 mani'r cwyluned agaf gydym yn gyfarchon y costs cyfrwysbeth newidu? Mae'r Fawr Llywodraeth y Cymru yn gwneud i gynnig, ydych chi Oliveiraidd cwyledd yn gondol, yn rhoi ddifesu gyda'r defnyddiaeth yn brakefau ar ei cynhyrchu winners. Y Llywodraeth Llywodraeth y Cymru yn gwneud i ddau cyfrwysbeth cyfrwysbeth cwyl noisydd, mae'r gweithio i ddechrau sydd— ddim yn gwybod ysgrifennu cynlluniaeth sydd yn gwneud. Mae'r buddau ardal ymgryd gyda'r gweithio cannot go out and hails for patient outcomes. The Herald reported on the 2000 boarders in july or august and should be seen in the context of over one million in-patient episodes each year in Scotland. Through our £50 million three year uncheduled care action plan NHS boards of committee to work to minimising all boarding of patients. Some £8.2 million investment from the action plan has been used this year to support additional capacity and innovative approaches to improve how patients move through and out of hospital. We have also introduced mandatory nursing with Wifery workload planning tools, and we are working closely with NHS boards to develop a bed planning toolkit. That new toolkit, which I believe is a first in the UK, will support NHS boards in Scotland and their partners to review capacity on a non-going basis. The system is in crisis. 3,309 patients were in the wrong ward because of capacity shortages. 1,706 were in the hospital in July when they should have been discharged, and 124 of those waited for more than six weeks to go home. The picture will, of course, get bleaker as the winter goes on. We have had some news today, but it will be too late to improve the situation immediately for the winter months. What measures has the Scottish Government taken to ensure that the health boards are prepared to be able to deal with the extra pressures this winter will bring? I have outlined the action plan that we are taking to deal particularly with the winter surge. Let me put in perspective over the summer the fact that 3,000 additional people boarded. That means that 96 per cent of patients were not boarded. Four per cent were boarded, and the ideal would be that we did not need to board any patient, but since 1948, there has been boarding of patients. What we have is an action plan, both in terms of unscheduled care, but also working through the recommendations agreed with the Royal College of Physicians in Edinburgh from their report last week. It is not us that is in crisis. It is a liberal democracy that is in crisis. It is a pity that the cabinet secretary resorts to cheap shots like that. He should maybe listen to the director of the Royal College of Nursing Scotland, Theresa Fife, who said that it is time for the Scottish Government to stop hiding behind sound bites. Nurses enter the profession because they want to deliver good quality care. 55 per cent report that they are not able to deliver care to the standard that they want to because of the strain. Boarding means that patients are on wards inappropriate for their needs, which puts additional pressure on staff. What is the Government going to do to look properly at the workforce to ensure that we have the right number of beds as well as the right number of people with the right skills to ensure service of the highest quality? In terms of bed capacity, we are developing a bed planning toolkit. We are the first health service in the world to develop such a toolkit. That is on top of the workforce planning toolkit. That is on top of the plans in place that are being activated right now that I referred to in terms of unscheduled care and dealing with a specific issue of boarding. I point the member out to the levels of satisfaction generally in the national health service, which has risen significantly in the past few years. The reason for that is that patients do recognise that we face significant challenges in the provision of healthcare, particularly against a background when we do not have control over our own budgets and we deny the resources from London, but they recognise that we are facing up to those challenges and we have plans in place that are being implemented as we speak to improve the service even further. Can I ask the cabinet secretary what investments have there been in the last two years by the Scottish Government and the NHS to improve the way patients move through their hospital system, which can help free up beds, reduce the amount of time that patients spend unnecessarily in hospital and thereby increase the capacity in our hospitals? There is a whole list of initiatives. Let me give you just one example. One of the reasons why there is a problem sometimes with patient flow, particularly for those third of patients who present to accident and emergency who have to be admitted, is that very often, because of the daily discharge profile, only 10 per cent in some hospitals of daily discharges of patients are done before lunchtime. That is not because the patient is not ready for medical discharge, they are ready for medical discharge, but the co-ordination of pharmacy, transport and other services often means that the daily profile means that most people are discharged in the afternoon or in the evening. One of the ways in which we are improving patient flow is that in hospitals it is to improve that daily discharge profile. If you look at hospitals such as Crosshouse, for example, in many parts of Crosshouse—I just picked that as one example—they have increased the daily discharge by lunchtime from 10 per cent to 40 per cent. That means that the beds are freed up for the afternoon and evening admissions. If every hospital in Scotland got to that kind of profile, then many of the problems that we have in terms of people waiting for a bed after being dealt with in A&E and other issues would take care of themselves. Presiding Officer, I have to say to you that I find the replies by the cabinet secretary breathtaking in their complacency. Three years ago, Nicola Sturgeon was cabinet secretary and we pressurised her on