 Mae cyfnoddau i chi'n gwyloedd o'r dweud, a'r ddwyloedd hynny yn rhaid o'r gwaith yng nghymru yng nghymru oedd yn dweud, ond rwy'n gwyloedd o'r ddullai ddechrau i gyfnoddau dechrau i gyfnoddau dechrau i gyfnoddau dechrau i gyfnoddau'u gyfnoddau dechrau i gyfnoddau'u gyfnoddau. Mae'n gwirionedd yn y cyfnoddau a'u dweud. Mae gennymau mewn mfrindwyr yn ychydig i fyfydlifatrach cyfan o'ch unedig eu hunain y Queen Elizabeth University yng Nghymru yn unedig. Mae y Rheoletheol Gwyrddiad Cymru yn yn跡 rwy'r peiriau'r cyfan o'r hefyd i mynd i eirio eu phoblastiau unrhyw yn eich hollod. Eryddiad gennymau i'r gweithio o'r wych i'r gweithio'r 15 of November, a'r gweithio'r gweithio'r cymaint o'r gyfrifogau cerddurdidol, ond mae'n gofio'r pwnghreifyd o'r gwaith cymaint, sy'n adnod gyda'r cyfrifogau cyfrifogau cyfrifogau cyfrifogau cyfrifogau cyfrifogau cyfrifogau? Jackson Carlaw. I thank the Cabinet Secretary for that reply. The performance at the Queen Elizabeth A&E has regrettably been a constant source of concern since the £842 million flagship hospital opened. Before the summer recess, dw i'r cwestiad, yn cael ei wneud o'i ddau. Rydyn ni'n gweithio eu cyfnodd yn seftymgr yn dda'r fawr o bob Doris ydy i'r wneud o'r ddau i gael ei ddau. Gwelwch yn ystafell, mae'r ffordd yn cael eu gwasgwch yn sylfaen i'r gweithio, a mae'n ffagwylio'n gweithio'n gweithio'n gweithio'n gweithio i'r dyfodol am y cyfrifolau i'i cyfrifolau i'i ddau i'r cyfrifolau i'r gwahogol, yn cael eu cyfrifolau i'r ddau y Gwein Elizabethf, fyddai'n gweithio'r gwaith yn ddaw'r bobl yn ddysgu'r Ffictorian Ffirmwyn. Rwy'n gweithio'r ffoil yn ddau'r wlad cyfnodol, ac yn ddidd提au cyfnodol, oherwydd rydw i fod yn iawn i'r cynnig, mae'n meddwl yn gyfynu'r gweithio i gael i'r cyfrifiadau i'r rhaid i'r ffyrddiaethol, ac mae'n meddwl i'r cyfrifiadau i'r cyfrifiadau i'r cyfrifiadau i'r cyfrifiadau Mae castilladau yn mynd eich concentrated ond ar cair bobinsioби flaen系 liquorol patentenion yn ond. Felly dyna nad 在 mae campaign yn mwrwad eff作 speciall, ac yn cair konkreulant, erbyn i ddarched mwy i bwysi gallery yn ddatbly Smithsonau es resembles ni wneud hefyd. F university', yn dweud wef yn dweud wef yn dweud Jaxon Carlaw dysgribe blives well, not just the A&E department across the whole hospital, but staff are very hard to achieve that. Of course, the support team has continued to work and, of course, an answer was given about the work of the support team over the summer. Jaxon Carlaw mentioned the immediate assessment unit, which is not the same as the A&E department, o'r newid hosbetyl. I absolutely deeply regret the death of the elderly gentleman on a trolley. That is unacceptable and, of course, a full review into his treatment has been initiated, and that's very important that that happens. What I can say, though, is that further developments around that immediate assessment unit have been taken forward. So, as of this week, there is a new ambulatory care area capable of seeing 10 patients at a time and is going to be an alternative location for the assessment of surgical and urology patients, which again has started this week. I visited the assessment unit this morning and the ambulatory service, and I can tell him that staff are working very, very hard to make those changes, and indeed the improvements from those changes are already visible. I can assure Jackson Carlaw and anyone else in the chamber that I take a daily interest in this issue, because it is important that that hospital performs as it should be, and the staff need to be supported in being able to deliver that. Richard Simpson, I thank the cabinet secretary for her reply. I don't think that any of us have any doubt that she's going to try and be on top of this, and we also know when has any doubt that staff is working very hard, but the continuing problem with the A&E unit does seem to indicate that it is under resourced. There just isn't enough space or staff or time to actually get patients through. In addition to that, we now know that there are 13 similar immediate assessment units under various names across Scotland, which are not being subject to the A&E waiting time, so we really need to have a very clear explanation, the public require, a very clear explanation as to what's going on, will the cabinet secretary provide that in the form of a statement of what's actually going on, because there are no longer teething problems with this hospital? There are serious issues that may have long-term effects. Richard Simpson again conflated two things, the A&E unit and the immediate assessment unit. Let's talk about the immediate assessment unit. Glasgow has said very clearly that it needs to be bigger than the modelling that was done. It has been quite clear about that, and therefore it is taking steps immediately to create the ambulatory care area and the other changes that I mentioned earlier in order to free up some capacity, but it is also expanding the size of the unit that it has been given to mid-December to do, so it is doing that in order that that unit has the size that it requires. It is not about the not enough staff at A&E, it is about the size of the immediate assessment unit not being big enough and not having the capacity. That is being acted upon and will be changed. Richard Simpson then mentioned about the units, which, as he says, have grown up across Scotland in different ways over many years. He's right that they are not subject to the four-hour