK, are doing important work around lung health in Scotland, and will she maintain regular contact with stakeholders to engage with their recommendations for how to best deal with lung disease? We have absolutely recognised the valuable contribution that our third sector partners play in supporting people living with respiratory conditions. To offer a couple of examples, we have supported the development with £160,000 worth of funding resources such as My Longs My Life, the online resource that was developed by Chest Heart Stroke Scotland, which helps people to understand and self-manage their condition. We have also recently approved funding of £112,000 to CHSS to support the development of an online learning resource to support professionals through e-learning. Colin Smyth Thank you, Presiding Officer. Although we have seen a welcome decrease in the proportion of people smoking, not least as a result of the ban on smoking in public places introduced by Labour in 2006, the rate of declining is much slower in the most deprived areas, and it is not expected to reach the Government's 2034 target, despite the fact that 60 per cent of those access in smoking cessation services live in the most deprived areas. Given that COPD is the only major rising cause of death in Scotland and is much more prevalent in socially deprived areas, does the minister believe that developing an action plan to tackle the slow pace of decline in smoking in the most deprived areas should be a priority for the Government? We absolutely share that, regardless of the party, we understand that inequalities exacerbate some of the public health challenges that we face as a country. That is to be congratulated that the Labour Party took forward that ground-baking piece of legislation. I think that in the spirit of that cross-party co-operation, it should be recognised that we have taken forward other bits of that bit of work to try and stop some of those poor choices around smoking or alcohol or drug dependency impacting most heavily on our most deprived communities. We should work together to try and tackle some of those things. We have a tobacco strategy that sets out some of the areas in which we want to make more progress. Of course, the member will also recognise that I think that next week we will be about to see the legislation come forward around smoking in cars with children. That work goes on across the different political parties to make sure that we can make the differences. However, like the member, sometimes we are always impatient for change to make sure that everybody has a fair chance to flourish and that our most deprived areas get the chance to have better health outcomes. I hope that that spirit of consensus we can probably try and work across the political parties to try and make the differences that I think we all probably want to seek. I note what the minister said in terms of the diagnosis and treatment of lung disease. The minister may be aware of the British Lung Foundation's battle for breath report, which looks at the impact of lung disease across the UK. The report states that more can be done to improve awareness, availability of screening and prevention in particular. What is the Scottish Government doing to improve in those areas? We know that there is a number of recommendations set out by the battle of breath, and we certainly will take on board the recommendations that we met. We will continue to work hard to ensure that diagnosis is better. We have outlined some of the ways in which we have funded our third sector partners in order to try to help and allow people to cope much better with their condition. We will certainly look at all ideas and recommendations to ensure that that can be improved across the piece. 6. Maurice Golden To ask the Scottish Government what analysis it carries out to ascertain which groups are most vulnerable to seasonal health risks. The Scottish Government relies on analysis provided by a range of experts and specialist advisory committees on seasonal risk to health. The sources of those analysis vary depending on the specific issue that is concerned. As seasonal health risks are an issue relevant to a wide range of health matters, for example, the Joint Committee on Vaccination and Immunisation provides advice on which groups should receive the seasonal flu vaccine, and Health Protection Scotland provides the Government with analysis on an on-going basis about threats to health such as infectious diseases that may have a seasonal trend to them. Maurice Golden I thank the cabinet secretary for that response. The Scottish Government's own figures show that last year almost 3,000 of our fellow Scots died during winter, above and beyond the average rate for the rest of the year. That figure is completely unacceptable. World Health Organization research suggests that around one-third of those 3,000 deaths could be attributed to cold homes. In our manifesto, my party commits to improving all properties in Scotland to at least an EPC band C rating. That would improve energy efficiency, tackle fuel poverty and make homes easier to heat. The National Institute of Health and Care Excellence makes the same recommendation. Will the Scottish Government help to tackle those needless deaths by committing to a similar goal and set out a plan of action on how that can be achieved? First of all, there is a lot of analysis done on deaths during winter to look at trends and to look at previous use and whether there is anything emerging from those trends that we should look at in particular. That is an on-going process. The member makes an important point that issues of fuel poverty are very critical in preventing deaths from cold homes. It is not just the health service response that