 To ask the Scottish Government what discussions it has had with NHS Lothian regarding GP services in Musselburgh. NHS 24 is delivering a pilot at the Riverside GP practice in Musselburgh, whereby it is triaging patients who have requested same-day GP appointments, where appropriate NHS 24 will signpost patients to other areas of the primary care system, which are better placed to meet their needs and offer more swiftly. Indications are that this pilot is working well, with a number of patients signposted to more appropriate support, freeing up GPs to deal with patients with more complex needs. A full evaluation is under way with a report due in the coming weeks, which will be shared with health boards and integration authorities. Earlier this month, 200 angry Musselburgh residents turned out at a public meeting because they have had real and persistent difficulties accessing GPs locally. They do not think that it is working that well, Health Secretary. Many of those problems are caused by a GP shortage, a point that both the practice and the BMA acknowledge. Can the cabinet secretary explain to my constituents why they have to phone NHS 24 to see their GP and when she expects Scotland's GP shortage to be resolved? First of all, the pilot that NHS 24 is running has been a system that has worked well elsewhere and has had really strong evaluation. I urge Kezia Dugdale to wait for the formal evaluation of the pilot. I am happy for her to be furnished with the evaluation if she would be interested in that. On the way forward for general practice, she will be aware of the new contract that has been put in place with substantial resources to back that up. We will invest £100 million in this financial year to support the new contract. We also have the ambition to increase the number of GPs by at least 800 over the next 10 years, but in addition to that will be that multidisciplinary team to make sure that we can reduce the workload of GPs. Thank you. Most of our residents, as Kezia Dugdale has outlined, are complaining of long waits, often half an hour, just to get through on the phone, cabinet secretary, and then waits of around three weeks before they are even seen by a GP. Does she think that that is acceptable? Cabinet secretary. No, I do not think that it is acceptable, but it is important that we try new ways of working and the NHS 24 system has worked well in other areas and has been well received by patients. Now, if there are issues with the way that this pilot is working in Musselboro, that needs to be picked up by the evaluation. More generally, Miles Briggs will know that the work around the expansion of the primary care team and the new GP contract and the increase in GPs over the next 10 years is all about making sure that we reduce the workload of GPs so that they can spend more time with the patients that they need to. That requires a multidisciplinary team, and that is going to take a bit of time to put in place. 2. Daniel Johnson To the Scottish Government, what the average waiting time has been in the last year for adults seeking diagnosis for ADHD and how many rejected referrals for diagnosis there have been? Minister. The data on waiting times for psychological therapies is collected by Information Services Division Scotland. The data is gathered in an aggregate form from NHS boards and does not allow waiting times and rejected referrals for adults with an ADHD diagnosis to be separately analysed. Daniel Johnson I thank the minister for that answer, but I think that it is regrettable that we do not capture this data because it is critical so that people can be directed to the right specialist. It is a bit like not knowing whether or not people are being referred to oncology or for orthopedics and physical health. Indeed, anecdotally I want your question please. So can the Government explain what they have introduced to capture this information so that people can be directed more effectively in mental health services? Minister. As I said in my previous answer, the essence for information is not collected at the moment, but we are looking into this and are in discussion with ISD Scotland on how we can move this forward. 3. Stewart Stevenson To ask the Scottish Government what action it is taking to meet the oral health needs of an ageing population. Cabinet Secretary. In January, we published Scotland's Oral Health Improvement Plan, which includes actions to ensure that older people receive appropriate oral health care. One of our priorities is to introduce a new domiciliary care service. For adults, including older patients, the plan also includes an action to introduce an oral health risk assessment. That will ensure that the dentist is able to offer tailored advice to older people on how to look after their oral health and minimise any risk of dental disease, including oral cancer. 