target. He will be aware, hopefully, that the Royal College of Physicians have already begun work over the last few months with the Scottish Government to look at those units of whether we can bring a standardisation and to look at how we ensure that performance is monitored and that patient safety is at the forefront of all that. That work is on-going, and when it concludes, I would be more than happy to inform Parliament of that in whatever way makes the most sense. If we are going to get through the questions, we need to have short questions and answers. Question 2, Jim Eadie. To ask the Scottish Government what recent discussions it has had with NHS Lothian regarding the private finance initiative contract at the Royal Infirmary of Edinburgh. The Scottish Government officials meet regularly with NHS Lothian staff to discuss a range of finance and infrastructure topics. The management of the Royal Infirmary of Edinburgh contract is a responsibility of NHS Lothian. Any particular issues relating to the contract can be discussed in this forum. Since April, NHS Lothian has been working to develop and consider a range of options for the improvement of the contract for the Royal Infirmary of Edinburgh, and officials are supporting NHS Lothian in those efforts. Jim Eadie. Thank you, cabinet secretary, for that answer. I welcome the Scottish Government's on-going commitment to work with NHS Lothian to improve the cost effectiveness and transparency of a PFI contract that is widely believed to be against the public interest. I am aware that part of the process of identifying savings was the establishment of an expert review group at the hospital who would carry out a full financial health check of the contract's current and retrospective performance. Will you be able to provide me with an update of this health check, and if any further savings have been identified for the benefit of the taxpayer? I am certainly aware of the member's concerns and interests about the contract for this hospital. He can be assured that I share his concerns and support NHS Lothian's work to make those improvements. He has established a group to identify and examine a full range of options around future management and operation of the PFI contract, with the goal of improving value for money. In that work, it is supported by officials and by the Scottish Futures Trust. The focus is on a long-term improvement in the performance and value for money of the services that are delivered through the PFI contract, rather than simply achieving savings in the short term. The board is actively investigating ways in which the contract might be improved and has strengthened the in-house management arrangements. Proposals brought forward by the group will be given full consideration in terms of affordability, value for money and the benefits that that will deliver. I am happy to keep the member informed about that. The name of Neil Bibby has not been lodged, and the explanation has been provided. To ask the Scottish Government for what reason the drug affinity is not available on the NHS in Scotland for the treatment of breast cancer. The Scottish Medicines Consortium provides advice to NHS Scotland on newly-licensed medicines. The independence of the SMC decisions on individual drugs is well established. The SMC did not recommend a valerian mus—sorry about that—for breast cancer due to uncertainties surrounding the overall clinical benefit that the medicine would provide for patients taken against the price charged for the drug. As a member will be aware, the SMC is expecting a resubmission from the pharmaceutical company for this drug. It is a matter of great concern to my constituents as they have to travel south to get certain treatments on the NHS, including a finitor. Have any stats been taken to ensure that that does not happen? I will say to the member that there are different decisions made sometimes around drug availability by NICE and SMC, so sometimes NICE do not approve drugs that are available in Scotland. We base our decision making around what the SMC advised, but I remind the member that we also have a £90 million new medicines fund, which has been established for absolutely the purpose of being able to get orphan and ultra-orphan drugs into the hands of patients. Indeed, even where the SMC has not approved a drug for wide-scale use, there is still the opportunity for the patient to apply through the individual treatment patient pathway. Finally, I should remind the member that we are reviewing the SMC and the views of patients around the issues. It will be very important as we take that review forward. To ask the Scottish Government what action it is taking to ensure access to GP services in the Mid-Scotland and Fife region. Under the legal framework for service provision, NHS boards are responsible for ensuring the provision of primary medical services for their areas. NHS Fife works with GP practices to ensure that everyone in Fife has access to GP services. I have written to the cabinet secretary recently regarding the canon surgery and methyl, which has recently been taken over by NHS Fife, due to a failure to recruit to principal GPs. Carcody is also experienced in severe pressure with eight surgeries, now closing their list to patients. Can the cabinet secretary say how much of the additional £60 million in Einstein June will be supporting GP services in Fife? Also, in her recent reply to me, she