 The first item of business this afternoon is portfolio questions on health, wellbeing and sport. As ever, in order to get as many people in as possible, short and succinct questions and answers would be helpful. Question number 1, Colin Beattie. To ask the Scottish Government how many GP appointments were missed by patients in the last 12 months. Thank you Cabinet Secretary, Shona Robison. As independent contractors, GP partners are responsible for their own practice appointment and patient consultation arrangements. However, the Scottish Government expects health boards and their contracted practices to ensure that satisfactory appointment systems are in place for patients reviewing outlier performance and providing advice and support where necessary. Additionally, as part of the negotiated general medical services contract settlement for 2014-15, access will be reviewed and Scottish GP practices by March 2015. I thank the cabinet secretary for that response. I have recently myself been in discussions with local GPs as to what solutions can be employed to minimise missed appointments and so ease the burden on GP practices. Can the cabinet secretary update the Parliament on what initiatives the Government is undertaking to enable patients to easily cancel appointments? I can tell the member that online services are currently available to all GP practices in Scotland via existing clinical systems. The Scottish Government officials are actively looking to promote the uptake and usage of those services, which include online appointments and repeat prescriptions. We certainly welcome any new and innovative ideas, and I would be happy to keep the member informed about the progress of that. Thank you, Richard Simpson. At the last audit, cabinet secretary, I think that it was only about 50 per cent of people who are practices who are actually using it. The initiative to increase its welcome. I know that the Government has announced that there will be an inspection system for general practice. That is about 18 months behind England, which has been going for that length of time. When will it start the inspection system? Will the cabinet secretary look at the recent article by Ron Neville, a GP in Dundee, who has an appointment system that seems to me to be absolute best practice, and hopefully the Government might look at it and promote it? Certainly work is going on pace on the new inspection system for GPs, but I will update the member at the meeting that we have towards the end of this month. I agree that the system that you have described that Ron Neville has developed is something that we should be having a closer look at. As I have said before, I am always keen to make sure that the best practice in those matters is rolled out elsewhere. Again, I will be able to update the member further on that at the end of the month. The cabinet secretary will be aware of the pilots by a number of GP practices to use text messaging to help to produce a number of missed appointments and to help patients manage their healthcare. What plans does the Scottish Government have to roll this out across the NHS health boards? As I said to Richard Simpson, I think that the innovative ways, and some of them, are very simple. Given the use of text messaging more generally, I think that it is a very effective way of reminding people about their appointments, but also giving them an opportunity for someone to cancel their appointment in advance, because an appointment can be given to someone else. I am very keen that all of those things become the standard practice. Obviously, that sometimes takes longer than we would all wish. Again, I am happy to provide the member with an update on how we are going to make sure that we roll that out as quickly as possible. To ask the Scottish Government what recent discussions it has had with the local authorities that have yet to submit a draft or completed autism strategy. The Scottish Government are funding a national co-ordination team based in Strathclyw University to bridge between the Scottish Autism Strategy and its implementation at a local level. In the past few months, the team has made contact with all local authorities, and the nine local authorities that are yet to submit a draft are finalising them locally and submitting to committees for sign-off. They have until 31 March 2015 to submit their action plans and strategies. The national co-ordination team is meeting with all local authorities' autism leads on 19 January to continue those discussions. I thank the minister for his answer. The minister may be aware that Aberdeen City Council has not yet submitted a draft or completed autism strategy. I note that the minister says that they have until 31 March 2015, but my understanding was that when the funding was initially allocated, the hope would be that those would be submitted by March 2014. I am due to meet the council leader next week to discuss the issue, and I am concerned that the autism strategy appears to have been conflated with the council's school inclusion review, which, while important, is not the same thing. Has the minister received information from Aberdeen City Council as to when its autism strategy will be completed, given the anxieties of service users and their families that this important piece of work has been on-going for some considerable time, with no visible sign of progress? First of all, I acknowledge Mr McDonald's personal and political interest in the matter. He is a great champion on that particular issue. I can tell him in the chamber that Aberdeen City Council has