 sydd y dyfodol electricitywyddiol i bethau reifon â unigddiwyddiol. The First Minister's Questions 1. I do not remember that ever have not before. To ask the First Minister what engagement she has planned for the rest of the day. Can I welcome Ingray back to First Minister's Questions? Albeit briefly, although with Labour, who knows these days? I will attend the Royal Highland show this evening. I will travel to Dublin for tomorrow's meeting of the British Irish Council and, in addition to that, I will have a range of engagements to take forward the Government's programme for Scotland. Iain Gray. Thank you to the First Minister for her kind-ish words. I cannot promise her that my questions will be up to John Stuart's celebrity standards, but I do promise to do my best and I promise not to compare the First Minister to Saddam Hussein. Adam Hussain, unless the opportunity presents itself. I'm sorry, Presiding Officer. I might be a little rusty at this. It's 183 weeks since I last did this. That's a lot of weeks, but can the First Minister tell us how many weeks it's since the SNP Government last met an accident, an emergency, and waiting time target? Of course, across Scotland, right now, around nine out of ten patients are seen at accident emergency departments within the four-hour waiting time target. We are working hard to improve that, and we are taking a range of measures in partnership with health boards to make sure that performance improves. The health secretary has been focused on this. Additional investment has been made available across the country where there are issues arising. Iain Gray, I know that he wasn't responsible at the time, although he was a minister in the last Labour administration. We didn't really know how the last Labour Government did on accident emergency waiting times, because he didn't bother gathering the data or publishing the statistics. Part of the problem with that answer, of course, is that nine out of ten is not the target, and the truth is that the SNP Government missed its four-hour A&E waiting time target for the 296th week in a row last week. The CMO's reassurances that we saw this morning about nine wells welcomed though they may be cannot hide the problems elsewhere. The last time we asked the First Minister about A&E waiting times, it was January, and she blamed the problem on winter pressures. I know that jet lag can mess up your body clock something terrible, but even she must realise that it is now mid-summer, and thousands of patients are still waiting far too long in A&E departments. We know that when the SNP took office in 2007, for example, 95 per cent of any patients in Greater Glasgow and Clyde were seen within four hours. After eight years of SNP Government, that figure is now 87 per cent. In the new South Glasgow University hospital, almost a quarter of patients waited more than four hours. Can the First Minister tell us why things are so much worse in Glasgow than anywhere else in the country? First Minister, let me deal with Ingrid's points in general on a Scotland-wide basis. First of all, I will specifically come back to the situation in the New South Glasgow hospital. The problem with Ingrid's question in terms of comparing things now with the winter is that we have seen a significant improvement since the winter period. I can point to the period since we started to publish weekly statistics on our accident and emergency department performance, since that time, which was 22 February, performance has improved by over six percentage points. That is not good enough. We intend to meet the target, but that is a significant improvement. We have seen all 14 boards in Scotland now treat around nine in 10 patients in four hours, with 10 boards meeting the interim target of 95 per cent performance. Of the 30 A&E core sites, 28 are seeing nine in 10 patients under four hours. 19 are exceeding the interim 95 per cent target, and 10 of those core sites are exceeding the 98 per cent target. Progress has been making. In addition to that, we have seen an 80 per cent reduction in eight-hour waits and an 90 per cent reduction in 12-hour waits, all since we started publishing the weekly statistics. There is more work to do. I am not for a second suggesting otherwise, but that is improvement, and I pay tribute to the staff who are working hard to achieve that. In terms of the South Glasgow hospital, all members across the chamber, I hope, will recognise that the transfer of services that has been undertaken there is one of the biggest and most complex ever undertaken anywhere in the United Kingdom. It was anticipated that there would be initial challenges around performance as a result of the migration of services from three acute hospitals into one single site, and that has proven to be the case. That said, performance in accident and emergency has been below the standards that we would have expected, and that is of considerable concern to me and to the health secretary. That is why we have done the right and responsible thing, which is to make available to greater Glasgow and Clyde health board additional support and expertise. The expert support group has already agreed actions with the health board, for example, to look at enhanced bed management and improved discharge planning. Obviously, we will keep Parliament fully updated with progress on that issue. Iain Gray I am sure that the First Minister intends to meet her waiting-time target. I am sure that she intended to meet it 296 weeks ago, but she has failed to hit it for 296 weeks in a row. If there is one place where we might expect that target to be met, it is in the new Glasgow hospital. It just seems obvious that if we spend £850 million on a brand new hospital, it should be the best in Scotland. However, this new hospital has the worst accident and emergency waiting times in the country, and they are getting worse. This is a hospital that is opened with great fanfare, just two months ago, and now it is being described as a war zone. The First Minister says that this is down to the challenge of the transfer of services from other hospitals, and she might have a point. In May, we suggested to the Government that they postpone the transfer of A&E patients to the new hospital to prevent the chaos that is now developed, and they dismissed that suggestion out of hand. They told us that there was no problem, so does the First