said that they were developing short-term recruitment initiatives. Can she tell me what discussion she has had with NHS Fife to make progress on that? I recently discussed a number of issues with the chair of NHS Fife. I can assure Clare Baker that we are absolutely determined through the investment of the £60 million to tackle some of the recruitment and retention issues. Some of those are more medium to long-term, as we encourage more young doctors into general practice. However, in the meantime, we are absolutely doing everything that we can through recruitment and retention initiatives to attract people who, for example, may have left the profession but could be encouraged back. Those who are looking for positions in the health service here in Scotland, we are offering opportunities for GPs and others to come and work here in the NHS, and we are looking at every opportunity to promote that. Where surgeries that she mentioned, the one in methyl, have been taken over by the board, it is not uncommon for boards to do that to ensure continuity of service to patients, and it should not be viewed as a negative thing if boards are taking over practices to make sure that continuity of service continues. However, I accept, as Clare Baker has heard me say before, that we have a lot more to do to make sure that sustainability of GP services, whether that is in Fife or elsewhere in Scotland, is taken forward, and we are determined to do that. Thank you very much, Presiding Officer. The cabinet secretary recently wrote to me stating that there is an increasing awareness of practices facing sustainability challenges across Scotland, including the Mid Scotland and Fife region. Six health boards have seen decreases in GP numbers since 2007, and we face a shortage of 900 GPs in the next 10 years. I would like more detail from the Scottish Government today how it can guarantee that rural and remote areas such as Mid Scotland and Fife will not be disproportionately affected by GP shortages. I am sure that Jim Hume will be aware of all the discussions that we are having around making general practice more attractive. We are looking at a transition year with a major dismantling of the co-off arrangements in advance of a new contract being put in place, and of course new models of primary care, all of which are designed to encourage people to young doctors to choose general practice as an option. We will look at what other mechanisms or methods that we require in order to take general practice into a place where it is actually the choice of young doctors. We are looking at how we expand access to medicine. We also have expanded the GP training places by a third. We are doing a lot of comprehensive work around that. Some of it will take a bit longer than others to deliver, but Jim Hume can be assured that we are giving us a top priority. To ask the Scottish Government how it is seeking to enhance community optometry services in the Glasgow region. Minister Maureen Watt. General Ophthalmic Services describes the national arrangements for the provision of high-street optometric services, including since 2006 the provision of free eye examinations for people living in Scotland, where appropriate NHS boards, including NHS Greater Glasgow and Clyde, can use shared service arrangements to tailor service provision in their area to suit local needs, such as rebalancing service provision from acute centres to high-street optometrists. Many more patients are now being treated within the community with optometrists being able to manage the treatment of certain eye conditions such as glaucoma. This is supported by a recent investment of £1.5 million, providing every community optometrist with a pacimeter, a device that will help to better refine referrals for glaucoma and ocular hypertension and enable more patients to be retained and managed in the community, in line with the Scottish Government's 2020 vision. The minister mentioned the redesign of services in Glasgow so that my constituents can get speedier and more effective treatment in the acute sector where necessary. Does the minister agree with me that it is important that my constituents know that their first port of call for eye care treatment should be the community optometrist, therefore taking pressure off the acute sector, but also ensuring that they get a quality treatment in their local community for their eye health, and that we should raise awareness of that to make sure that everyone is as informed as possible to see the most appropriate allied health professional for their healthcare needs? The Scottish Government is committed to providing a first-class community-based eye health care service in Scotland, treating more patients in the community, as I said, entirely consistent with our 2020 vision. Community optometrists are better placed than ever to manage a wide range of conditions in the community. For example, the provision of NHS prescribing pads is allowing an increasing number of optometrists in Scotland to treat acute eye conditions, and a third of all the independent prescribing optometrists in the UK are in Scotland. We welcome the latest report from the WHO. The report classes the consumption of red meat as probably carcinogenic to humans, and the consumption of processed meat as carcinogenic to humans. The findings are broadly in line with the recommendations of the 2010 from the Independent UK Scientific Advisory Committee on