given the Scottish Government assurances that its strategy, the autism strategy, was being finalised last week, and it will be submitted to the Scottish Government this week. I am aware that the final draft that the minister was going before the committee at Aberdeen City Council this month and once signed off, the final strategy will be made public. I want to reinforce the point that I have already made. The Scottish Government will continue to hold discussions with local authorities to ensure that all autism strategies and action plans are made public. Constituents have come to see me and tell me that the strategy is not working, and they feel that there is no access to appropriate services in Highland, leaving themselves and their families unsupported. I am pleased that Strathclyde has been asked to co-ordinate the national strategy, but I am asking what work will they do with local authorities and NHS boards, and what work will they also do to include service users and their families in designing local services for them? I can inform the minister that Highland Council is one of those that has submitted its draft. We would, of course, always want to make sure that service users and those who take a great interest in the matter are consulted on. Indeed, the team that I have referred to will maintain a great interest in what is happening in the Highland Council air and across the country, Presiding Officer. To ask the Scottish Government how many acute hospitals in Scotland were in red alert in each of the last week of 2014 and the first week of 2015. Cabinet Secretary, Shona Robison. While hospitals have experienced pressures over the recent holiday period, none have needed to declare a major incident due to the demands that they were facing. On a daily basis, boards have been keeping the Scottish Government informed about pressures and actions that are being taken to addresses. Additional support has been provided to the boards where required. Thank you, James Kelly. I thank the cabinet secretary for that answer. There is no doubt that, in recent weeks, the crisis in Scotland's A&Es has intensified, with many patients facing unacceptable long waiting times, including constituents of mine. Does the cabinet secretary agree that that is unacceptable? Does she accept responsibility? In each of the last two weeks, how many patients have waited greater than 12 hours? I say to James Kelly that it is unacceptable that anyone has to wait longer than they should in A&E. Of course, the pressure on A&Es across Scotland and across the rest of the islands has been unprecedented. Glasgow, for example, has told me in some detail about the level of very sick elderly patients that are turning up in numbers that they have not seen during winter pressures in any other year—many more admissions than normal, which puts pressure on the whole system. In answer to his question specifically, the number of 12-hour waits in the Greater Glasgow and Clyde area for the week ending 11 January was 84. That is a significant number of the 175 for the whole of Scotland. Those patients should not have had to wait 12 hours, but we need to understand that staff in A&E were doing absolutely the best that they could, that the winter pressure preparations had been gone through in great detail, and staff and managers had put in place everything that they could have. Unfortunately, due to the surge of patients who were having to be admitted, the A&E departments, particularly in Glasgow and Clyde, faced unprecedented pressure. However, we will absolutely learn the lessons from this winter and, in preparation for the months coming, we will make sure that we deal with some of those pressures, particularly the delayed discharges, which were not the whole story given the level of admissions, but certainly do add to the pressure that boards are facing. To ask the Scottish Government when it last met NHS Ayrshire and Arran and what issues were discussed. Can I say to Margaret McDougall that ministers and Scottish Government regularly meet with representatives of health boards, including NHS Ayrshire and Arran, to discuss matters of importance to local people? It was a pleasure to conduct NHS Ayrshire and Arran's annual review, the first one that I have done since becoming Cabinet Secretary. As the Cabinet Secretary will know, Crosshouse hospital has been in the headlines for the wrong reasons recently. Firstly, £1.3 million worth of surgical equipment was stolen and sold on the black market. That led to cancellations of operations and, of course, the cost of replacement. Secondly, an unannounced inspection found widespread blood contamination of patient equipment in maternity and A and E departments. A second inspection, a month later, saw some improvement but still it did not get a clean bill of health. Staff are doing all they can but they are underfunded and overstretched. Are those two issues indicative of what is happening to our health service across Scotland under the Scottish Government? They recently announced £3.2 million for Ayrshire and Arran. I am just coming to it and that will not even cover the replacement of stolen instruments. So what is the Cabinet Secretary going to do to ensure that our once-envied health service is properly funded and supported? Our health service still is envied across the world and it is properly funded. A £380 million rise in the budget next year breaching £12 billion for the first time ever now by any reasonable person's standards. £12 billion is a lot of money for the health budget. Can I turn to Crosshouse hospital itself? I