4. Stewart Stevenson What discussions has the Scottish Government had with the UK Government to include dentists in the proposed visa cap scheme in particular, given that there are large numbers of EU nationals operating as dentists in the north-east of Scotland, whose future in the service might be a threat? Cabinet Secretary. The member is quite right to point to the number of EU nationals working not just in the north-east of Scotland, but particularly in Dumfries and Galloway, as dentists due to previous successful recruitment campaigns. I would be very concerned to lose any of them from Scotland. In terms of last week's announcement confirming that doctors and nurses are to be excluded from the cap on skilled work of visas under tier 2 of the immigration rules from 6 July, although that is welcome, we need to see the detail. It may be that it increases the capacity for other applications from outside the health professions, but dentists are not directly covered, but it is something that we would want to take up with the UK Government, and we will seek further detail on that in the coming weeks. Nisarwa Rathbone I note our register of interests that I am a former practicing dentist and my wife is still a practicing dentist. The health secretary will be aware that the BDA has raised concerns about the new oral health action plan and the risk that it might have in more patients turning to private plans, such as the DEN plan, as a result. Can the cabinet secretary tell us what assessment has been made of the number of patients going to DEN plan, and would she agree to meet me and a delegation from both the BDA and practicing dentists to discuss this further? I have discussed this with the BDA and the opportunities that I have engaged with dentists. Both positive issues about the new plan and some of the concerns that Nisarwa Rathbone has raised. First of all, as he will understand, this is about an appropriate risk assessment. The whole idea is to make sure that dentists can spend more time with those with the poorest oral health. That means that the appropriateness of the plan is dependent on the person's oral health. That is something that I would hope that we can all agree on, but in terms of the implementation, it is important that the chief dental officer and others continue to engage with the BDA and others to reassure them on the issues that they have raised. To ask the Scottish Government what discussions it has had with NHS Fife regarding the withdrawal of primary care emergency services from St Andrews. What action will it take to ensure that the town is considered as an option for future service provision? My officials have been in regular contact with Fife health and social care partnerships during the contingency period for primary care out-of-hours service in Fife, but the provision of safe and sustainable out-of-hours service is the responsibility of NHS Fife in collaboration with the health and social care partnership. I understand that the partnership will shortly be consulting on the future of the out-of-hours service across Fife. The review, including an options appraisal, has been in development for some time in response to the recommendations of Sir Lewis at Richie's report on out-of-hours in Scotland, published at the end of 2015. Willie Rennie Does the health secretary understand the level of anger and frustration that there is in the whole of north-east Fife? St Andrews community hospital is not even an option in the consultation that she just talked about for primary care emergency services consultation, even though local GPs have offered to support a local solution in north-east Fife. Will the health secretary intervene to make sure that it is considered as an option so that the whole of Fife can get the service that it deserves? As I said, my officials are in regular contact with the partnership, and I understand that the partnership is continuing discussions with the GP colleagues in north-east Fife regarding the future of the out-of-hours service and its potential contribution. I have certainly asked to be kept informed of those discussions as they are taken forward. Liz Smith Does the cabinet secretary agree with Professor Sally Mapstone, who is the principal of St Andrews University and her senior officers, who argued at the recent public meeting that Mr Rennie has just referred to, that the large percentage share of students in the town creates a unique demography that, in itself, is reason to treat St Andrews as a special case when it comes to the provision of medical services? Cabinet Secretary Obviously, in taking forward those proposals, they will have to look at the whole of the area, including St Andrews and the provision of the area. I would expect them to take into account the demographics and the population, including the student population that Liz Smith refers to. All of that should be looked at. I will make that point that Liz Smith has raised to officials to pass on to the partnership from this question time. To ask the Scottish Government what action it has taken to fill vacancies at NHS Dumfries and Galloway. NHS Scotland boards are required to have the correct staff in place to meet the needs of the service and ensure high-quality patient care. The Scottish Government works closely with boards to support its efforts in staff recruitment. The Scottish Government remains fully committed to a sustainable NHS and its workforce, which continues to deliver consistently high-quality healthcare services to the people of Scotland, including in Dumfries and Galloway. Dumfries and Galloway are currently exploring a number of options to meet the continuing recruitment challenges, particularly in relation to medical staffing. The board has reported that it has made a number of recent offers of appointment and that further targeted recruitment activity is planned. Does the cabinet secretary realise that NHS Dumfries and Galloway, with the vacancy rate for pharmacists, is 28.4 per cent? For consultants, it is 22.1 per cent. The bill