 The First Minister's Questions 1. Ruth Davidson To congratulate the Presiding Officer on his recent membership of Her Majesty's Privy Council and to ask the First Minister what engagement she has planned for the rest of the day. The First Minister's engagement is to take forward the Government's programme for Scotland. Ruth Davidson It is clear that the Scottish NHS is in crisis. Orate Scotland has said and I quote, is no evidence of a clear long-term plan from government to put the NHS in order. The First Minister has been in charge of this for nearly 10 years. Can she really claim today to have one? The First Minister? Over the last decade, there have been improvements in the way health services are delivered and reductions in the time that patients need to wait for hospital treatment. There have also been improvements in overall health, life expectancy, patient safety and survivor rates, for a number of conditions such as heart disease. My words are the first paragraph of the Audit Scotland report published today. Context is important. However, notwithstanding all that, the NHS faces challenges, which face the rising demand principally from an ageing population. Those challenges are in no way unique to oedd eich cyfreon oedd hyfforddau cyffredinol gwaith i dda, oedd eich cyf figoedd oherwydd cymdeithasol yn cyfrifiadau i wneud gael i gefnogiadau i ddiwrnod hyn yn cyfrifiadau i gael i ddawodd cyffredinol i ddiwrnod cyfrifiadau i gael i ddiwrnod cyffredinol i gael i ddawodd cyfrifiadau i gael i dwi'r gwyrdd amddangosol am hyn rydych chi'n mynd i gael hiad fan hyffordd Llyfridd嘅f ydyn nhw ar y tingaith yma. Ydyn nhw yw gweldden nhw'n deillu wathchai hwnnw, rymdyn nhw'n ddifrinol i hwnnw, gweldd yn ymgyrchu maes anhygoel a'r dargwydiau, gweldd drws ar gyfnogi ddeu llwyddegol, a ffairwyr hwnnw, a'r ffairwyr hwnnw i ddauwyl iaith iaith i ddefnyddoedd mewn bydd. Felly nid wych nhw wedi ei pryd yn dweud o'r llywodraethiance yma o'r hwnnw yn Ysgolladdol infrared i ysgoladau, ond mae'r ddweud o'r gwaith o'r panfodol yn gyfweldofnol i'n ei ddim yn ei ddau'r gweithio. Y ddim ddweud i gael y cwestiynau cyfrifOD, ac mae'n gweithio i gael eich gweithio i gael'r gweithio i gael, erbyn y gweithio i Gweithio i Gweithio i Gweithio i Gweithio i Gwyrdd. Mae'n gwneud yn 2007, mae'n gwneud i gael'r Gweithio i Gweithio i Gwyrdd, ac yn gweithio i gael gweithio i Gweithio i Gweithio i Gwyrdd, again with the exact same warnings as it was giving nearly 10 years ago about the lack of a clear plan, about the failure of this Government to get a grip, and that has inevitable costs, waiting time targets that have been missed, doctors and nurses under ever greater pressure and health boards that are on the brink. The Royal College of Nursing asks today how many reports will be published by Audit Scotland before action is taken, and that's a fair question, First Minister, so what's the answer? I'm very happy to compare the situation in the health service today to the situation in the health service in 2007 when this Government took office. There is now more than £3 billion extra investment in the health service compared to the time when we took office. There are 11,000 more medical professionals and nurses and other healthcare professionals working in our health service. That's why Audit Scotland today says that staffing levels in our health service are at an all-time high. Of course, there are challenges around waiting times in our health service, but let's look at the position when we took office. Back then, just 85 per cent of inpatients were seen within 18 weeks. Today, more than 90 per cent of inpatients are seen within 12 weeks. The NHS is performing better against a tougher target. Let's look at outpatients. When we took office, 70 per cent of outpatients were seen within 12 weeks. Today, more than 85 per cent of patients are seen within 12 weeks. Our accident and emergency departments, the performance of our accident and emergency departments are 8 per centage points higher than the accident and emergency departments in England, where the Tories are in government. Yes, there are challenges in our health service. That's why we have our vision 2020 strategy. It's why we have in place our new clinical strategy. It's why we are planning increased investment in the health service. It's why we are determined to shift the balance of care into community, social and primary care. It's why we will continue to focus on making sure that we improve the health service so that it continues to have what it has today at high patient satisfaction levels. To my first question, no answer to the charges levelled by Audit Scotland. To my second question, no answer to the charges levelled by the RCN and by Scotland's nurses. I think that we need to spell out things today for what they are. That is the failure of this Government to get to grips with our NHS and it is an outrage. Health boards are having to make huge savings in order to break even, to take out loans, to keep going and to put off essential repairs to hospital buildings. Yet, because of this Government's failure to manage staffing, there has been a 47 per cent increase in agency nursing and midwifering staff. Staggeringly, the individual agency doctors are being paid over £400,000 each to provide cover for periods of less than a year. All of that, while patient care suffers from cuts and hospital buildings, are left to crumble. I call it a scandal. What does the First Minister call it? The health service funding is higher than we took office. The number of people working in our health service is higher than we took office and waiting times are lower than when we took office. The