 The next item of business is portfolio questions and today it is health and sport. Can I make another plea for succinct questions and answers, please? Question number one, Kenneth Gibson. To ask the Scottish Government whether it can confirm that the new accredited specialist endometriosis unit will open in Glasgow in April 2019. Jeane Freeman. I am delighted to confirm that the west of Scotland specialist accredited severe endometriosis service is expected to be fully operational from April this year. Kenneth Gibson. I thank the cabinet secretary for that heartening answer. Despite endometriosis affecting one in 10 women, it still takes an average of seven and a half years for a woman to be diagnosed. While there is no cure for endometriosis, having a diagnosis enables women to receive appropriate treatment, stay in work, by having a condition understood and managed and make informed choices about fertility. Does the cabinet secretary agree that reducing diagnosis times should be a key priority for the new specialist unit? Jeane Freeman. I am grateful to Mr Gibson for that additional question. I do agree that for this unit and indeed for the two other units in Aberdeen and Edinburgh, reducing diagnosis times should be and indeed is a key priority. I also recognise that part of the length of delay in diagnosis is in part due to the diverse symptoms as well as a lack of reliable diagnostic tests, with no solid evidence yet into what causes endometriosis to occur. We have taken some additional steps to assist in this situation last year. We invested £162,000 in a study with the University of Edinburgh to inform the design of a large UK-wide clinical trial for the condition, and we have engaged recently with Endometriosis UK to discuss possible areas of mutual research interest. Research, coupled with the three specialist centres in Scotland, will go some way, I believe, in raising awareness among the public and, importantly, among healthcare professionals to facilitate access to speedy diagnostics and the best treatment available. Monica Lennon. In our recent written response, the cabinet secretary said that the Glasgow endometriosis centre activity has been modelled on an expected demand of 20 cases a year. I am surprised at that low level, given that one in 10 women have endometriosis. Will the cabinet secretary advise how that figure was reached and will she give her assurance that women in Glasgow and the surrounding area will not be forced to join long waiting lists for much-needed treatments? Jeane Freeman. I am grateful to Ms Lennon for that. The estimate of the number of patients is done using a number of factors, including the use of the service in Aberdeen and in Edinburgh, and what clinicians in the area that the Glasgow centre will serve the west of Scotland anticipate to be their demand. That is the basis on which the centre has been designed. It can in fact accommodate up to 24 patients. However, what I said earlier about research, improved diagnostic testing and so on, would I expect, over time, as the research proceeds and the diagnostic tests are developed, I hope, through the clinical trials, that we may then see a significant increase in cases? We have that in mind for all three centres and we will look at how the centres progress in order to be able to increase the capacity, if that is something that we need to do. 2. Gordon Lindhurst To ask the Scottish Government what role participation in sport and leisure plays in the health of the population. Jo FitzPatrick. Being physically active is one of the very best things that we can do for our physical and mental health, whether through sport, active forms of recreation such as walking or gardening or active travel. There is abundant evidence that it helps to prevent heart disease, strokes, diabetes and a number of cancers. It plays an important part in helping us to maintain a healthy weight on reducing the risk of developing depression. Sport and physical activity are also a powerful means of addressing isolation, building community cohesion and developing confidence. Gordon Lindhurst. I thank the minister for that answer. The minister may be aware of cuts to Edinburgh leisure's budgets, which are symptomatic of the financial pressures that the Government has put on local authorities. Price increases have been announced recently by Edinburgh leisure, including a reduction in the discount rate for over 65 per 10 per cent. Does the minister agree that making sport and leisure facilities more expensive for elderly people in particular is a false economy, especially in Edinburgh, given the current crisis in social care? Jo FitzPatrick. Obviously, all local authorities, the same as the Government, have to make decisions about the priorities that are within their responsibility. Those areas that are within Edinburgh councils' responsibilities are just that. I do not think that the member would—I am assuming that the member does not support the idea that the Scottish Government would come and tell councils how to go about their business. As I understand it, in Edinburgh Council, when the budget was decided, there was not a proposal from the Conservatives at Edinburgh City Council to provide further funding to Edinburgh leisure. Of course, in the chamber, the Conservative party's budget proposals came through. They were £500 million less across a whole range of our budgets, and that would clearly have impacted on Edinburgh Council, among others. Mark McDonald's supplementary question. Dainston medical practice, in my constituency, is one of more than 700 parkrun practices in the UK, in which patients and staff are encouraged to get active at their local parkrun, whether that is walking, jogging or running. Does the minister agree that it would be great to see more medical practices taking on parkrun practice status? Will he join me in congratulating the volunteers who put on Aberdeen parkrun, which will celebrate its 400th event this weekend? I agree with all the points that the member makes. Parkruns are an amazing phenomenon that is taken off right across Scotland. I would encourage members to go along and experience the fun. I have just signed up to go along to the one in Dundee, Dainston. Question 3, Michelle Ballantyne. To ask the Scottish Government what plans it has to improve NHS Lothian's infrastructure in order to cope with East Lothian's rising population. The £70 million East Lothian community hospital is due to be complete in August this year, with capacity for 132 inpatient beds, together with 14-day beds for minor surgery and endoscopy patients. NHS Lothian is also currently developing a business case for a £2.8 million extension to