for locums is at eye-watering £12.6 million a year, because they cannot fill vacancies. Newton, Stewart and Moffat hospital has just had to cut the number of beds by a third because there is a shortage of nurses. The health board has reported the community. No, I need a question, please. I am asking the cabinet secretary if she is aware of all those things. Is she aware of all those things? No, thank you, cabinet secretary. Yes, of course. That is why, in my initial answer, I referred to the recruitment campaign that Dumfries and Galloway is undertaking. That is something that we are supporting them in doing. I hope that it is part of our international campaign, which I announced just this week, that Dumfries and Galloway will be part of that to help to fill key specialties that are very difficult to fill here. Briefly, Emma Harper. Very brief. To ask the Scottish Government what action it is taking to grow our NHS workforce across Scotland. Cabinet secretary. Of course, the workforce has increased by over 10 per cent under this Government to historically high levels. It has risen by almost 500 in the past year alone to nearly 140,000. Because we have more posts, that sometimes does impact on the vacancy level, but that is something that we are determined to address. Finlay Carson. In 2015, we saw GP recruitment and retention programme only recruit 18 doctors at a cost of £2.5 million and none in Dumfries and Galloway. Only this month, with anouncement of yet another similar scheme, this health secretary has been trying these schemes since 2015 and they seem to be failing. Does she not agree that fresh ideas for recruitment in rural areas are urgently needed? Well, if you have any, they would be gladly received, but the ones that we have have been based on the evidence base of how to recruit very, very difficult recruitment of GPs anywhere, not just in Scotland, but those incentives have proven to attract GPs. We want to do more of that. Of course, as I said, the international recruitment campaign that we have launched this week will look at the key specialties, and I am sure that general practice will be one of those. Question 6, John Mason. To ask the Scottish Government what its position is on whether Parkhead should be the location for a new health and social care hub for the east end of Glasgow. The decision on the location of the new health and social care hub is a matter for local determination by Glasgow health and social care partnership in consultation with local stakeholders. I expect the initial agreement to be submitted to the NHS capital investment group for discussion at its next meeting in August. Before any final decision is made, I expect the partnership to carry out a site options appraisal. This will be an open and transparent process, as required by the Scottish capital investment manual. I thank the cabinet secretary for that reply, and I accept that the decision will and should be made locally, but will she at least accept that the transport links to Parkhead are much, much better for public transport especially than to the likes of Lightburn and other sites, and Parkhead is by far the best option. Full marks for John Mason for trying, but, as I said, I expect the health and social care partnership to engage fully with the local community before coming to a conclusion. All the issues that John Mason raised, including transport links, deprivation and analysis of the best site, will all be taken into account. Once a short list of options has been agreed, further engagement will take place. To ask the Scottish Government what action NHS Ayrshire and Arran has taken to tackle its gender pay gap. NHS Ayrshire and Arran's latest published gender pay gap information shows a male to female pay gap of 2.84 per cent to NHS Agenda for Change staff overall and 4.63 per cent within its consultant cohort. Each health board has published its own gender pay gap data, and it is not collated centrally across the whole of NHS Scotland. However, the figures for NHS Ayrshire and Arran compare favourably with the full-time gender pay gap in Scotland, which was 6.6 per cent last year compared to a UK-wide gap of 9.1 per cent. The reality in Ayrshire is that across-house hospital there is an average of 35,000 pounds pay gap between male and female consultants, with men earning a staggering 61 per cent more than their female counterparts. If the cabinet secretary is going to bring forward any new proposals or strategies to address the reasons why there are such huge variations in pay gap between genders in and in NHS Scotland? The Scottish Government has taken clear steps to promote NHS Scotland as a modern, inclusive and diverse employer, and is supportive of all measures to promote women in strategic leadership roles and deliver a more equal workforce, including tackling the pay gap. As NHS staff receive NHS pay rates and the rate for the job—although that is the same rate for male and female workers—evidence for a gender pay gap is sometimes quoted as average earnings, but that does not take into account hours worked and any allowances accrued. The gender pay gap at this grade reflects the fact that, historically, there were very few female consultants in NHS Scotland due to childcare and career breaks, but that is slowly changing, with the most specialities report, that between 30 and 60 per cent of females in post in the middle grade of trainees, that means that when those doctors