is required here, it is a cross-government response. Of course, we will look at ideas from across the chamber, although I point out that fuel poverty measures have been taken forward by the Government for a number of years now that are important in lifting people out of fuel poverty, but it is very, very challenging. The only point that I would make is that the situation is not helped by some of the welfare reforms that have been introduced by the UK Government, which has put pressure on family budgets, particularly those on low incomes. That does nothing to help to address fuel poverty and, in fact, can make the situation much, much worse. As to the Scottish Government, how many GPs have been recruited in Dumfries and Galloway through the bursary initiative and how many posts remain vacant? Of six GP specialty training posts that are eligible for the bursary in the Dumfries and Galloway region, three posts were initially filled, but one individual has since declined their job offer. That leaves four vacancies that will be advertised in the forthcoming 2017 recruitment rounds. Finlay Carson, I thank the cabinet secretary for her response. Galloway in Western Fries rural GP practices are in crisis. GPs are working longer hours than ever. Practices are being forced to merge and there is a fear in local communities that some practices will close. Will the cabinet secretary meet with me to discuss the possibility of giving the Galloway community hospital in Srinrar training hospital status and exploring the possibility of seconding armed forces doctors to ensure vital GP services can be delivered in rural areas? I am happy to meet with the member to discuss any of those ideas. I am always looking and happy to speak to members about ideas coming from across the chamber. Obviously, we would have to look at whether those ideas were practical and deliverable, but I am certainly willing to meet with the member to discuss them further. I would point out that we have a huge amount of work under way to improve the position within primary care. A £500 million investment over the course of this Parliament, some short-term measures to stabilise the position and address recruitment and retention issues, particularly in rural areas. Again, I am happy to furnish the member with more detail of that, but I would be happy to meet with him to discuss the issues that he raises. To ask the Scottish Government what its assessment is of health services in the Murray area. Health services across the Grampian are assessed at a board level. The NHS Grampian annual review took place on 6 October. The process ensures the rigorous scrutiny of the board's performance whilst encouraging as much direct dialogue and accountability between local communities and NHS Grampian as possible. I have issued a letter to the board that contains my observations on the board's performance in relation to a range of issues. It details a number of initiatives and actions to be taken forward over the coming months. The letter shall be posted on NHS Grampian's website in the near future. I am grateful to the cabinet secretary for that response. I have a constituent from Murray who has been treated for breast cancer at Rhaig Mawr, but because she lives within NHS Grampian she faces significant challenges with her treatment. For example, she cannot have her bloods taken at the Oaks in Elgin, an excellent facility that will save her going into a GP waiting area with her low immune system because the Oaks do not send samples to NHS Highland only to NHS Grampian. She also had an NHS Highland prescription for a wig, but the hairdresser closest to her home in Elgin could not deal with that because she did not have an NHS Grampian prescription. What can the Scottish Government do to improve the service of care for patients within the Murray area who face similar problems because they choose to be treated closer to home at Rhaig Mawr rather than within the NHS Grampian area? I think that the member raises some very important issues here. I would be happy to look into the specifics. It sounds as if there are boundary issues here, potentially getting in the way of some sensible solutions that would make it easier for the patient that you are referring to. What would help me is if you were to write to me with further detail and I can follow that up and respond to the member on the important issues that he raises. The cabinet secretary will be aware that one of the reasons for some of the pressures in Murray health service is attracting health professionals to come and live in our more rural areas. In the case of consultants to work at some of our smaller hospitals in Scotland, would the cabinet secretary be willing to look at the extent to which incentives are available to attract health professionals to work in such areas? As I think this is something that could make a real difference to helping to address some of the pressures. There have already been a number of incentives to encourage those health professionals to go and work particularly in rural communities. We have, for example, bursaries and golden hellows that are available, in particular specialties, to try to attract them to harder-to-fill posts. We also have regional workforce plans that are in the process of being developed, which will again be an opportunity to look at the particular needs of remote and rural Scotland. However, I will ask my office to get in touch with Richard Lochhead to perhaps get more details on the issues that are of concern to him within the Murray area, and I will be happy to respond to him on that basis. To ask the Scottish Government what improvements it considers necessary to the provision of abortion in Scotland. NHS boards are responsible for the provision of