hypocrisy of Ruth Davidson is absolutely staggering. She talks about the financial performance of health boards in Scotland, and of course that is challenging. However, health boards in Scotland met all of their financial targets, as narrated by Audit Scotland today. In the same year that Audit Scotland is looking for, at the NHS in England, it had a £2.5 billion deficit—three times the deficit that it had in the previous year. Agency spend for nurses is 0.400 per cent of the total budget. Agency spend per head of population is less than a third of what it is in England, where the Tories run the health service. The point that I am making here is this one. Our NHS faces challenges, but those challenges are not unique to Scotland. They are challenges faced by health systems across the world. However, as the Auditor General herself said this morning, when it comes to facing up to those challenges, Scotland is performing well compared to other parts of the UK, and we will continue to focus on making sure that we do so. Ruth Davidson The point is this, while there have been some improvements in some areas over the last 10 years, which is welcome as far as it goes, but the big question on the reforms to give our NHS a sustainable future is to allow health boards to budget for the long term. Successive SNP health ministers, including this First Minister when she was in the role, have ducks the big challenges. When the SNP came to power, we had the opportunity to avoid this, but now we have an unavoidable crisis on our hands. This Government has preferred sticking plaster solutions and a strategy of no clear framework, no milestones and no costings as we have heard today. Orate Scotland and the Royal College of Nursing are recommending today that health boards are given more flexibility to plan by having three-year rolling budgets rather than annual financial targets. We will back that, will she? That last question was a case of not waving but drowning, grudgingly accepting that there have been some improvements. There have been lots of improvements in the NHS in Scotland, unlike the situation in England where her party is in charge. We will continue to focus on that. That is why we have integrated health in social care. It is why we have in place a new national clinical strategy. It is why we have a range of work to improve population health. All that is adding up to delivering our 2020 strategy and our broader strategy to 2013. Of course, Ruth Davidson should know that there is work under way to combine all that work into a single delivery framework that will be published before the end of this year. I do not deny the challenges in our health service. There are challenges faced by health services right across the world, but the performance of our health service is a good one. Those who are working in it deserve our thanks, and this Government will continue to work hard to make sure that we are supporting them. To ask the First Minister when she will next meet ScotRail. Scottish Government ministers meet regularly with ScotRail. The transport minister did so most recently last week. We discovered today that ScotRail is not the only thing going off the rails under this Government. The independent experts in Audit Scotland gave our NHS under the SNP a check-up, and the results of a decade of SNP control produced a grim diagnosis. Funding is not keeping pace with increasing demand and patient need. Only one of eight key targets has been met. A workforce crisis that has been brewing for years is getting worse. Those problems did not appear overnight. It is the legacy of a decade of the SNP controlling our NHS. The First Minister was the health secretary for the best part of those 10 years. Does she accept full responsibility for the problems that it now faces? Yes, I accept as First Minister full responsibility for what happens in the health service. I also accept responsibility for the fact that the health service budget is £3 billion higher than it was when we took office. I accept responsibility for the fact that there are 11,000 more staff working in our health service than there were when we took office. I accept responsibility for the fact that, whether we look at inpatient waiting times or outpatient waiting times, those are lower today than they were when this Government took office. I accept responsibility for all that and more. I also accept responsibility for the manifesto commitment that we made in the recent election, where we said that we would, over this Parliament, build on the increases that we had already made and increase the health budget by £500 million more than inflation. I think that Kezia Dugdale has got a cheek to stand here and talk about funding in our health service when she authored a manifesto that promised the lowest funding increase to the health service of any party contesting the election. Perhaps she should put her own house in order. Kezia Dugdale. The First Minister can read out every statistic that she likes from that big book of excuses, but there is. There is a human cost to a decade of SNP mismanagement. Just ask the patients. There is one patient that is not satisfied is James Nielsen from Falthouse. Mr Nielsen was a miner. He worked down the pit his whole life. He has a blocked artery in his leg. He wanted to be in the gallery today, but, when I spoke to him this morning, he was in too much pain to leave the house. Mr Nielsen has been told that he will have to wait seven months for an appointment. That is not seven months for treatment. That is a seven-month wait for an appointment. We have heard the First Minister rhyme off a lot of statistics already today, but