boarding out. As the cabinet secretary said, a system was monitoring was introduced. Three years on, that is not being used to any purpose, as our FOI shows. We did conduct that FOI also to assess whether there was any joined-up thinking in respect of boarding out, because whilst, as he has admitted, it is bad for every patient, it is particularly bad for those with cognitive assessment problems, with assessed cognitive problems, those two things are not joined up at all. When will he accept that there are really serious problems with bed-occupied days and boarding out, which is affecting not numbers, but the number of 3,000 individual people are affected by that? Unlike the previous administration, under my predecessor and under me, we have been taking action to tackle the challenge of boarding. That is why, along with the Royal College of Physicians of Edinburgh, for the first time in a long time, we had a specific piece of work done in relation to the specific problem of boarding. As with many of the other challenges that are facing the national health service, the issue is about better planning, and the issue is about improved patient flow. That is why we have taken action in introducing a workforce planning toolkit and a bed capacity planning toolkit. Those things do not appear overnight, because it is the first time that they have been done in any healthcare system, and they take time to fulfil their results. However, that is happening. Let us get that in perspective. As I said earlier, although the ideal would be that nobody would need to board, those numbers represent just under 4 per cent of all patients who were in hospital in Scotland during the time period of the FOI. 96 per cent of patients were not boarded. I do not think that that is a system in crisis. It is a system with a 4 per cent challenge that we are working through, but it is not right of Opposition politicians to, every time they stand up, describe the health service as being in some kind of crisis when, in fact, our health service has been rated as the best in the world and the safest in the world. To ask the Scottish Government what its state of readiness is for dealing with bird flu in the light of the recent outbreak in Yorkshire and what priority it now gives this disease. The Scottish Government has published detailed contingency plans for dealing with notifiable animal diseases, including avian influenza and exercises those plans regularly with operational partners and other administrations across these islands. Although there are no cases reported in Scotland, we have alerted our stakeholders to the outbreak and encouraged them to remain vigilant and seek to maintain high levels of biosecurity. Meanwhile, we are in constant contact with relevant agencies across the UK and are ready to respond to any outbreak that occurred in Scotland. Alex Johnson To give a clear indication that the strain that has been reported in Yorkshire is not likely to give any concern over human health and that, as the specialist poultry industry in Scotland approaches its most important annual market, we are in a position to guarantee the quality of Scottish product and make sure that it sells into a buoyant market. I can indeed give comfort to consumers and the member. The H5N1 strain, the strain known to cause risk to human health, has been ruled out in this case in terms of the three cases known across the continent and down south. Therefore, the chief medical officer in England has said that there is a very low risk to public health and indeed the food standards agency has said that there is no risk to food safety. However, of course, we continue to monitor the situation closely, but I certainly agree that, as things stand, we can fulfil confidence in the Scottish product. There are restrictions that have been put in place in terms of exports from this country. Hopefully, they will be only temporarily while we await the full scale of this outbreak. In the event that a strain does become present, which is in danger of human health, are we in a position today to ensure that, if the previous outbreak, which we had a number of years ago, were to record, we would be in a position to ensure that resources were available to cope with a more dangerous strain should it become present? Yes, I am confident that we have the arrangements in place, but I think that we have to be very careful. The situation at the moment is the strain that is known to cause a risk to human health has been ruled out. Therefore, this is a different strain that we are speaking about, and it is very important to convey that message to the country and to the industry in particular. However, we have these contingency plans in place, and therefore we have a set of arrangements that will be urgently put in place should the situation change at any point in the future. However, this particular outbreak does not give us rise to concern in terms of any threat to human health or to need food safety. Cabinet Secretary, I believe that it has been suggested by some experts that the outbreak in New Yorkshire has originated from migratory birds. Do you agree? If so, should the public at large in Scotland be looking for signs amongst the wild bird population who have migrated here for the winter? Well, as I said before, we are asking everyone to be vigilant, particularly the industry itself, in terms of any dead birds that are identified should be reported immediately. However, the fact that the three recent outbreaks covering Germany, the Netherlands and indeed here on these islands have occurred in the proximity of damp areas with wild birds and the absence of any other possible link between them points towards wild migratory birds as a possible source of the virus. However, those investigations, as you understand, are on-going and, as soon as the facts are available, we will put them in the public domain. Thank you. We now move directly to the next site of business, which is a statement by Alex Salmond, the First Minister of Scotland.