finish training, the percentage of female consultants will increase across NHS Scotland. I think that that will help to close the pay gap. To ask the Scottish Government what action it is taking to ensure that GP appointments are available in a timely manner. The new GP contract by investment of £110 million in 2018-19 will ensure that GPs can spend more time with patients when they really need to see them as well as developing wider multidisciplinary teams to support GPs and improve patient care. We are also working to increase the number of GPs by at least 800 over 10 years to ensure a sustainable service that meets increasing demand. James Kelly Thank you, cabinet secretary, for the answer. Lack of GP appointments is a constant issue across the region. One woman from Blantyre recently raised an issue with me where it was going to take more than three weeks to be allocated an appointment. I have raised this issue with the cabinet secretary in writing, and I am still waiting for a reply 10 weeks down the line. Can I ask the cabinet secretary when she will reply to the issue that she raised on behalf of my constituent? What specific action is it taking to address the GP crisis? Llyr Gruffydd Cymru As I outlined in my initial answer, the level of investment and the new GP contract in the primary care plan and the ambition to increase the number of GPs by at least 800 over the next 10 years shows the plans that we have to expand primary care. However, in terms of the reply, I will chase the reply to James Kelly's question and make sure that he gets that as quickly as possible. 9. Linda Fabian To ask the Scottish Government how it is progressing the distress brief intervention pilot. The distress brief intervention went live in June 2017, initially in Lanarkshire only, with the other pilot areas in Aberdeen, Scottish Borders and Inverness going live in October 2017. The pilot is being hosted and led for the Scottish Government by North and South Lanarkshire health and social care partnerships and is progressing well. Linda Fabiani Can I ask the minister to recognise what a sensible scheme this is with local public agencies in Lanarkshire having a responsibility to do early intervention if people are seriously distressed and also to recognise that this is well worth training all staff in public agencies on this kind of early intervention? The minister? Well, I thank Linda Fabiani for her interest in the pilot, which is in her area, and also for hosting the parliamentary reception for the international initiative for mental health leadership, which had a worldwide week of collaboration in Scotland to learn about the DBI and which they were very impressed about and were hoping to replicate in their own countries. 10. Jackson Carlaw To ask the Scottish Government whether it can provide an update on the inquiry by Professor Alison Britton into the review of mesh implants and when it expects the findings to be published. I understand that Professor Britton's review is progressing, but, as it has been carried out independently of the Scottish Government, the precise detail, including publication date of our final report, is a matter for Professor Britton and her team. Jackson Carlaw Will the cabinet secretary join me in paying tribute to Michelle McDougall, a brave soul who recently died of cancer and was tragically unable to receive chemotherapy due to the debilitating consequences of faulty mesh devices implanted into her grind in Abdenham years earlier? In view of the national, indeed international, attention and importance of Professor Britton's review, will the cabinet secretary agree now to a full parliamentary debate in the autumn when the report is published and on the wider developing issues now associated with mesh? Cabinet Secretary Will the cabinet secretary join me in paying tribute to Michelle McDougall and I try to be helpful to Jackson Carlaw by saying that, when Professor Britton produces her report, I will be happy to bring that back to Parliament in whatever form is appropriate. As I said, I do not know the timescale for that, but we will have to allow Professor Britton to continue and to conclude her work in due course. I was at Michelle's very moving and quite inspiring funeral. Can I say that the mesh woman who attended her resolve is greater than ever? I remind the chamber that 101 members of this Parliament called for no whitewash of the mesh reports. We will be watching that very carefully. I hope that the debate happens very early in Government time in that new session. As I said, it will be down to Professor Britton to determine when her report is published. Of course, it will be her report, but, as I said to Jackson Carlaw, I will be happy to make sure that Parliament is given the time and opportunity to discuss that report. To ask the Scottish Government whether it will provide an update on the work of the respiratory improvement task force and remind the chamber and the convener of the cross-party group for lung health. Officials are working closely with the recently appointed chair of the respiratory task and Finnish group and key partners to finalise the constitution of the group, set out the objectives, including required work streams, to develop a plan for respiratory care for Scotland. Emma Harper This week is pulmonary rehabilitation week, and PR is one of the most powerful and cost-effective interventions for people who live with COPD and other lung