can she explain to Mr Nielsen why he has to wait seven months to see a consultant under her Government? The First Minister. Would I absolutely agree with Kezia Dugdale that, behind all the statistics that all the sites in the health service lie human beings, I am very happy to ask the health secretary to look into the case of Mr Nielsen. I am not going to comment on that today without having all the details. It would not be reasonable for me to do so. However, I will repeat the point that I made earlier on. As long as one patient in our health service is waiting too long, that is one too many, and I will be the first to say that and the first to say that we have got more work to do. I look back to when we took office and repeat again that at that time 70 per cent of outpatients were being seen within the target 12 weeks. Today that is 85 per cent. That is not good enough, but it does mean that we are performing well. The health service is performing well and better than it was when we took office. I say again that I think that we have a great deal to be proud of in the way in which our health service operates and the services that it delivers. That is why there is record patient satisfaction in our health service, but of course there is much work still to do, and that is why this Government is focused on doing it. Kezia Dugdale. Mr Nielsen does not want to know what was happening 10 years ago. He wants to know when he is going to see a doctor. The First Minister might not want to listen to me on the NHS, she might want to disregard Mr Nielsen's case but she cannot ignore what NHS staff are saying. One in four GP surgeries are short of staff. Nine out of ten nurses say that their workload is getting worse. This summer the First Minister set up a listening exercise but she is not listening to patients, she is not listening to doctors and she is not listening to nurses. The First Minister should stop living in denial. When will she wake up to the NHS crisis that started on her watch? The problem sometimes for opposition leaders is that they forget that there are people sitting at home watching our exchanges right now and they will know that I did not disregard the case of Mr Nielsen. I said that I would be very happy to look into that case and if Kezia Dugdale wants to pass me his details I will do so. However, she will also know the fact that underpin all of this. I am not standing here saying that everything is perfect in our health service, nor am I saying that there is not more work to be done, but I am pointing to the progress that has been made, the progress that we are now determined to build on. Kezia Dugdale talks about nurses. Our nurses do a fantastic job in the health service. They work incredibly hard. They work under very difficult circumstances. However, there are 2,000 more nurses in our health service now than there were when this Government took office. There are more staff. There is a higher budget. Waiting times are lower, so progress has been made. However, much work still has to be done. That is why this is the Government that is not just investing in our health service but determined to undertake the reforms in our health service to make sure that it is fit not just for today but for the future as well. To ask the First Minister when the Cabinet will next meet. The Scottish Government is due some credit for its work on climate justice, aiming, in its own words, to secure global justice for the many victims of climate change who are usually forgotten. It says that that does not exclude people in our own communities. It is not simply an international issue. It seems, though, that this principle does not apply to people living under the flight paths at Heathrow. A third runway would cause a quarter of a million extra flights a year, a massive increase to emissions, the single biggest threat to the whole UK meeting its climate change targets. It would leave thousands of people's homes too noisy and too polluted to live in, and unknown tens of thousands more left suffering the damaging health effects. I can only imagine the outrage, and I would join it from the Scottish Government and from their colleagues at Westminster if the UK Government was to inflict this kind of damage on so many lives in Glasgow or in Inverness or in Dundee in exchange for alleged economic self-interest, yet they will now trip through the voting lobbies to bail out a Tory Prime Minister who stood for election saying no ifs, no buts, no third runway. What is the point of a principle like climate justice when it is surrendered so easily? I will let the Prime Minister explain her own position. The decision on another runway in London—whether it is Heathrow or anywhere else—is of course a decision for the UK Government, not for the Scottish Government. In welcoming the announcement that was made this week, we recognise that there are many hurdles still to be overcome in terms of the decision around Heathrow. In reaching the judgment of the Scottish Government on this, this work was led, of course, by Keith Brown, our economy secretary. We look very carefully at the option that delivers the greatest benefits to Scotland, not just in terms of our economy, but also in terms of connectivity. When you look at connectivity, 40 per cent of long-haul visitors to Scotland connect through Heathrow, compared to just 4 per cent who do so through Gatwick. Obviously, we are working hard with our airports to increase direct flights, but that hub connectivity remains very important to Scotland. On the economy, there is a potential for significant construction spend in Scotland and thousands of jobs. In the nearer term, there