Nutrition, which recommends that we limit intakes of red and processed meat to no more than 70 grams a day. Scotland's dietary goal for red meat and processed meat is based on the latest evidence from the Scientific Advisory Committee on Nutrition's report, which is called Iron and Health. The risk reflects the links between high consumption of processed meat and certain cancers, which recognise that red meat is a good source of nutrients and can be consumed as part of a healthy, balanced diet. The minister for that reply, in view of the additional advice from the World Health Organization that studies show a higher risk of colorectal cancer in people eating a diet low in vegetables, legumes and whole cereals, does the minister agree that we need to heed the overall collected advice about a healthy diet and recognise the value of vegetable consumption and a high-fibre diet generally? I recognise the member's continuing interest in this area, and it is correct that we need to look at the overall balance of the diet. Food standards Scotland advise eating a healthy balanced diet, including plenty of fruit, vegetables and starchy carbohydrates, as well as eating some dairy foods and some meat, fish or vegetarian alternatives, and at the same time, as we know, avoiding foods high in fat, sugar and salt. The Scottish Government is taking a range of action to improve diet. We are spending over £10 million in the four years to 2016 on projects to encourage healthy eating. Those include a feel better campaign, which will launch its next phase in January and include advice on how to affordably increase fruit, veg and fibre intake. We know from the evidence from academics and at the cancer conference this Monday that the public health campaigns are valuable but do not hit our populations that suffer the most health inequalities. Minister, given that 40 per cent of cancers are preventable, what specific action is the Scottish Government taking on diet and public health? In my previous answer, I gave an example of some of the ways in which we are trying to improve the country's health. I recognise, as the member suggests, that there is still inequality in relation to those suffering from cancer, but the figures, as she mentioned, are going in the right direction. We always know that more can and will be needed to be done. To ask the Scottish Government what assistance is available for GP practices that encounter problems regarding staffing levels. Over the next three years, the Scottish Government will invest £60 million as part of the primary care fund to address immediate workload and recruitment issues in primary care and put in place long-term sustainable change to support GPs and improve access to services for patients. As part of that, £2.5 million will be invested in work to explore with key stakeholders the issues surrounding GP recruitment and retention. That investment is beginning the process of finding new ways of working, helping to address the problems of recruitment and retention that are common to primary care services across the UK and beyond. I thank the cabinet secretary for that answer. We have explored in the chamber on a number of occasions the particular issue of the deep-end practices, and particularly the Balmor practice in my constituency. What action is the cabinet secretary going to take to assist a practice like Balmor that has now been reviewed by Greater Glasgow and Clyde health board and has been told that it will have further help to review its processes and to help with, and I quote, lean working, whatever that might be? Those practices need help now, and money that is being invested in the future is not going to help them out of immediate crisis, so what action can be taken to assist them now? I think that it would be unfair to suggest that there has not been any support given to the Balmor practice. I have a list here of the support that is being provided with three additional doctor sessions per week in order to provide the headroom to engage in a comprehensive review package involving several other professionals groups in order to better understand the underlying reasons for this situation. The practice review support team involves, among others, an experienced GP and other clinical support. I am aware that the health board has been again in discussions with Balmor about extending the support for the practice into the new year. The board has no interest in leaving the practice in a fragile state and wants to continue to work with the practice in supporting it. On her wider point, Patricia Ferguson raises issues that I have spoken to her about before in the chamber, and that is that the new contract provides an opportunity to ensure that it better recognises the needs of practices working in areas of deprivation more than the current contract does. I am keen to take that forward. In the meantime, I will keep a very close eye on the communications between Glasgow and Balmor, and it is important that that leads to the practice being sustainable, not just in the short term but going forward as well. I thank the cabinet secretary for meeting with me in relation to recruitment and retention problems at Balmor practice in Pawsal park. I welcome that the local GP's support will now be extended into January, but I ask the cabinet secretary to, as I have done, or to create a Glasgow and Clyde health board to extend that support through to the end of March to support the