 The next item of business is portfolio questions on health and sport. Question number one, Richard Lyle. To ask the Scottish Government what steps it is taking to ensure that NHS Scotland stays in public ownership. Jane Freeman. Government remains absolutely committed to the founding principles of a publicly owned, funded and operated national health service, which is free at the point of need. We will oppose any attempt of post-Brexit or any other trade talks impinging on that in any way. Our NHS in Scotland is not on the table in any trade deal. Richard Lyle. I thank the cabinet secretary for her assurance that some surely people of Scotland will be very happy. Can I ask how the continued interrogation of health and social care in Scotland is assisting the Government in protecting and managing the precious resources of the NHS and what discussions the Scottish Government is having with local health boards to ensure that our NHS is safeguarded against any future proposal by the UK Tory Government? Jane Freeman. As Mr Lyle will know from the budget that was agreed in this chamber, our additional investment in health and social care, exceeding £700 million, is about shifting the balance of care in terms of what people need to their local community, except where it is clinically required for them to be in acute settings. The health and social care medium-term financial framework sets out that approach, however, what I can assure him that we will not be doing as the nursing times has revealed is NHS Warrington and Halton hospitals, i.e. NHS England, now producing a pricelist for procedures that really should be provided free at the point where they are needed, cataract surgery, £1,700 replacement surgery, and that that only covers one pre-op, one-day case and one follow-up attendance. That is what is happening to the health service in England. Getting it ready to trade it off will not happen in NHS Scotland. May I ask all members that, if supplementaries are given, they make them quick questions, please? Miles Briggs, followed by David Stewart. In 2017, NHS Scotland signed a £400 million private company contract for local staff. Last year, a further contract of £30 million was also signed with six private companies. Is that not the increasing use of the private sector under the SNP? Jeane Freeman. No, it absolutely is not. I will explain to Mr Briggs and his amused colleagues why that is the case. The first contract that he refers to is with IHI, not for profit organisation. The other contracts that he refers to may indeed be our use of the private sector in the interim as I set out in the waiting times plan to reduce the long waits. What it is not, Mr Briggs, is selling off of sections of our health service to Virgin Health—your colleagues in England are doing precisely that—or allowing any of our boards, as your colleagues in England are doing, to produce priceless—priceless for hip surgery, for cataracts, for knee replacement. The day in our UNI might have a proper conversation. David Stewart. Thank you, Presiding Officer. Has the cabinet secretary investigated the wanting implications of investor state dispute settlements being produced as part of a trade deal that would allow foreign companies the right to sue the Scottish Government as a result of devolved health decisions? Jeane Freeman. Mr Stewart makes a very important point indeed. It was one that came up, I believe, when deals were being looked at before. That is the vulnerability in terms of the UK being seen as a single state when trade deals are negotiated and whether or not that places are at NHS in Scotland is in a vulnerable position. We looked at it at that time and have up-to-date advice at that time. We are looking at it again to ensure that we are as prepared as possible. I am absolutely certain that, with colleagues there in the Labour benches and elsewhere in this chamber—perhaps not over here in the Conservative with the people of Scotland—we will absolutely defend our health service. Question 2, David Torrance. To ask the Scottish Government when beauticians, hairdressers and others who provide ascetic procedures, will be regulated in the same way as medically qualified practitioners. Claire Hawke. Thank you, Presiding Officer. Independent clinics were brought within the regulation of Healthcare Improvement Scotland on 1 April 2016. The policy was to ensure that certain healthcare professionals are working independently from the NHS and that they do so in a clinic registered with Health Improvement Scotland. That work put Scotland at the forefront of regulating independent private healthcare in mainly the cosmetic, dentistry, midwifery and slimming clinics, to name but a few. Until 2016, there was no regulation whatsoever around cosmetic procedures. It is crucial that aesthetic procedures that are currently provided by non-healthcare professionals are subject to a similar level of inspection and scrutiny going forward as those of medically qualified practitioners. We plan to bring forward a consultation later this year to inform our legislative amendments. David Torrance. I thank the minister for that answer. Can the minister clarify what action can be taken in the meantime to highlight to consumers the risk that they face when submitting to procedures such as Botox and lip-filling injections carried out by unqualified practitioners who may have no training and may not have any insurance and may not be regulated? Claire Hawke. I think that Mr Torrance brings forward a really important point here to the chamber. Unconsidering undergoing such a treatment should always use a regulated provider, details of which are available on the Healthcare Improvement Scotland website. Unregulated providers will not appear on this list, nor will they have any his accredited literature to prove their competence. We would also urge consumers to use their due diligence checks on the provider. 