is potential for a supply chain hub at Presswick, which is extremely important in terms of economic impact and jobs. A £10 million root development fund, a reduction starting in January in passenger charges, will make services between Scotland and Heathrow much more viable in a new marketing campaign. Those are the reasons on which our decision was based. Patrick Harvie rightly raises the issues of climate change and emissions. The UK Government will have to answer questions and satisfy people on their answers to those questions. In terms of the Scottish Government, we have shown global leadership by including domestic and international aviation in our emissions reduction targets. Where policies—either policies of the Scottish Government or policies that we support would increase emissions in aviation, we have to work harder to reduce emissions in other areas in order to meet our overall target. Climate change meeting our emissions reduction target is something that the Government has got a strong record on, and we will continue to make sure that we show leadership on. The arguments about connections to more destinations would make sense if that was going to be instead of more short-haul aviation, but the Scottish Government's own approach shows that it wants more of both. As for the job creation figures, they are entirely spurious. We begin with the airport's commission, £59,000 by 2030 and then £75,000 by 2050. Heathrow's own pie-in-the-sky estimate of £180,000. That is about as believable as the job projection figures for Donald Trump's golf course. We are not surely going to fall for this, are we? What were the Heathrow bosses putting in the drinks at SNP conference? As for fares, both with the Heathrow deal and with the Scottish Government's policy on cutting APD, they seek to reduce fares on aviation, despite the fact that aviation already enjoys its privileged position as the only transport mode that pays no tax on its fuel. Public transport remains overpriced, unreliable and run for private profit. Rail fares from Glasgow or Edinburgh are often three times the price of flying to London. Surely the First Minister must accept that it is time to focus on the affordable, sustainable, low-carbon transport that people need in their daily lives instead of boosting the most environmentally destructive, most unhealthy and most unsustainable transport mode. First Minister. Firstly, I totally respect Patrick Harvie's position on that. I would say to him that when he comes to take decisions and the Heathrow decision is not the Scottish Government's decision, we have made a judgment about which option best suits Scotland's economic and connection connectivity interests. When he comes to taking these decisions, it is not always either or between all the things that Patrick Harvie talks about. We have to strike the right balance. Of course, public transport, good quality, affordable and accessible public transport in Scotland and connecting Scotland to other parts of the UK and other parts of Europe are extremely important. However, we have the air links that allow our economy to grow and to boost the connectivity that our economy often depends on. Those are decisions that we have to balance. Obviously, around all of that is our moral obligation to meet our climate change targets and to reduce emissions. I would simply say there that the Scottish Government's record, although I am not complacent about it, is a very strong and a very good record. Unlike many other Governments, we include emissions from aviation. We have met our target years ahead of schedule and, of course, we are already working on increasing that target and making sure that we get the policies in place to meet that. Those will always be difficult decisions to strike and difficult balances to strike, but meeting our climate change targets and ensuring that we have the infrastructure to enable our economy to grow and support jobs are not mutually exclusive objectives. Those are things that Governments have to do in the round. 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. The Audit Scotland report on our NHS is a horror show. The Government said that it would eradicate bed blocking by now, but thousands of people are still stuck in hospital. It said that it would meet all the targets, but miss seven out of eight. It said that it would recruit enough GPs, but the shortage has got worse. The Royal College of Nursing is right to ask how many more reports will be published by Audit Scotland before action is taken. Does the condition of the NHS give the First Minister sleepless nights? The NHS is always uppermost in my mind day and night because it is one of the most important responsibilities of any Government to make sure that we have a health service delivering for patients who need it. As I have already said in response to earlier questions, we have a health service that is performing well in difficult circumstances. There have been significant improvements over the time that this Government has been in office, but the health service phases have significant challenges in common with health services across the world. Willie Rennie mentioned delayed discharge in particular. A number of bed days lost to delays has actually reduced in the last year, so progress but much more work to be done. Similarly on primary care, we have recently made clear our commitment to shift resources from acute care into primary care so that, by the end of this Parliament, for the first time ever, half of the total health budget will be spent not on acute hospitals but in the community. I think that that is a really important commitment and one that