diseases, allowing people to self-manage and stay out of hospital. Can the cabinet secretary therefore outline what action the Government will take to ensure that every person who would benefit from pulmonary rehab gets access to a programme? Emma Harper The Scottish Government recognises that pulmonary rehabilitation is an important element of respiratory disease care. It has a well-established evidence base for its benefit in helping to support self-management and reduce exacerbation in hospital admissions. It is a key recommendation in the national clinical guidelines that we expect boards to follow. Access to pulmonary rehabilitation will form an important part of our quality improvement plan for Scotland. I am pleased to advise that the Scottish Government is funding participation in the national asthma and COPD audit programme, which will collect data on the provision of pulmonary rehabilitation across Scotland. That will be a valuable tool in improving the care and outcomes for people in Scotland living with COPD. 12. What priority does the Scottish Government give to suicide prevention? Mental health and suicide prevention are an absolute priority for the Scottish Government. Over the past several years, we have been working with a wide range of partners to tackle suicide. The suicide rate has fallen by 17 per cent over the past decade. Before recess, we will be publishing the new suicide prevention action plan, which will be designed to continue the long-term downward trend. Emma Harper Oh, I'm sorry. Brian Whittle I beg your pardon, I'm all gullled up here. Claire Adamson, Ms Adamson, my apologies. Thank you, Presiding Officer. The minister will be aware of particular circumstances of my constituency when a number of young men have taken their lives, leaving their families and their friends in the wider community devastated. My own staff are undergoing safe talk training and, last year, I myself undertook assist training. What opportunities are there for young people to access those training services across our communities in Scotland? Every life matters and every death by suicide is a tragedy. Everyone has a role to play in suicide prevention. NHS Health Scotland provides a range of training on suicide prevention. We are committed to continuing support for the mental health first aid and suicide prevention training. The new suicide prevention action plan will be published, as I said, before recess and is supported by an extra £3 million over the next three years to support innovative work on suicide prevention. Strangely enough, Mr Whittle. To ask the minister if she's aware of Chris Boyce's charity, which was formed after the tragic death of his brother on their approach to encourage those suffering to come forward and discuss their issues and break down that stigma associated with mental health. Does she recognise that approach and also the importance of peer-to-peer work in the prevention of suicide? Minister. I thank Brian Whittle for his question. Yes, I am aware of the Chris Boyd trust. There is a wide range of interventions. Peer support is crucial and I am keen that, in the suicide prevention action plan, peer support for families and relatives who have been bereaved by suicide are given the support that they need. To ask the Scottish Government which NHS boards offer the Freestyle Libra Glucrose monitoring system. Currently, seven NHS boards in Scotland have included Freestyle Libra sensors in their local formulary—NHS Borders, NHS Forth Valley, NHS Lothian, NHS Dumfries and Galloway, NHS Greater Glasgow and Clyde, NHS Lanarkshire and NHS Ayrshire and Arran. David Stewart. Presiding Officer, if Freestyle Libra is good enough for patients in Edinburgh, why not for patients in Inverness? Of course, he knows that it is up to NHS boards to determine what is available based on the best clinical evidence. There is still a bit of work to be done around the clinical evidence and that will allow, once that is established, NHS boards to work out how they best support patients with type 1 diabetes in their local NHS board. I will continue to keep the member updated as we expect the Scottish Health Technology Group to publish their advice, which will enable health boards to take an informed decision on that. Jenny Gilruth Can the minister outline when the Scottish Health Technology Group will report on the long-term clinical evidence of Freestyle Libra, as I understand some boards, including Fife, will be waiting to make local decisions based on those findings? Jenny Gilruth is absolutely right and that is why I said what I did to David Stewart around the evidence that is required for NHS boards to make and establish their own decision on that. We expect the Scottish Health Technology Group to publish their advice statement in July 2018. Question 14, Richard Lyon. Thank you, Presiding Officer. To ask the Scottish Government what the NHS policy is on accessing IVF treatment by couples. Minister. Couples must meet certain eligibility criteria before being referred by either primary or secondary care providers for NHS IVF treatment. Eligibility criteria and provision for NHS IVF has changed on a number of occasions over the last few years following recommendations from the national infertility group, all because of the view to improving the service for the majority of patients and improving outcomes for babies born following IVF treatment. I am pleased that Scotland has one of the