practice at the height of its winter pressures and provide it the breathing space so that a long-term solution can be found. I will certainly continue to have discussions with Glasgow, as I am intimated to Bob Doris both when I met him and indeed today, that I want Glasgow to do what it can to support the Balmor practice. It should be said that there are other practices in the area that are performing very well indeed, and that Glasgow is also in communication with it. It is not fair to say that all the practices in that area are having the same challenges. Balmor has challenges that are particular to Balmor, and it is important to recognise that. That is why it is important that Glasgow supports that practice. We want that practice to succeed. We want it to be a success, and I will encourage Glasgow, as far as I can, to do all that it can to support the practice through the winter and beyond that. To ask the Scottish Government what the success rate is of the treatment of pancreatic cancer and whether it will provide an update in progress with research. We know that the outlook for those who are diagnosed with pancreatic cancer remains poor in comparison with other cancers. In Scotland, the age-standardised five-year relative survival for men is approximately 3.6 per cent and for women it is approximately 5.5 per cent. In research, Scotland is currently the only part of the UK whose Government is specifically co-funding research into pancreatic cancer along with a charity. Our chief scientist's office and pancreatic cancer UK each committed £75,000 to fund two Scottish-led projects submitted to the research innovation fund. I was delighted to confirm at the pancreatic cancer event at the Scottish Parliament yesterday that the co-funding arrangement is to be extended for a further year. That will make almost £400,000 available to fund research in Scotland on pancreatic cancer. I thank the cabinet secretary for that answer. She is clearly aware that survival rates from this disease lag far behind survival rates of other cancers, particularly when measured over the one in five-year survival rate period. We know that early detection of cancer is vital, but with this particular cancer it is particularly difficult. Would you consider how we might make some further progress in this, either by public education via screening or further research? Last night at the event, I was speaking to clinicians and patients and I was very struck by the importance of detecting this cancer early. That is not an easy thing to do because of the nature of the symptoms of this disease, but those patients who had survived it was very much because this cancer had been detected early. That is why research is very, very important. The resources that I mentioned in my first answer will help. We are well placed to be a leader for research into pancreatic cancer. The Stratified Medicine Scotland innovation centre based at the new hospital is an example of a Scotland-wide initiative that will allow many diseases to be studied in the population at the molecular level. The new cancer plan that we are working on with stakeholders now, I hope, will help to gather some of those issues for pancreatic cancer and other cancers in how we take that forward over the next five to ten years. To ask the Scottish Government what action it is taking to tackle NHS workforce challenges in rural areas. We recognise the particular challenges faced by NHS boards in securing a sustainable workforce for the future in remote and rural areas. The Scottish Government is supporting a number of initiatives to help to address this. We are working with boards to sustain services in remote and rural hospitals by developing networks with urban hospitals in some areas that involve rotating staff between them. Through the being-here programme, the Scottish Government is funding new primary care approaches in four NHS Highland sites, and NHS Education Scotland has developed rural fellowships to give qualified GPs the opportunity to work in rural areas and develop the generalist skills that are required to work in those areas. The cabinet secretary knows that the NHS Tayside 2020 vision document seeks to increase delivery of health services in rural settings. However, projected population change figures for Angus up to 2037 predict a marked downturn in the number of residents from that age range that the NHS would recruit staff from, yet a sizable increase in the number of over 75s, the age group most likely to require health services. Can I ask the cabinet secretary whether the Scottish Government is aware of the demographic challenge that, at least in Tayside terms, is peculiar to Angus, and what measures might be taken to tackle that? Yes, we are aware of that and we expect NHS board workforce planners, including those in NHS Tayside, to take full account of local factors, including the demographic issues referred to by Graeme Day, preparing workforce plans and projections as they are required to do. We are working with HR directors and those workforce planners and boards to support a more consistent sustained approach to national NHS workforce data and intelligence, ensuring not only enough staff, but they are in the right place, doing the right thing at the right time. I am sure that that will help to address some of the concerns that Graeme Day has for parts of his constituency. The cabinet secretary will be aware that professional recognition