is right. We have got work to do. I will be the first to admit that, but compared to health services in many other parts of the UK and all other parts of the UK, our health service is performing well and it is facing up to those challenges and this Government's job is to support it to do. I would say just one last thing to Willie Rennie. I mentioned earlier on that our health budget has increased by £3 billion since we took office. In many of those years, of course, that was against a backdrop of a Conservative-liberal coalition at Westminster that was reducing Scotland's overall budget by 5 per cent in real terms, so maybe Willie Rennie should reflect a bit on that before he stands up and talks about funding for the health service. The First Minister is blaming everyone else for the last 10 years. It is about time that she accepted responsibility for her own responsibilities. Workforce planning is the way to get valued staff with right skills in the right place, but the Auditor General is very critical of this Government's workforce planning. The Royal College of GPs say that we will now be over 800 GPs shot. The health service has only five-yearly workforce plans, but it takes seven years to train a doctor. So isn't it the tragedy that it takes nine years to educate an SNP Government to take this seriously? That completely ignores the fact that there are more doctors working in our health service today than there were nine years ago. There are more staff overall working in our health service than there were nine years ago when we took office. We will continue to make sure that our health service is adequately resourced. In terms of the planning, as I have said in previous questions, we are working to implement our new national clinical strategy. That, together with the integration of health and social care, our working population health is how we will deliver our 2020 vision. Work is under way, as I said earlier, on bringing all those strands together into an integrated delivery framework, which will also inform our workforce plan and our investment decisions to make sure that those strategies can be implemented. I know that I am now repeating myself, but it is worth saying again that our health service is making progress. It is performing well, but, in common with other health services, it faces real challenges. That is why this Government is promising. It has already delivered record investment, a record number of staff. Waiting times are lower than when we took office, but we take nothing for granted. We continue to work hard with the health service to make sure that we can build on that progress. The First Minister will be aware that Associated British Ports is attempting to entice the lifeline R and ferry service from Ardrossan to Trun with a loss of at least 165 Ardrossan jobs, despite the fact that the existing service is the most direct, shortest, fastest and cheapest route for passengers, cars, buses and hauliers. Can she confirm that Ardrossan Harbour remains the Scottish Government's first choice airship port in serving Arran? When can we expect a decision to ensure that the new £47 million ferry that is being built in Port Glasgow to serve Arran will sail from Ardrossan Harbour? We are committed to providing the best possible service for Arran, including works at Brodick Harbour, as well as the new ferry that Kenny Gibson refers to. A task force has been set up, led by the Transport Minister, to look at Ardrossan in the first instance. Although, of course, no options are off the table, any consideration will take into account the local social and economic benefits and the impact on public spending, but principally the needs of ferry users. I can assure Kenny Gibson that no decisions have been made and we will continue to engage closely with all stakeholders in analysing the options. Jackie Baillie On radio this morning, the health minister stated that the Opposition was standing in the way of service change. The irony of that statement is not lost on this chamber. Assuming that the First Minister is taking responsibility for service closures, will she therefore name the health services that she believes should close? Is it the children's ward at the RAH? Does that mean that she has already decided to close the Vale of Leven maternity unit? Does that mean that the promises made to my community by the First Minister and the health secretary before the election count for absolutely nothing after the election? All of the particular services that Jackie Baillie refers to are currently undergoing due process. That is the right and proper way to proceed, and that due process will continue. I say again that I will take no lessons from Labour when it comes to protecting local health services. We have talked a lot today about the situation in the health service when this Government took office. When this Government took office, Monklands and Ayr accident emergency services were on the brink of closure and they were saved by this Government. Generally speaking, there is a moment of truth coming for the Opposition, because it is all quite happy to talk the language of shifting the balance of care from acute health services into the community. We will soon see whether they are prepared to back that rhetoric with action when it comes to supporting the implementation of our clinical strategy. I suspect that we all have a suspicion about how they will behave in those circumstances. SNP pressure at Westminster has prompted the UK Government to review their two-child limit and rape clause for benefit payments. Will the First Minister join with me in urging people to respond to the consultation and