refurbish Harbour's medical practice in Coquensay and build an extension. Michelle Ballantyne. I thank the cabinet secretary for that answer. East Lothian population is the second fastest growing in Scotland with population projections for 2026, predicting a near 10,000 person surge from regional migration alone. Can I ask the cabinet secretary if she can guarantee that the new hospital has been future proof to meet the needs of East Lothian's rapidly rising population? If she has commissioned an impact assessment on how the rising population will affect NHS Lothian's overall provision of care. Jeane Freeman. Ms Ballantyne is, of course, correct. Population figures show that one of the highest areas of growth, 23 per cent between 2012 and 2037, is projected for East Lothian, with the highest growth in the population being among those over the age of 65, increasing by something like 72 per cent, many in single occupant households. All those factors are factors that a board is expected to do. Indeed, a health and social care partnership, in this instance, given the split in that rise in population, is expected to take full account of as it plattens its services ahead. I believe that East Lothian and the council and the health and social care partnership are fully cognisant of those figures. Indeed, some of them came from those sources, and the board is actively engaged with that knowledge in both what I have already announced but in looking at what else it needs to do in terms of the provision particularly of primary care and intermediate care services. Question 4, Johann Lamont. To ask the Scottish Government what its response is to the Sue Ryder report, A Better Grief. Jo FitzPatrick. I welcome the helpful focus on bereavement that this report brings. My officials have recently met with Sue Ryder to discuss some of the themes that are contained in the report. Officials are exploring with NHS independent and third sector colleagues as to how the messages in the report can shape a bereavement work to help to ensure that people with grief can access the care and support that is right for their individual circumstances. Johann Lamont. I thank the minister for that response. The minister will know from this important report that 72 per cent of people have been bereaved at least once in the last five years, but only 40 per cent of people know what kind of help or support to offer someone who is bereaved. Can the minister outline what plans the Scottish Government has to carry out research into the availability of bereavement support and the impact of different types of bereavement services, as proposed in Sue Ryder's A Better Grief report? Jo FitzPatrick. The Government is in discussion with a number of organisations, including the Scottish Partnership for Pallative Care. As I said, we have met with Sue Ryder in order to understand how we can better provide support. I recognise the member's long-standing interest in supporting bereave families in this area. I would be happy to meet her if she wants to discuss how we can take that forward. Miles Briggs. I want to thank and congratulate Sue Ryder and Hospice UK for that report, but specifically there was an ask within it about local primary care teams identifying and signposting support for people. I think that that is really important. Many of us will meet people and constituents who are in that position. Can I ask whether or not the Government will help to support that and fund potential posts in GP surgeries? Jo FitzPatrick. Accessing support is an important thing. Bereavement is unique to each individual. Bereavement services have to be flexible and connect with local networks that may provide support. As I said, officials have discussed with Sue Ryder and our discussion with other partners how best we can do that, including cruise bereavement care. It is an important area. It is an area that we can work across the Parliament on in order to make sure that we are providing the best possible support that is right for individuals. We have specifically asked the Scottish Partnership for palliative care to work with NHS Inform to improve online content that is available relating to palliative care and end-of-life bereavement care, but I think that it is an on-going process that we need to continue to do what we can to make those services better. To ask the Scottish Government whether it will provide an update on GP out-of-hours closures at Glenrothes hospital. Jeane Freeman. The out-of-hours service at Glenrothes continues to be closed because of on-going difficulties in securing staff for rotas. Patients who are required to be seen during those periods are redirected to another centre or may be provided with a home visit if that is more appropriate. However, the health and social care partnership has made some progress in recruiting an advanced nurse practitioner on the GP rota, an advanced pediatric nurse practitioner who is now seeing patients. Additional advanced nurse practitioners were also appointed in January and the out-of-hours centre is now a practice placement for students. Nonetheless, I continue to keep in touch with the health and social care partnership about how much more progress it can make in this area. I thank the cabinet secretary for that answer. As the cabinet secretary will be aware, both the Glenrothes area residents federation, who submitted a participation request and North Glenrothes community council have been assidious in their commitment to ensure that we do not lose our GP out-of-hours service in Glenrothes. I appreciate that decision is not ultimately in the cabinet secretary's gift. Will she agree to meet with my constituents to discuss their concerns? Jeane Freeman. The member will be aware. I am sure that NHS Fife met to discuss the Glenrothes area residents federation participation request on 15 March. It also met St Andrew's community council regarding its participation request on 14 March. Those discussions are on-going. I think that it is important that we allow the board and the community to conclude them. I will be kept up to date on those and I am happy to discuss that further with Ms Gilruth once we know the outcome of those discussions. Glenrothes is not the only hospital affected by those closures. St Andrew's community hospital is facing similar difficulties. Can the cabinet secretary confirm what pressures have been placed on the Scottish Ambulance Service, given concerns from the student population that the Victoria hospital is just too inaccessible? The Ambulance Service has not raised any specific issues with me in that regard, although I have had discussions with one of the GPs from St Andrew's, and an outlined discussion