and pay often depends on the depth of knowledge that a clinician has or indeed a member of the medical team has, rather than the breadth of knowledge that they have, which is often required in rural medicine. What will she do to change that balance and to make rural medicine more attractive? Rhoda Grant makes a fair point. We have to ensure that the skill mix and the level of skill required to work in rural practice, whether that is in primary care or in secondary care, is very challenging and sometimes is not as recognised as it should be. A lot of good work has been done about recognising rural medicine as a discipline in itself, and the sustainability of the six rural general hospitals has been very much about putting that discipline of rural medicine to the fore. I think that there is more work that we can do around that and helping to recruit and retain staff. That is something that I am certainly happy to look at in more detail as we take those matters forward. Presiding Officer, to ask the Scottish Government what support is available to provide public access defibrillators to communities. Mr Maureen Watt. Increasing the accessibility of public access defibrillators pads is a key part of our goal to reduce the number of out-of-hospital cardiac deaths. In 2014, the Scottish Government invested considerably in providing pads across Scotland. That included £1 million to install defibrillators in dental surgeries and £100,000 to increase the number of pads available across Scotland's communities. The Scottish Ambulance Service offers support and advice to organisations interested in putting in place a defibrillator. That includes guidance on funding sources and there is a range of initiatives to provide support for pads. A key aim of our strategy of out-of-hospital cardiac arrest, which was launched in March 2015, is to enable the public to recognise early signs of cardiac arrest and take appropriate action to save lives. To realise that, communities across Scotland participated in the launch of Save a Life for Scotland, which was held last month and provided opportunities to learn CPR. Can she advise what training is given to dispatchers at the Scottish Ambulance Service's command and control centres regarding the location of pads and when they should be used? Can she also confirm what procedures are in place to ensure that pads across Scotland are accurately logged into the system? The member makes a very good point. Scottish Ambulance Service is pivotal in the co-ordination, clinical governance, co-orletary assurance and delivery of much of the response to our out-of-hospital cardiac arrest strategy. The Ambulance Service has agreed to realise a number of different actions in order to support the successful leadership and implementation of the strategy. A key commitment of the strategy is to optimise systems and training in ambulance control centres to provide a rapid recognition of cardiac arrest, expert support to bystanders in using the pads and to maintain and extend the community first responder network. To ask the Scottish Government what action it is taking to improve child and adolescent mental health services. We introduced the CAMHS heat target for faster access to specialist care. That has resulted in significant reductions in time children and young people are waiting to access specialist child and adolescent mental health services. We have made available to NHS boards 16.9 million since 2009 to increase the number of psychologists working in specialist camps and we have further committed another 3.5 million this year. In May 2015, we announced an additional 85 million over five years for mental health. That is in addition to the 15 million over three years announced in November 2014 for the mental health innovation fund. Part of that money will go to make further improvements to child and adolescent mental health services and bring down waiting times. Can I thank the minister for that answer? The Audit Scotland report NHS in Scotland 2015 shows that the 90% target for CAMHS was not met in 2015, standing at 81.1% down from 98.5% in 2013, after the changes to waiting times were lowered from 26 weeks to 18 weeks. While reducing the waiting time is a positive step, the Scottish Government is failing young children who suffer from mental health issues unless proper resourcing is in place. In addition to that, of particular concern to me are the 6,000 children a year whose referrals are rejected. Will the Government at the very least undertake an audit of the outcomes for those children? We are disappointed that some NHS boards will not meet the target, but we should reflect on the journey that has been taken. We have seen an increase in referrals from 4,734 in June 2012 to 7,777 in June 2015, an increase in the number of children seen from 2,640 in June 2012 to 4,444 in June 2015. NHS boards are doing a significant amount of work in redesigning their services to increase the capacity to meet the CAMHS target on a sustainable basis. We monitor not only those children who are in referral and their outcomes, but we also continue to notice how many are not referred on. To ask the Scottish Government whether the cleft pallet unit in Edinburgh will be retained. Yes, because only the specialist surgical element of cleft services is within the scope of the review. All other services that are delivered by the cleft pallet unit in Edinburgh and the wider cleft network are