leave the tories in no doubt that their pernicious policy should be scrapped? The rape clause policy is disgusting immoral. It should never ever have seen the light of day in the first place. I take the opportunity to pay tribute to Alison Thewlis, who represents a part of my constituency in the House of Commons. She has been steadfast in her determination to fight the clause. The announcement this week of a consultation is welcome, but it is too early to declare victory. I would encourage people to respond to that consultation. I would call on the UK Government, without any further delay, to drop a policy that forces women in certain circumstances if they want to access tax credits to prove that they have been raped. I cannot think of anything more disgraceful than that. Neil Findlay. Over the past 30 years, the Blackburn local employment scheme in West Lothian has helped over 3,000 young people, including many who have been in care, into employment. The future of the scheme is extremely uncertain due to the inflexible way in which SDS grants are managed. I have twice written to the cabinet secretary seeking a meeting to try and find a solution, and both times my request has been refused. Developing the young workforce is supposed to be a priority for the Government. Will the First Minister now instruct the cabinet secretary to meet with me and representatives from BLESS so that we can find a way forward for this essential service? First Minister. I am happy to ask the cabinet secretary to meet with the member. I am not familiar with this particular service in detail, but I know that services like this do a fantastic job in local communities. The member is raising a reasonable point, and the cabinet secretary will arrange to meet with him and discuss it in more detail. Can the First Minister provide an update on discussions with the UK Government on protecting Scotland's position in the EU? As mentioned in Mike Russell's statement to Parliament yesterday, he and I attended the joint ministerial committee at Downing Street on Monday. Mike Russell also met David Davis and David Mundell last week. On Monday, we again set out our determination to protect Scotland's place in the single market. Despite a full and frank exchange of views around the table, we learned nothing about the UK Government's approach to the EU negotiations than we already knew when we went into the meeting, which was, to put it, mildly frustrating. However, we now have an agreement that a detailed work programme will be developed for the GMC sub-committee, which will be integrated into the wider process so that devolved administrations can influence key cabinet sub-committee decisions. The Scottish Government will continue to focus on protecting Scotland's interests—the economic and social interests that have been put at risk by the Brexit decision. I thank the First Minister for that answer. Expert research shows that Brexit threatens up to 80,000 jobs in Scotland and could cost the economy over £11 billion a year by 2030. We now know, thanks to the Goldman Sachs tips, that Theresa May privately agrees with forecasts like this. Publicly, she says, Brexit means Brexit. Privately, Brexit means disaster. In discussion on Monday, did the Prime Minister offer an explanation to the First Minister as to why she is now happy to be led by the wishes of hard-right Brexiteers over economics and common sense? The First Minister No, she didn't, but I suspect the truth is that the Prime Minister doesn't have a plan for Brexit, so the hard-right Brexiteers are able to impose their own agenda. When we met this week, the Prime Minister was unwilling or, I suspect, unable to answer even the most simple and obvious questions. Brexit might mean Brexit, but the Prime Minister couldn't tell us exactly what that platitude means in practice. The only new information that we got on Monday was that the UK Government has set up what they have called a hotline to David Davis. I can share with the chamber today that Michael Russell's office called that hotline this week. He called it just before midday on Tuesday. It took until after 6 p.m. yesterday to actually get David Davis on the hotline. That's 36 hours. So, yes, there is now a telephone line that we can call, and it's just currently not very hot. Adam Tomkins Thank you, Presiding Officer. When is the First Minister going to understand that securing the best possible Brexit deal for Scotland requires ministerial collaboration and co-operation with the UK Government, not hostility and threats? Yesterday, in his statement to Parliament, Michael Russell was unable to identify even a single positive contribution that the Scottish Government has made to the JMC Brexit process. All we heard was moaning about the United Kingdom. Can the First Minister do any better today? The First Minister Of course, what the Scottish Tories want the Scottish Government to do is, I suppose, what they have done, not collaborate but capitulate, and that's not what we are prepared to do. I do think that collaboration is essential. I just wish that the UK Government would start collaborating with us. 36 hours to get through on a hotline does not strike me as very constructive collaboration. I have been very clear about my priorities. First, I want to work right across the UK and across the political spectrum to avert a hard Brexit for all of the UK, because I think that it will be a disaster. If that is not possible, we will put forward proposals to avoid a hard Brexit for Scotland to keep us in the single market, even if the rest of the UK chooses to leave. When we put forward those proposals, it will be interesting to see