3. Jeremy Balfour To ask the Scottish Government what steps it is taking to reduce excessive waiting times for young people in Lothian to access mental health support. Claire Hawke. Through the mental health access improvement support programme, NHS Lothian is scheduled to receive an additional £4.7 million between 2016-17 to 2019-20 from the Scottish Government to support mental health workforce development and capacity building. The director of mental health has written to NHS Lothian to seek reassurance about the approach that has been taken to address long waits and confirmation that patients are kept informed of their situation and provided with support and advice while waiting for on-going treatment. 3. Jeremy Balfour I thank the minister for her answer. However, the fact remains that, in the last quarter, 85 young people in NHS Lothian waited for over a year and 118 of young people waiting for over a year across the whole of NHS health boards. Does the minister agree with me that I am the Scottish Children's Service Coalition when it states that there must be a radical transformation of our mental health services? Claire Hawke. Long waits for CAMHS treatment and support are unacceptable. I have said that on more than one occasion in this chamber. The Scottish Government expects all health boards to meet and sustain performance against mental health waiting times targets. To help achieve that ambition, our 2018-19 programme for government outlines a package of measures supported by £1.25 billion of additional investment. That comes in addition to £54 million, which has already been invested to help boards to improve their performance against waiting time targets. Mary Fee I look at the broader picture of access to CAMHS across Scotland. The latest figures show that over a quarter of referred children are not seen within the 18-week target waiting time. When does the minister expect to reach the 90 per cent target of children and young people accessing CAMHS within 18 weeks? Claire Hawke. Mary Fee I thank Mary Fee for her question. All boards now have in place improvement plans for CAMHS and psychological therapies supported by the mental health access improvement team with milestones over the next two years. The Scottish Government is currently working with health boards, including Lothian and Fife and others, to agree their annual operating plans, which include how they will deliver those standards. Question 4, Neil Findlay. To ask the Scottish Government what work it has done to plan for the lifting of the ban on mesh implants. Jeane Freeman I have been consistently clear that the complete halt to transvaginal mesh procedures, which I announced last September, would only be lifted if a high-vigilance restricted use protocol is developed to my satisfaction. I have not instructed any planning to consider the lifting of the halt and that the Scottish Government has undertaken no work to that effect. Neil Findlay I warmly welcome the news that it looks possible that the US surgeon Dr Varunicus may come to Scotland to help mesh injured women. I thank the Scottish mesh survivors, the Sunday Post and the parliamentarians who have kept the pressure up on this. Can the cabinet secretary and the interests of transparency ensure that all the minutes of the accountable officers group and the short-life working group on mesh are published today so that we can see very clearly what has been discussed at those groups and whether they are planning for the return of mesh? Jeane Freeman As I have made absolutely clear to Mr Findlay, whether mesh is ever returned will be my decision as a cabinet secretary. I have been very clear in this chamber that I have not instructed any work to plan for that return and I have not had any work undertaken by the Scottish Government to plan for that return. It really is vitally important that, in this chamber and elsewhere, we are crystal clear on that and not cause further distress to those who are affected by incorrect information. In terms of the minutes of those two groups, the minutes of the short-life working group, which I established following a meeting with some of the women affected by mesh complications in March, published the first minutes of their first meeting today. Subsequent minutes are published when the group approves those minutes. That applies to the one meeting that the earlier group, which was set up following my statement in September, looked at the High Vigilance protocol and looked at the work in terms of the audit that I committed to being undertaken. That group also has to approve its minutes before those are published. When all of that is done, including declarations of interest, all of that will be published on the Government's website. To ask the Scottish Government what actions it is taking to tackle safety concerns in Fife hospitals. Jeane Freeman The safety of NHS Scotland's patients and staff is a key priority for the Scottish Government. The Scottish Government introduced a range of measures to protect and improve patient safety, including the Scottish patient safety programme launched in 2008. In terms of NHS Fife, it has contributed to the effectiveness of that Scottish patient safety programme, with, for example, a fall of 9.8 per cent in hospital standardised mortality ratios, a fall in cardiac arrest and a reduction in falls over a period of six years. Alexander Stewart I thank the cabinet secretary for that response, but during a recent unannounced inspection of visits at Llanrothys hospital by Health Care Improvement Scotland, a number of concerning issues were uncovered, including contaminated equipment, used waste and sharps being stored in accessible areas and inappropriate monitoring of water safety associated with Legionella. So what action will the Scottish Government take to restore patient trust in this hospital? Jeane Freeman That is precisely why those inspections are so important and why they are