have to say that I was very impressed with the hospital and the staff who were working very hard within it when I visited Crosshouse. The surgical equipment being stolen was reprehensible that that happened and of course the police investigation is ongoing and has reached an advanced stage. The inspection reports are important and previously there were no such inspection regimes and I think that it is really important even when it makes difficult reading that HEI are going in and shining a light on all of our hospitals particularly when they are unannounced and it means therefore that they can know where they have to put matters right and of course a lot of work has gone on by Ersin, Arran and particularly at Crosshouse hospital to address the issues within those inspection reports. I will say to Margaret MacDougall that there is still more to be done and I am the first to accept that but that is not under sell the good things that our NHS provides and the hard-working staff within it. Supplementary John Scott Thank you, Presiding Officer. Cabinet Secretary will be aware of the ongoing lack of bed availability at Air and Crosshouse hospitals with occasional but regular closures of Crosshouse hospital leading to extra burdens on staff, particularly at Air hospital. Notwithstanding the almost herculean efforts of nurses and doctors at both hospitals, this entirely foreseeable, predictable and now well-documented problem remains and my question is what is the Cabinet Secretary doing by way of discussion and planning with NHS Ayrshire and Arran senior management to get this now long-standing problem resolved? Cabinet Secretary can I thank John Scott for his question? Yes, this is absolutely a discussion that is going on between ourselves and Ayrshire and Arran. It is very important that all parts of the health system have the right number of beds in the right places with the right staff to support them at the right time. What we also need to do is to make sure that those beds are being used to their optimum and because of the issue and challenge of delayed discharge at the moment that is not the case because too many beds are being used by people who do not require them because they are not being able to be discharged because of all the reasons that we know in terms of care in the community and some of the support requirements there. We are doing a lot around that and I have more to say about that in the next few weeks but I can assure John Scott that those discussions are on going and I will write to him to update him on the latest. To ask the Scottish Government the progress to provide an update of the progress of the new Dumfries and Galloway royal infirmary. Cabinet Secretary. The replacement for the Dumfries and Galloway royal infirmary is currently progressing as planned, construction commencing in the spring of this year following financial close of the project in February. The board is working in partnership with the consortium High Wood Health, appointed as preferred bidder. Full unconditional planning consent for the project was obtained on 16 December. The construction and handover of the new hospital to the health board by HWH is planned for the end of August 2017 to become fully operational by the end of that year. I thank the cabinet secretary for that answer. NHS Dumfries and Galloway have said that they are fully committed to delivering real community benefits as part of the procurement, construction and operational phase of the hospital project. Could the cabinet secretary outline what sustainable training, employment and local development opportunities that the project will bring? Yes, I can. NHS Dumfries and Galloway has a requirement in the project agreement for targeted community benefits, including recruitment and training, small and medium enterprise supplier development and educational opportunities. High Wood Health, the project delivery partner, is working closely with Dumfries and Galloway employment and education specialists, and that includes a commitment to create 150 new jobs, 36 of which will be apprenticeships. NHS Dumfries and Galloway's project team as enablers will work in partnership with HWH and the agencies to maximise opportunities arising during the delivery of the contract. To ask the Scottish Government how many times NHS 5 failed to meet its four eight and twelve hour accident emergency waiting time targets between the 24th of December 2014 and the 4th of January 2015. Unvalidated figures have been reported to the Government for the two-week festive period. NHS 5's four-hour accident and emergency performance for core accident and emergency departments was 87.3 per cent in the two weeks ending the 4th of January this year. Official ISD Scotland statistics on accident and emergency activity for October, November and December of last year will be published on February 3. A&E figures will then be published on a monthly basis thereafter. I thank the cabinet secretary for her response and I would obviously want to put in record my sincere thanks to all those workers and hospitals and across the public services who were working over Christmas in the year to look after and care for the elderly and most vulnerable in our communities. The figures that I have are for four hours 154 times, eight hours 25 times and 12 hours target three times. I would be grateful for a meeting with the minister to follow that up. She has previously, and the previous question talked about delayed discharges. Is she aware that NHS 5 took a decision to shift nine patients and then followed up by another 13 