what the response of the Conservatives will be. Of course, in the referendum campaign, Ruth Davidson was very clear, and she has been clear in the days after the referendum that she thought Scotland should stay within the single market, that the UK should stay within the single market. The proof of the pudding around this will be to see whether the Scottish Conservatives are prepared to back proposals that are in Scottish interest, or whether they are going to continue to capitulate to their bosses at Westminster. Maurice Corry To ask the First Minister, further to the decision by the Scottish Secondary Teachers Association to take industrial action, what steps does the Scottish Government never take to resolve the issue of teacher workloads? The Scottish Government's education delivery plan, published in June, made clear our commitment to tackle bureaucracy and address excessive teacher workload. We have worked with teachers, parents and other partners in education, both nationally and locally, to take concrete steps to address workload issues. Those include the recent announcement of the removal of unit assessments in the national qualifications. The removal of those units is part of a package of measures designed to address unnecessary bureaucracy and liberate teachers to focus on what they do best teaching young people. Maurice Corry I thank the First Minister for that answer. On these benches, we share the view that strike action is not appropriate, but, nonetheless, there remains a serious issue with teacher workloads. The Scottish Government's own figures show that, between 2008 and 2015, there was a 11 per cent decrease in the number of secondary school teachers in Scotland, representing a loss of some 3,008 staff. In particular, since 2007, more than 100 stem teachers a year have been cut, with 187 fewer computing teachers, 410 fewer mathematics teachers and 105 fewer chemistry teachers. That is clearly having a strong impact on teacher workloads in key subjects. In light of those statistics, what action is the Scottish Government taking to stem and reverse that trend? The First Minister As the member will be aware, in the last couple of years, the Scottish Government has provided funding to local authorities to maintain teacher numbers. We encourage them to continue to do so, to ensure that we have the right numbers of teachers in our schools to teach young people. The issue of workload is an important one. John Swinney, since he has been appointed education secretary, has spent so much time and effort working with teachers to try to address the legitimate concerns that they have. The changes to the national five higher and advanced higher qualifications that the Deputy First Minister announced are part of a package of measures that are designed to address unnecessary bureaucracy and to take away workload from teachers that was felt not to be necessary and not to contribute to their job of teaching young people. When you look as a whole at the plans that we have in place, making sure that funding is getting to areas of greatest need, bringing new transparency to school performance, our governance review, making sure that power and responsibility lie where it should as close to or in schools as far as possible with headteachers. That is all about a determination to ensure that teachers are able to do what they do best and that the contribution of teachers in teaching is helping us to raise the standards in education and close that attainment gap. It is something that we are absolutely focused on and will continue to be so. Fulton MacGregor To ask the First Minister how the Scottish Government will seek to improve systems supporting children in care. The First Minister On 15 October, I announced an independent route and branch review of the care system. The review, which will be the first of its kind anywhere in the world, will be taken forward in partnership with young people who have experience of care and will look at the legislation, the practice and the ethos and culture of the system. It is of vital importance that we listen to young people's experience of being looked after and I am absolutely committed to using what they tell us to help to change the care system, put love at the heart of the care system and make their lives better. Fulton MacGregor I am delighted by the First Minister's commitment to a review. What other action is the Scottish Government taking to support care experience young people to have the best opportunities in life? First Minister We have already taken specific action to modernise our children's hearing system to review secure care, establish our youth justice improvement board, support kinship carers, review learning and development opportunities for foster carers and residential workers and support families on the edge of care. Those are just some of the things that we have already done and the list could go on. There are improvements being made. School inclusions, for example, are down. More young people are impermanent rather than in temporary placements. When we look at the statistics for young people who experience care, none of us can be satisfied that we are yet doing enough. Those statistics are absolutely horrifying. When I speak to, as I have been doing a lot recently, young people who are in care or who have been in care, the simple message that they give me is that the system works well to stop things happening to them. It should, to some extent, have safeguards in place, but what it does not do is always operate to make things happen for them. We need a system that ensures that where young people cannot live with their own families for