with the principle of St Andrew's University in terms of the additional steps that it is taking, but looking in particular at whether we can be more co-operative between that university and our national health service and the partnership to see how we can deliver an adequate service to that part of North East Fife. 6. Ross Greer Thank you. To ask the Scottish Government what action it has taken to address patient access issues at GP practices. Jeane Freeman The new GP contract will improve patient access to GP practices by increasing the transparency on surgery times and making a wider range of healthcare professionals available to patients. In addition, our commitment to increasing the number of GPs by 800 in the next decade will ensure that GPs can spend more time with patients who need to see them. The latest figures show that we now have a record number of GPs in Scotland and additional 75 GP and GP registrers. Targeted initiatives such as ScotGem and increasing undergraduate medical education places and increasing undergraduate training in primary care settings will, I believe, ensure a sustainable GP workforce in the future. Ross Greer I thank the cabinet secretary for that answer. One of the welcome objectives in the new GP contract—the NGMS contract that she mentioned—was the redistribution of some of GP's workload to other relevant staff. The problem is that patients don't know about this and we've got quite a lot of anecdotal evidence now that GPs are spending quite a portion of their 10-minute appointment times explaining the changes to staff. Can I ask the cabinet secretary to outline what steps she's taken to fill a commitment that she's made to ensure greater patient awareness of the change? Jeane Freeman I'm grateful to the member for that additional question and I'd be very happy to have from him where that anecdotal evidence is coming from in particular practice areas, because I have information that there are many patients across different parts of Scotland who are benefiting from that additional access to other professionals. There are ways in which we can help those independent contractors, and we need to remember that they are independent contractors to our health service, but there are many ways in which we can help them to make sure that information is available to patients and through community pharmacies and so on. I'd be very happy to look at the particular issues that Mr Greer is raising and to see what more we can do in those areas. Willie Coffey To ask the Scottish Government what the mortality rates are for cancer, heart disease and stroke in the Comarant and Irvine Valley constituency, and how they compare with Scotland as a whole. Jo FitzPatrick ISD Scotland does not routinely publish data at the constituency level, however, I can provide the member with data from Ayrshire and Arran health board. The latest mortality data shows that in Scotland over the last 10 years, stroke mortality has reduced by around 42 per cent, heart disease mortality by 36 per cent and cancer by 10 per cent. In relation to Ayrshire and Arran health board, ISDN figures show that cancer mortality has reduced by 2.1 per cent, stroke by 43 per cent and heart disease by 30 per cent over the same period. Those figures show that there is continued downward travel in the health board area. Willie Coffey I thank the minister for that answer insofar as it gives us a position across Ayrshire, but I hope that we can at some stage in the Parliament begin to produce data on a constituency basis that most of us represent. I wonder if the minister agrees with me about the clear link between poverty and ill health, which has been a consistent problem in my part of Ayrshire for many years. Could he give me some indication of what the Government is doing to address this and help to close that gap? Scotland has seen significant improvements in public health, but there are deep-rooted and historic issues with population health. We are working hard to address a number of our strategies. We know that heart disease, stroke and certain cancers, such as other lifestyle-related illnesses, are most pronounced in areas of deprivation. Tackling those inequalities can only be done by tackling the root causes rather than simply trying to address the consequences. That includes ending poverty, paying fair wages, supporting families and improving our physical and social environment. Those are all areas in which we are putting a real emphasis on across the Government. Of course, those issues are made much more difficult to address by the UK Government's continued welfare reform programme. To ask the Scottish Government how the provision of a care and treatment hub at Pitlockery community hospital will improve healthcare for high-limb pressure residents. The care and treatment hub will bring services together, such as phlebotomy, wound care, post-operative wound care management, suture and also care, and, by doing so, will increase access to appointments. The Parth and Conross health and social care partnership intends to have the hub open from October 2019, and the provision of those services through the hub will also self-evidently free up GP time to spend longer with patients who need their particular skills. I thank the cabinet secretary for that answer and for the information that has been provided. There is a lot of interest in the community around Pitlockery and Highland Pasteur in terms of what is currently being proposed. Can the cabinet secretary tell us how the community will be involved in designing the services that are available and what information has been made available to them about exactly what is going to be an offer from October? On the latter part of Mr Fraser's question, a very good supplementary question about how the community will know what is being made available, I am very happy to ask the local partnership to send me, and I will share it with you, Mr Fraser. There is a detailed plan about what are the various outlets, pharmacies and so on, the GP practices by which they are going to make that information available to potential patients in the local community and how they can make use of those. Of course, using social media is always a particularly good idea in this instance. My understanding is that the original thinking and the design around the creation of the hub came from feedback from patients, but again I will make sure that that is the case. If you like the feel of the new hub, you will have an involvement in that through the community council or by other means. I will make sure that Mr Fraser is aware of that. That concludes portfolio questions, and we will shortly move on to the next item of business.