patients into care homes without the guidelines and the assessment, the social work assessment actually taking place, which is a form of boarding patients into care homes? Does she support such a move and will she agree to look into and respond to me whether this is a change in policy and practice taking place in terms of boarding patients into care homes? I would be happy to meet her to discuss the issues in more detail. NHS 5 and 5 council, as I am sure the member is aware, came in to see me jointly to discuss the challenges of delayed discharge within their area. It was actually a very productive meeting. From that meeting, a number of actions were agreed and Scottish Government officials have been supporting the partnership in taking forward some of those measures. Some of that is to look at the boosting of home care to get people obviously moving safely home. However, one of the other areas was the opening of what we call intermediate care beds. Those are beds that are step-up, step-down beds that can be used for people who are ready for discharge but perhaps not ready to go home. They are not people who are boarded out because they are ready for discharge but they are people who maybe need a bit of rehabilitation to be able to go home independently. However, I am happy to discuss that in more detail with Alex Rowley in due course. To ask the Scottish Government whether it can provide an update regarding the proposed commonwealth games legacy sporting facilities that will benefit the people of Glasgow? Glasgow 2014 has been used as a catalyst to raise the profile of sport in Glasgow, accelerate the development sport and create a lasting legacy of world-class sporting facilities. The people of Glasgow continue to benefit from the fantastic facilities used to host the commonwealth games, such as the Emirates Arena and the Glasgow National Hockey Centre. Furthermore, communities across Scotland have been supported by the LEXI 2014 Active Places Fund since its launch in 2012. A total of 154 projects from 31 local authorities, including 13 in Glasgow, have received awards totaling over £8.1 million. I thank the minister for that answer. I am wondering if he could furnish me with any information on the possibility of a development of any or whether three G pitches in my Glasgow Anise land constituency. What I can say to Mr Kidd is that there has been investment in his constituency. In terms of sports facilities, there are nine community sports hubs up and running in Glasgow, including an area-based hub in Drumchappel, and a variety of local venues, including the high school sports centre and leisure centre, and a disability sports hub based at Scotland leisure centre. I am sure that he will be interested in that. In terms of three G pitches in his constituency, sport Scotland has not provided any funding towards three G pitches in recent years, but there are various funding sources available that can be applied for sports projects, including the installation of three G pitches. If there is any specific project in Anzenland that can be of assistance in pointing Mr Kidd or others in the direction of those funding sources, Mr Kidd just needs to ask. Question 8, Jim Huw. To ask the Scottish Government what plans it has to increase the number of mental health officers being trained. Local authorities have a legal duty to appoint a sufficient number of mental health officers to discharge functions under the relevant legislation. They must decide on the number of mental health officers appointed in the area taking into account local needs and circumstances. The Scottish Social Services Council's latest mental health officer report indicates a 39 per cent increase in admissions to mental health officer award programme in 2013-14. Minister for his reply, evidence from that Scottish Social Services Council shows that the number of mental health officers is declining and the workforce is aging. The Mental Welfare Commission states that 42 per cent of emergency detentions in hospitals had no mental health officer consent, even though that should be the case, and that 62 per cent of short-term detentions did not have a social circumstances report critical to patients getting the right treatment and care. When will the Government address the shortage of mental health officers and look to have a Scottish-wide recruitment and training strategy for them this year? Well, of course, I should say that we will always take serious the views of the Scottish Social Services Council and the Mental Welfare Commission and others who express a view in relation to those matters. I would go back to my original answer and make the point again that the latest mental health officer report indicates a 39 per cent increase in admissions to the mental health officer award programmes in 2013-14, but we are exploring mental health officer capacity and other issues with key stakeholders, including local authorities and mental health officers, to better understand what the issues are and what plans there are at a local level to address any shortfall in mental health officers. This is something that the Government places great priority on, Presiding Officer. Thank you. Briefly, please, Mary Scanlon. Can the minister tell me, given that the out-of-hours mental health officers is now at an all-time low, what recourse do mental health patients have to the Government when there is no mental health officer there to provide them with the advice and support that they need in accordance with the Mental Health Act? Well, of course, this Government takes very seriously the