unaffected and will continue to be delivered locally, because only the specialist surgical element is part of that consideration. That is why there is a review under way to identify sustainable delivery of high quality specialist cleft surgery in Scotland. Of course, we have seen the recommendation from the options appraisal group to locate cleft surgery on a single site in Glasgow, but that does not represent a final decision at this stage. I thank the minister for the clarity of that answer and say to her that parents were absolutely devastated at the decision to remove cleft surgery from Edinburgh. It is a key part of that unit. Will the minister clarify whether there has been acknowledgement of the serious concerns about outcomes for patients with cleft surgery? That is a key issue. People are worried that there will be a damage to patient health and that the analysis was not carried out. The minister is aware that the analysis was not properly carried out to look at those outcomes and that people are very concerned that there was no proper independent review and that parents, patients, staff and stakeholders were not consulted about this decision, which they were reassured would not happen four months ago. The cleft community across Scotland was consulted on the need for an options appraisal in August. The aim of this consultation was to invite comments not just from clinicians but from patients, families and clapa to inform the options appraisal exercise. A public engagement meeting was hosted by NSD and supported by clapa in October. This engagement highlighted that the options appraisal would consider the configuration of the cleft surgical service only, not other services. NSD has advised stakeholders to have further opportunities to further input before a final decision is made. The process for that briefly is that the findings from the option appraisal group will be considered by the National Specialist Services Committee on 9 December. They will consider the review findings and make a recommendation on the way forward to board chief executives before the final recommendation is passed to Scottish ministers for decisions in the new year. To ask the Scottish Government what plans it has to improve outcomes for people who have survived and acquired brain injury in Lothian. This year, the Scottish Government has provided £40,000 grant funding to NHS Lothian to support a pilot project designed by the Scottish-acquired brain injury network, which aims to ensure that all admitted head injured patients will be cared for by neuroscience clinicians in a dedicated multidisciplinary service. The project aims to deliver recommendations for a systematic roll-out of the model across Scotland, which, if implemented, could represent a huge improvement in standards and put Scotland at the forefront of integrated brain injury services. Does the cabinet secretary agree with me that Edinburgh headway is doing a phenomenal job in this field? Does she share my view that Edinburgh headway has a vital role to play going forward? Yes, I would agree with that and pay tribute to the work of Edinburgh headway. They do a fantastic job, as do many organisations working in this field, but they are particular standouts and I hope that they continue to do that work. Thank you very much. We will go on to question 15 as well. Colin Beattie. To ask the Scottish Government what discussions it has had with NHS boards regarding planning for winter. Myself and Scottish Government officials have been engaging with NHS boards over the spring and summer period to agree and develop winter planning guidance for 2015. The guidance was issued to boards almost two months earlier than last year. As part of the winter planning process, we met all boards at a national event on 17 September to discuss winter plans and preparations. I have monthly meetings with the chairs of boards and at our last meeting we considered board winter preparations. Of course, we have allocated over £10.7 million of additional funding this year to help boards to prepare for winter. I thank the cabinet secretary for her response. As the cabinet secretary will be aware, NHS Lothian faced a challenging winter period last year. What reassurances can the cabinet secretary give the people in my constituency and throughout the Lothians that these challenges will be met this year and going forward? NHS Lothian and their partners have strengthened their winter planning this year by taking an approach across the whole of the health and social care services within the board. Their winter plan sets out how the board and its partners will support admission avoidance and delayed discharge this winter. The board also has contingency plans to open additional staffed acute beds in a managed and orderly way. The board is also investing in their HPE and imaging workforce to cover seven-day working to support effective discharge. We have certainly learned lessons from last winter on the things that are the focus on of the additional monies. One of those really important elements, not just in Lothian, but elsewhere is making sure that weekend discharge takes place and that social care assessments can happen over the festive period. Many thanks, my apologies to those people who have been unable to allow their questions to be asked. We now move to the next item of business, which is a debate on motion number 14859 in the name of Margaret Burgess on an ambitious house