whatever reason, where the state becomes their corporate parent, we give them a sense of family, a sense of belonging, a sense of love and that the whole system is operating to make sure that they can reach their full potential. That is what I am determined to do, but the Government cannot do it alone. The Parliament cannot do it alone. We will only succeed if that is driven by the experiences of young people in care, and that is what will make the review unique. Liam McArthur Thank you very much, Presiding Officer. I welcome very much what the First Minister had to say there, but I urge her to look in particular at an area where those with care experience are glaringly underrepresented in that in terms of access to higher education. Will she look specifically at the support that is available to those with care experience to ensure that the maximum opportunities are provided for them to gain the benefit of a university education? Yes, I will give that commitment. Indeed, we have already announced certain changes to help to make sure that that commitment can be delivered. I mentioned the statistics earlier on. One of the horrifying statistics is that only 6 per cent of care experience young people will go to university. That is why we have already accepted the recommendations that came from our widening access commission to ensure a guaranteed place at university for a care experience young person who has the grades, but also to ensure full grants for care experience young people going to university. That is one concrete example of progress that we are already making, but we have got to do much more. We have got to do it in partnership with those who are the experts here, those who are in care or who have experienced care. I have been moved beyond belief by some of the conversations that I have been having with care experience young people in the past few months. I have no doubt that, if we come together, not just as a Parliament but as a country and if we put those young people at the heart of what we are trying to do, we can do something really special—something that, in years to come, we can all look back on with pride. To ask the First Minister what the Scottish Government's position is on the statement from the RCN that nursing in Scotland is facing a perfect storm. The First Minister Well, we appreciate the dedication of our nurses in midwice and indeed all of our NHS staff and recognise the pressures that they face. Under this Government, there are now more than 2,100 extra-qualified nurses in midwice, which is a rise of more than 5 per cent since we took office. We are, of course, not complacent. That is why this year we will again increase the number of trainee nurses in midwice—a fourth successive rise. We will also spend £450,000 to enable former nurses in midwice to retrain and return to the profession. The member used the phrase that I accept was the RCNs about a perfect storm. What will add to the challenges that our health service is facing, of course, is a situation in which those who work in our health service from other countries are prevented from doing so in the future. When we value our health service staff, make sure that we value all of them, regardless of where they were born. Miles Briggs. With the First Minister taking responsibility for the health service today, does she believe that it was a mistake as health secretary to cut the number of student work placements in Scotland? Can she tell Parliament why it has taken 10 years for her Government to bring forward an NHS workforce plan? Workforce plans are in place in health boards. As I have just said, the number of qualified nurses in midwice working in our health service today is higher than it was when we took office. That, I would suggest, means that the policies of this Government have been the right policies, but we have more work to do. That is why, as I have been saying earlier on, we are determined to do that work, to focus on the challenges and work with our NHS staff to make sure that we can meet them. This morning, we requested an emergency question on the publication by Audit Scotland of the Worst Reports Since Devolution on the State of the NHS, with only one out of eight standards met. On refusing the reason, as I understand it, was that Thursday provided an opportunity through First Minister's questions. Emergency questions are the opportunity for Parliament to hold the relevant minister to account. The standing orders are clear that emergency questions can be asked on any sitting day, including a Thursday. It cannot be right that the cabinet secretary of her health hides behind the First Minister, or that she is simply out of her depth. This report is a damning indictment of the health secretary, and she should be coming to Parliament to address this chamber. The tone from the SNP benches tells you how much they respect the NHS, and its hard-working workforce. Therefore, can you let us know if you have been advised by the health secretary had any indication— Sorry, Mr Sarwar. I cannot hear the point of order. Would members please let him speak? Mr Sarwar. Isn't it amazing that we hear everybody's voice, apart from Shona Robinson's voice on this issue? When can we have a statement from the health secretary to this Parliament about how she has let our NHS decline like this? The member makes a point, but it is not a point of order. The member is perfectly capable of speaking to his business manager and raising it through the business manager at the bureau on Tuesday morning. That concludes First Minister's questions. We move on to members' business. I would ask members to be quiet in moving their seats, please.