provision of mental health services across Scotland. I have made the point that capacity is increasing. We hope to be able to see more mental health officers come on stream. I should make the point that the workforce planning is a matter for each individual local authority, but, of course, as part of its responsibilities in terms of mental health, just on 20 November, the Government announced additional investment of £15 million over the next three years to improve mental health services. I think that that gives some indication in terms of the importance that we place in this area. To ask the Scottish Government what steps it is taking to promote women's football. The Scottish Government is a committed supporter of Scottish women's football and recognises the positive impact that football can have in communities throughout Scotland. In May 2014, under the Cashback for Communities programme in the Scottish FA, it was awarded up to £2.25 million through to 2017. The funding is supporting development of various aspects of girls' and women's football, including proactive engagement with girls via regional development officers to increase participation for females aged between 9 and 24. Richard Lyle. I thank the minister for his answer, and I know that he is a committed football supporter. I note that, sadly, Scotland's women's football team did not unfortunately qualify for the 2015 World Cup in Canada. What steps has the Scottish Government taken to improve our chances of qualifying for the next women's football World Cup in 2019? Opposite, the women's national team did unfortunately not qualify for the 2015 World Cup in Canada. I think that we should recognise the tremendous progress that they made as a team, because they performed very well in a strong qualification group, reaching the playoffs for the first time in their history. They are now ranked 21st in the FIFA World Rankers and 12th in the European Rankers. I hope that Mr Lyle and others in the chamber have understood that they do not particularly want ministerial responsibility for guaranteeing whether or not our national teams qualify for international tournaments, but I would go back to my initial answer, which demonstrates the significant funding that we are leveraging into women's football directly. Of course, we have committed £500,000 each year since 2008 to support the active girls programme, which aims to increase the number of girls participating in PE, physical activity and sport in and around schools, which includes football. We are committed in that end, and I am sure that I speak for the whole chamber when I say that I wish the women's national team all the very best in their efforts to qualify for the next World Cup. Question 10, Liam McArthur. To ask the Scottish Government how often the short-life working group on heart failure has met and what conclusions it has reached regarding strengthening the role of heart failure nurses. The heart failure hub has met in a formal capacity twice and has been integral to two learning events, the second of which will take place on 6 February 2015. The national programme of work being taken forward by the heart failure hub recognises that heart failure care is critically dependent on heart failure teams with heart failure nurses being central to this. To this end, we have appointed two heart failure nurses to support the work of the heart failure hub and to draw heart failure nurses even more closely into this advancing agenda. Thank you, Liam McArthur. Can I thank the minister for her response and also, belatedly, welcome her to her post? The minister will be aware that Orkney is the only area in the country without a heart failure nurse. It is an issue that I raised in the chamber back in 2013. It is a concern of the Orkney Heart Support Group, which has been in regular contact with the NHS Orkney Board. NHS Orkney itself accepts that the heart failure nurse could be cost effective, beneficial to patients and reduce hospital readmission. Will the minister agree to engage with the board in Orkney to see whether the appointment of a heart failure nurse in Orkney can be included in the board's delivery plan for the coming year? Maureen Watt. Yes, I am happy to engage with NHS Orkney on this, and they recognise, as the member has said, that it does not have a heart failure nurse service as detailed in the Scottish Heart Failure Nurse Forum 2013 report. However, we should recognise that Orkney currently has two consultant physicians in post and have recently recruited a third consultant physician. Heart failure patients in Orkney are cared for in a shared manner between the physicians based at Balfour hospital, both with previous cardiologist experience, NHS Grampian and the local primary care teams. Although Orkney does not have a formal heart failure nurse service, the consultant physician's cardiac specialist nurse, who is a heart failure nurse practitioner and the hospital farm assist all provide advice to any member of the multidisciplinary team caring for a patient with heart failure in Orkney. As the Scottish Government, what support it provides to people with lipidemia? The Scottish Government recognises that lipidemia can be a distressing and painful condition. As with all long-term conditions, we want people living with lipidemia to be able to access the best possible care and support wherever possible. The recommendation of any particular treatment is a matter for discussion between a patient and their doctor, and any issues surrounding the provision of a treatment are a matter for the relevant NHS board. I