most generous provisions of NHS IVF treatment in the UK. Richard Lyon. I thank the minister for her answer. My constituents have been unsuccessful twice in treatment. We are told that they could get a third attempt, but Greater Glasgow and Clyde health board maintained that my constituents are not entitled. Will the minister meet me and my constituents to discuss what can only be described as an outrageous situation for them? If Mr Lyon's constituents were referred from primary or secondary care for NHS IVF treatment after 1 April 2017, they should have been considered for a third cycle of treatment. If the constituents were referred before 1 April, they are not eligible to be considered for a third cycle of treatment. I am disappointed to hear that Mr Lyon's constituents were given conflicting advice about whether they were eligible for further treatment, especially when it relates to something as emotional as that for the longing to start a family. I will ask the health board to investigate the serious issue and to meet Mr Lyon and his constituents. Of course, I am always happy to meet Mr Lyon to hear about his concerns directly around this case. To ask the Scottish Government what its position is on the provision of health services in the private areas. The Scottish Government is committed to ensuring that there is adequate provision of health and social care services across all areas of Scotland. It is worth noting that the new GP contract is designed to support areas with higher levels of deprivation. Decisions on the level of provision required are a matter for local determination. The extent of Glasgow contains an extremely high proportion of Scotland's most deprived community, so it is good news that Lightburn hospital was saved and that health services in the area are to be enhanced. I will be conducting my own survey of constituents over the service that has sustained local views on the scope and shape of local services. Does the cabinet secretary agree with me that full public consultation is essential to ensure that the service then deserves in the best locations, including the Lightburn site, if appropriate? As I said earlier on to John Mason, it is important that there is full consultation, full analysis and full site options appraisal. That is an open and transparent process that is required by the capital investment manual, and that is what should happen in the extent of Glasgow. To ask the Scottish Government when it last met NHS Lanarkshire. Ministers and Scottish Government officials regularly meet with representatives of all health boards, including NHS Lanarkshire, to discuss matters of importance to local people. A meeting with NHS Lanarkshire recently raised the issue of the drawl of phlebotomy services from GP practices in Stonehouse. NHS Lanarkshire had no knowledge of that, but ensured that the nurses got access to accommodation to continue this much-needed service in Stonehouse hospital. Can the cabinet secretary discuss with NHS Lanarkshire as a future meeting the need to improve communication with GP practices, especially when there are significant changes to services available at the practices? As part of the development of the primary care improvement plans, which need to take place in every area to implement the new GP contract, integration authorities should liaise with their local GP community around changes to services. My officials are engaging with NHS Lanarkshire in this process, and I am happy to write to Christina McKelvie on this matter in the near future. To ask the Scottish Government how the NHS supports the health and well-being of prisoners in HM Prison Edinburgh. NHS Lothian is responsible for the delivery of healthcare in HMP Edinburgh. The healthcare in HMP Edinburgh provides primary care, mental health and addictions trained nurses who provide for the on-going health needs of the patients in the prison environment. There is also access to visiting specialists, including psychiatry, psychology and dentistry, and patients have access to a full range of secondary services. Gordon MacDonald I thank the minister for that answer. Softon, the president of my constituency, has had a substantial increase in prisoners self-harming to 74 cases in the last year. What action is being taken to specifically address self-harming in prisons? I thank the member for raising that important issue. Of course, the Scottish Government always takes mental and emotional wellbeing of people in prison incredibly seriously, and that is why action 15 of the mental health strategy taken forward by Maureen Watt commits the Government to increase access to mental health workforce by 800 additional staff in key settings, including in prisons. The Scottish Prison Service is committed to ensuring that those in their care who are experiencing distress and who are at risk of self-harm have access to the support that they need, including from NHS Lothian and other partners. The Scottish Prison Service ensures that staff are fully equipped to promote a supportive environment in which people in prison can ask for help, and all prison establishment staff are trained in suicide prevention and the SPS supports Scottish mental health first aid training. Again, I am happy to meet the member if he would like to discuss it further, so that we can ensure that we are doing all that we can to support the very vulnerable people in the prison that he represents. To ask the Scottish Government