abortion services in Scotland. The Scottish Government recognises that there are opportunities to improve that provision, which is why we funded research by Glasgow University on issues surrounding women requiring abortion later in pregnancy and women who have more than one abortion. Both of those pieces of research are now published, and we will be informing how NHS boards deliver abortion services. The 1967 Abortion Act allows abortion up to the time limit of 24 weeks, but as the minister is no doubt aware, research has shown that, in practice, unofficial time limits are operating in Scotland, which range from 15 to 20 weeks, leaving women in Scotland in many circumstances having to travel elsewhere, including the time and the money that it takes to do so and the unnecessary stress that is added to their experience in order to access abortion. Why are women in Scotland facing those unacceptable barriers to exercising their reproductive rights? I thank Patrick Harvie for raising this incredibly important issue. I know that we did have a meeting planned, and we have one in the future to discuss the wider issues that he raised at First Minister's questions. There is one reason for some NHS boards offering other time limits or local limits to abortion is often around delivering a sustainable and safe service for a very small number of patients requiring that specialised procedure. Also, women travel from Scotland to England for later abortions if that is required. Costs for that are met by NHS boards in Scotland. I am happy to look more fully at the issue and to engage with Patrick Harvie when we are scheduled to meet up as well and to also any other member who is interested to look to engage with him as well. There are issues around sustainability and the safety of that service for women, which is one of the reasons why sometimes NHS boards offer different time limits, but there are relationships with other NHS boards and partnership relationships with NHS boards to ensure that women have access, but certainly around travelling in the distance that some women have to embark upon to access the right that they have. We are also looking at that issue because we understand the points that Patrick Harvie makes when he raises. Statistics show that abortion rates are higher among women living in the more deprived areas. What will the Scottish Government do to ensure that all women have equal access to contraception and sexual health advice? That is one of the reasons why we asked Glasgow University to look at some of the issues around abortion, including why women have more than one abortion. We also ensure that women have access to adequate sexual health advice and support should they need it. One of the issues around public health is that sometimes our most deprived communities suffer the greatest and that is something that we need to tackle. Again, I am happy to engage with Brian Whittle on that issue, but those issues are issues that we are certainly making progress on. We have certainly commissioned research from Glasgow University to look at some of the elements of that. However, if he has issues that he thinks require further look, I am happy to engage with him on that issue because it is important that we get it right and we act to prevent issues before having a woman take that very difficult decision to have an abortion should they require. I ask the Scottish Government what its position is on the reported short rise in social care charges for disabled people under 65 in Dumfries and Galloway, and whether it considers that this is a consequence of the cause of the recommending and applicable income allowance of £132 per week. I am disappointed that Dumfries and Galloway Council have chosen to adopt a lower income threshold for people under the age of 65. However, the Scottish Government funding has ensured that the threshold at which they begin to be charged for their social care has not been lowered further still in Dumfries and Galloway. The additional funding of £6 million that we provided to local authorities as part of the £250 million additional funding for social care in 2016-17 was intended to enable all local authorities to increase their charging thresholds to a minimum of 25 per cent in order to take those on the lowest incomes out of social care charges altogether and reduce social care charges for many more service users. Although several local authorities do not begin charging until well above the cause of the minimum, only Dumfries and Galloway Labour Control Council has chosen to immediately and dramatically reduce the threshold for care charges for existing service users and increase the rate of which they pay, despite the money that they have been given by the Scottish Government to reduce charges. That has resulted in vulnerable people with severe disabilities facing charging increases of 500 per cent and bills of £70 a week. Does that come from their already pressured benefits? Does the cabinet secretary agree with me that that is cruel and unjustified? As I said earlier, I am disappointed that Dumfries and Galloway have chosen to reduce the threshold for social care charges. The cosilar charging guidance gives the threshold as a minimum, not a maximum, and other local authorities have higher thresholds. We provided additional funding to local authorities in 2016-17 to tackle poverty. If those people on the lowest incomes are worse off now than they were as a result of those changes to the charging thresholds in Dumfries and Galloway, that will fly in the face of the council being provided with extra money to reduce charges. I would hope that Dumfries and Galloway Council will seriously consider the representations that are made locally and in the chamber on that issue.