thank the minister for that answer, but can she advise whether the Scottish Government will consider how to improve the level of support offered to those who have lipidemia? If that will include increasing the number of specialists employed by NHS Scotland, I understand that at the moment there are in fact only two in Scotland. Yes, I understand that lipidemia can cause many difficulties and can be very painful for people who have this condition. I am also aware that for some patients it can take some time for them to receive the correct diagnosis. Increasing awareness of lipidemia is clearly important, and I am pleased to note that the Royal College of General Practitioners launched a lipidemia course for GPs and medics in May 2014, which was developed in partnership with lipidemia UK. I also recognise the importance of the third sector in providing valuable support to those with lipidemia. My officials have confirmed that they will update lipidemia charities about the possible opportunities of grant applications for 2015-16 under the section 16B scheme. The Scottish Government is fully committed to providing the people of Scotland with the NHS services that meet their needs and maintain high standards of care. While the Government provides policy, framework and resources of high-quality healthcare in Scotland, it is for each NHS board to decide how best to deliver those services to meet the needs of the population. To ask the Scottish Government whether it supports the role that community hospitals play in helping with the provision of local healthcare and freeing up beds in larger hospitals. Community hospitals can play a vital role in the provision of local healthcare, and are being developed to provide a range of community services such as bed-based intermediate care services or health and social care hubs. It may be developed to provide a range of medical and social care services in one place. Bed-based intermediate care can be provided a step up from home as an alternative hospital admission or step down following a hospital stay. We encourage partnerships to develop more of those services as alternatives to acute hospital admission. I thank the minister for that answer. The minister may be aware that as part of a review of clinical services, NHS Borders is considering the future of hospitals in Duns, Hoik, Kelso and Peebles. I have been flooded by emails and letters from concerned residents, patients and staff who cannot understand why busy local hospitals, which free up beds in the Borders general hospital, might be lost. The Scottish Government's community hospital strategy says that community hospitals are an important part—it is more important than ever—in providing both health and social care services for local communities. The Scottish Government's vision for healthcare includes shifting the balance of care from large institutions into community settings. Has the minister had any discussions with NHS Borders over the suggestion that facilities in Duns, Hoik, Peebles and Kelso may close? Given the Scottish Government's apparent support for community hospitals, will the minister join me in making it clear to NHS Borders that those local facilities must stay open and rule out supporting any closures in the Borders? Let me acknowledge that Mr Lamont is doing what you might expect to do. Of course, he represents his constituency interest. I should say that we shouldn't put the cart before the horse here. This is ultimately a matter for NHS Borders, and I'm aware that they are proposing to carry out a review of all their clinical services, not just community hospitals. I would expect any review to be carried out in line with our 2020 vision for the future of healthcare in Scotland. Those proposals will have to give clear evidence of how the board would address the impact and outcomes for people in communities. To ask the Scottish Government whether it considers staffing levels in NHS Lanarkshire satisfactory. In NHS Lanarkshire, staff in post numbers are at a record high, the number of consultants is at a record high and the number of qualified nurses and midwives are at a record high. NHS boards, including NHS Lanarkshire, are responsible for ensuring that they have the correct mix and number of staff to deliver and maintain high-quality services for their patients. We expect all NHS boards to plan for their workforce, utilising staff banks where appropriate, and we have supported the development of workload and workforce planning tools, the use of which were mandated in April 2013. Mark Griffin? I thank the cabinet secretary for that answer. It is the cabinet secretary who is aware that the out-of-hours service in Cuminald has now been closed since June 2014 because of a lack of available GPs, meaning that local people now have to travel to Munklands hospital in Airdrie, adding more pressure to that service. Does the minister think that it is acceptable that that situation has been allowed to drag on for over seven months and what action can she take to get Cuminald out-of-hours service operational again? Obviously, Mark Griffin will be aware that NHS Lanarkshire is embarking on a review of their out-of-hours services. What I can say is that it is very important that NHS Lanarkshire move to ensure that the out-of-hours service meets the needs of the local population. I hope that Mark Griffin will welcome the fact that NHS Lanarkshire is one of the biggest gainers of the enrack uplift that I announced this week and is set to receive £13.5 million in next year's budget. I am sure that that will help when it