what its position is on the value of the talks by the Teenage Cancer Trust to make young people aware of the signs and symptoms of cancer and how it ensures that local authorities encourage schools to hold such talks. The Scottish Government supports the Teenage Cancer Trust's work in delivering vital awareness in education sessions in secondary schools. I encourage that 80 per cent of schools in Scotland have already received an awareness session from the charity this academic year alone. I am even more heartened to see that the figure is 100 per cent in my constituency, Dundee. I am written to all MSPs asking them to engage their relevant local authorities to encourage schools in their catchment area to welcome this cancer education programme. Like the cabinet secretary for the answer, does the minister agree with me that promoting these talks in our schools should be a priority in helping to improve survival rates of young people in Scotland with cancer? I absolutely agree with the member that educating our young people on the possible signs and symptoms of cancer at an early age is of vital importance not only for their own wellbeing but also in their role as influencers on older adults within their family circle. In the year of young people, it is timely that we acknowledge that we need to equip our young people with the skills and information that they need to know about the benefits of good health and when they might need to seek medical advice. Question 19, Rachael Hamilton. To ask the Scottish Government what action it is taking to reduce delayed discharge at NHS borders. Scottish Government officials are meeting senior officers from the partnership today, in fact, and we will continue to work closely with them to reduce the level of delays. A range of improvement measures have already been put in place, which has led to a reduction of over 30 per cent in bed days lost between November 2017 and April 2018. Rachael Hamilton. I thank the cabinet secretary for that answer. ISD statistics have revealed that NHS borders lost on average 1,000 bed days a month over the last two years, which is just not good enough. What will the Scottish Government do to help rural boards like NHS borders to ensure that when a patient is fit to leave, they can? At the April census, 10 partnerships recorded standard delays over three days in single figures. The worst four partnerships accounted for 43 per cent of the total delays, so it is really important that we focus particularly on those partnerships. The board's partnership has introduced a range of measures aimed at reducing delays. That included an 850,000 investment in a step down intermediate care facility and the development of a hospital-to-home reablement service. The reablement service was initially piloted in two localities and that led to a 40 per cent decrease in long-term care requirements. The partnership now plans to roll the service out across the area with increased AHP input. I think that that will make a real impact on reducing bed days loss further. To ask the Scottish Government what action it will take to tackle the reported high levels of COPD in the scenario area and whether that will include installation of new air monitoring equipment. We know that Scotland has high rates of COPD and that is why we are working with our clinical experts and key partners such as the British Lung Foundation, Chest Heart and Stroke Scotland, to develop a respiratory health plan for Scotland. That plan will include key priorities of prevention diagnosis, treatment and research of respiratory conditions, including COPD, and will build on the work of the COPD best practice guide that was published in November last year. It is my understanding that under the 1985 Environment Act local authorities have a duty to designate areas where air quality objectives are not being met as air quality management areas. There are currently no air quality management areas identified within Dumfries and Galloway that will be kept under review to ensure that we make the most efficient use of limited resources such as our networks of high precision and real-time air quality monitors by focusing our attention on areas of concern. Finlay Carson, I thank the minister for that response. As the minister may be aware, Sronard does not only have the highest levels of COPD in Scotland, it has the highest levels in the world. An interag project called breath is currently investigating the reasons behind the high incidence. Can the Scottish Government outline how it may help the breath project to establish a centre of excellence in Sronard? Again, I recognise the interest that the member takes on in this. I am aware of the breath programme that he outlined. Scotland participates in the interag VA programme, the cross-border programme 2014-2020, with Northern Ireland and the border region of Ireland. The eligible areas for Scotland are regions in the western Isles and the west of Scotland. Of course, we will keep a real interest in the project and the programme as it progresses to make sure that we can stand to get the best evidence of how much more we can do to help to support people in particular areas where there is high incidence of COPD and ensure that we recognise the learning that can be got from things like that to enable us to tackle it across the country. That concludes portfolio questions. I have a short pause before we move on to the next item of business.