undertaken. The inspection report in fairness to Llanrothys hospital also found a number of areas where the hospital was satisfactory. It is only fair that we note that as well in the chamber. The board has a requirement then, alongside that report, to produce an action plan about the specific actions that it will undertake. It has done that and I am happy to ensure that Mr Stewart sees a copy of that. Let's go back and report again on those actions and, of course, my officials keep that under review constantly. If there are matters that require my intervention, then I hope that he is assured that I will do so. Ruth Maguire Government, how it will evaluate the delivery of the alcohol and drug treatment strategy rights, respect and recovery. Joe FitzPatrick NHS Health Scotland is leading on the development of a monitoring and evaluation plan that involves the Scottish Government as well as other key stakeholders. The plan will enable the Scottish Government to measure progress and assess the impact of the strategy. Ruth Maguire The landscape for treatment and recovery services can be complex in the process of how funding for early intervention and recovery work versus core clinical services is allocated is a little opaque. Can the Scottish Government see how it will address that? Audit Scotland's report from May 2019 highlights that making performance-related reporting public could help. With accountability, does the minister agree? Joe FitzPatrick We welcome the Audit Scotland report and our national alcohol and drug strategy published last year set out a number of actions that will address issues identified in the report. The Scottish Government and COSLA intend to publish a partnership delivery framework in the coming weeks to support local planning arrangements to address alcohol and drug harms. As I mentioned before, we are working with NHS Health Scotland to develop a monitoring and evaluation framework for the new strategy. The introduction of the new drug and alcohol information system, or DAISY, later this year will also provide clearer links between spending and outcomes and will demonstrate how investment in drug and alcohol services contributes to improving health outcomes. Bill Kidd To ask the Scottish Government what its response is to the health impact of the 2019 drum wealth games, which took place on 14 June and saw over 500 primary five-to-S1 pupils participate in sport activities. Clare Haughey First, I would like to congratulate everyone involved in the drum wealth games in its seventh year, a great legacy of the common wealth games in 2014. Being physically active is one of the very best things that we can do for our physical and mental health. The drum wealth games are testament to what can be achieved through partnerships between schools and clubs, with drum chapel community sports hub, active schools and Glasgow sport working together in partnership. Sport at an early age provides a fun and sustainable contribution to physical activity, which will hopefully lead to longer, happier lives. Bill Kidd I thank the minister for that response. The drum wealth games encourages children of all capabilities to try out new sports. Does the minister agree that it is important for all children in Scotland to be introduced to a wide variety of sports with the opportunity to pursue those that they find a passion for? Clare Haughey Yes, I do agree with Bill Kidd. That is why programmes like active schools offer over 100 different activities ranging from football to dancing movement, giving children the opportunity to be active and take part in the activities that they enjoy. While I was deputy convener of the health and sport committee, I was fortunate to visit the drum chapel community sports hub, and I was very impressed by the facility that provides an opportunity to improve health and wellbeing for all of the local community. Question 8, Dean Lockhart. To ask the Scottish Government what support it is giving to NHS 4th valley to reduce waiting times for chronic pain. Jeane Freeman As Mr Lockhart will recall, the waiting times improvement plan specifically targets in its initial work those waiting longest and those with a clinical priority. In 2018-19, NHS 4th valley received additional £4 million, which it focused on support for general surgery, ENT, trauma and orthopedics. In this financial year, NHS 4th valley planned to utilise the additional funding from waiting times improvement to recruit new staff to the chronic pain service to increase capacity by running parallel pain management programme with ESP physiotherapists. That programme runs in parallel with consultant-led services and will contribute to and complement the national work that we are doing to improve chronic pain service development across the NHS. Dean Lockhart I thank the cabinet secretary for that response, but recent figures show that more than a quarter of patients in NHS 4th valley have waited over 18 weeks for treatment for chronic pain. Only 73 per cent were seen within the 18 weeks of referral below the target of 90 per cent. That made NHS 4th valley the second worst-performing health board in Scotland on this measure. The cabinet secretary referred to additional funding, but what real measures will she take to provide additional support to NHS 4th valley in order to improve this situation? Jeane Freeman I think that additional funding is part of the real measures that we do take. It is precisely because of the situation that Mr Lockhart has outlined at 4th valley, as all the boards are required to do, target those areas with the longest waits and where there is a clinical priority. That is why they are targeting their chronic pain service in this financial year. We will see the effectiveness of that as we see the figures come out in due course. That concludes portfolio questions in health and sport, and we will move on to the next item of business as soon as everyone gets seated.