comes to the design and provision of their out-of-hours services. To ask the Scottish Government what its position is on the availability of child and adolescent mental health services in North East Scotland. NHS boards have done significant work in service redesign to increase the capacity—their capacity—to meet the CAMHS target on a sustainable basis. As a result of redesign, NHS Grampian has already identified where they need to increase capacity. We support the board and the work that they have done in the back of a process that gives sustainable performance in patient facilities covering the north of Scotland, which includes the NHS Grampian, which is provided by Dudh Hope House and Dundee, which is a further six beds becoming available in May 2015. The additional six beds will increase the bed base serving the north of Scotland and improve the quality of the estate. As the minister says, there are no CAMHS in-patient facilities in the NHS Grampian area. Instead, a young patient from, say, my hometown of Ellen would be placed over 100 miles away from home in Rheymor hospital in Inverness, where currently the socament's NHS bed is in the north. Even Dudh Hope House, as the minister mentions, is more than 82 miles away. How are families to support their children at such distances? One GP, responding to a recent SAMH survey, said, for mental health it needs to be local, local, local, and as much as possible, face to face. Does the minister agree, and how does he intend to improve access for my younger constituents to local, responsive and age-appropriate services? Of course, there is always an important balance to be had, and I recognise that where we can provide services as local as possible we should see to that. Those are, of course, specialist services and we cannot provide them, sadly, absolutely every location. That is why they are located in specialist centres, but there is always the possibility that beds can be made available at other locations in certain circumstances where that might be appropriate, and that can be taken forward. To ask the Scottish Government what requirement there is on health boards to undertake adverse incident reviews in respect of patients dying whilst on the delayed discharge database. NHS boards must ensure that a system to record these cases is in place, and the medical director should consider all such cases and carry out a review if it were thought that the delay in discharge had been a contributory factor to the person's death. Any adverse incident review should be carried out in line with guidance in the learning from adverse incidents through reporting and review document. Can I thank the cabinet secretary for her answer? There were 1,000 deaths of patients on the delayed discharge database, in other words, patients fit for discharge. A freedom of information request by the Labour health team shows that only two reviews were carried out. Does the minister find this appropriate, and if not, what action will be taken? The number of reviews that would be carried out would be if it was thought that the delay in discharge had been a contributory factor to the person's death. There is a process through the guidance that I described in my earlier answer, learning from adverse incidents through reporting and review document that sets out which cases should be reviewed in that way. We are talking about very frail elderly people, many of whom have had a number of conditions. However, I would be the first to acknowledge that, even when it comes to end-of-life care, a hospital is not the place that many of those frail elderly people would want to die. They would want to die with their family at home and, quite rightly so, they should be given that option. That is why I have said absolutely that dealing with the delayed discharge and eradicating the delayed discharge out of the health system is absolutely my top priority, and it is for that very reason that it is so. Question 16 has been withdrawn and a satisfactory explanation has been provided. To ask the Scottish Government what measures it has taken to protect NHS staff in light of the recent reports of high levels of injuries at work and sick leave due to stress. Our staff are at the heart of the NHS. Their health and wellbeing is something that the Government takes very seriously. The staff governance standard for NHS Scotland commits all boards to providing a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients in the wider community. Through our monitoring arrangements, we are ensuring that boards have policies and actions in place to support staff. I thank the cabinet secretary for that response. I am sure that everyone will agree that injuries and sickness within the NHS are a serious problem, whatever the cause, but would the minister agree that it would be useful to have regular updates made available by health boards about the nature and incidents of such problems and what action they are taking to address them? Yes, I would agree with John Pentland. I think that that may well be something that would be useful and I can certainly be happy to look at how we could do that. I think that it is important that we understand the nature of those injuries, particularly where the violence has been involved in any of those. Importantly, as John Pentland also said, what action each board is taking to address those issues. I am very happy to take that forward and I will get back to the member in due course. That concludes questions this afternoon. We therefore turn to the next item of business, which is a debate on motion number 12045.