Minister not now agree that she should have delayed the closure of other A&E departments in Glasgow until the new hospital was ready to cope? The term war zone is not an appropriate term to use, but any of our will reflect seriously on his choice of words there. Secondly, however many weeks he said it was since he had last done First Minister's questions, he has not got any more coherent in the intervening period. I think that I am losing track of the acting Labour leaders that I am taking questions from at First Minister's questions, but I think that it was Kezia Dugdale when she last asked me about accident and emergency in Glasgow. I think that one of the hospitals that she was criticising at the time was the Victoria infirmary in Glasgow, which, of course, is one of the hospitals that has now migrated into the new South Glasgow hospital. I do not think that it would have been the right thing to do to delay the transition to that new hospital. Any transition of the scale and complexity that we are dealing with in Glasgow right now will always throw up initial challenges whenever you do that transition. The important thing to do, the responsible thing to do, the right thing to do is to make that transition and support the board as they do so. I have already said that notwithstanding the initial challenges, any performance in Glasgow has been below what I would have expected it to be. That is why, as a responsible competent Government, we have sent in a support team, a support team made up of clinical expert advisors from the Royal College of Physicians Edinburgh, the Royal College of Physicians and Surgeons Glasgow, the Scottish Government and health board experts. They are now working with the board to make sure that we see rapid improvements so that that great new facility—because it is a great new facility—can ensure that it is delivering for all patients. Can I say one final thing just by way of context, Presiding Officer? While we are seeing challenges—and I do not deny those challenges around accident and emergency—if you look at the performance of the new hospital in terms of planned and scheduled care, it is performing generally very well. The transition of the new children's hospital was made last week. That is a big exercise. All of us should get behind the staff who are working so hard to make it happen and make it a success. Frankly, Presiding Officer, the First Minister is damn right calling a new hospital a war zone is not appropriate, so she should ask herself why it is that staff and patients in that hospital have had to say that. We do know that less than two months after it opened, an expert team has been sent in to rescue the A&E situation at that new hospital. That is not a good thing. That is a bad thing. That is not something to boast about. It is in addition to similar hit squads that have been sent in to the Royal Alexandra and Paisley and previously the western infirmary in Glasgow earlier this year. How many A&E hit squads does the First Minister have to send in before she does the right thing, the responsible thing and admits that there is a fundamental systemic problem here? How many winters have to come and go? How many patients have to spend all day waiting in a corridor or on a trolley or an ambulance queue before she admits that there is a problem? People are tired of the excuses. They are weary of piecemeal solutions that are not working. Just how many weeks and months and years does this SNP Government have to be in office before they sort out this accident and emergency mess? I have to say that it is somewhat gobsmacking to hear the member say that there is a fundamental systemic problem of capacity in an accident in emergency departments. The reason it is gobsmacking to hear him say that is that he is a member of a party who, had it had its way, would have shut two of our emergency departments. If Ian Gray and his colleagues had had their way, Scotland would be dealing with the increased demand on our A&E departments with one less accident in emergency departments in Lanarkshire and one less in Ayrshire. Thank goodness Scotland did not follow the advice of the Labour Party. We are doing the right thing by our national health service, protecting its budget, making sure that there are more people working in our national health service but also where there are challenges, making sure that we are working with our health boards to address those challenges head-on. That is what responsible competent government does. It is probably the reason why I am standing here and Ian Gray is not standing here right now. We will continue to do that, because the national health service is precious to all of us. It must deliver the highest standards for patients across this country, and I and the health secretary will continue to remain absolutely focused on making sure that it does just that. Thank you, Presiding Officer, to ask the First Minister when she will next meet the Prime Minister. I have no plans in the immediate future. The Sutherns A&E figures are a red flag for deeper problems within the NHS, problems that were relayed to the Scottish Government over a year ago. Last May, Audit Scotland warned that around a third of patients delayed an accident in emergency units were waiting because hospital beds were not there when they needed them, with more delays caused by a lack of staff. Specifically, since that Audit Scotland report last May, what improvements have been made in those two areas? Does the First Minister think that they are working? I said that when I launched the programme for government when the issue of delayed discharge was put by me at the centre of the Government's priorities for the weeks and months that lay ahead, I said that Cabinet would be monitoring delayed discharge figures on a weekly basis. It has been doing exactly that, and the efforts that the health secretary has been making with health boards around additional funding and working systemically with health boards and local authorities to tackle delayed discharges has been beginning to bear fruit. The most recent figures that were published two weeks ago on delayed discharges demonstrates that, while there is work to be done, we are starting to see success there. On staff numbers in the national health service, I think that I said this to Ruth Davidson. The last time we exchanged questions at First Minister's questions, there are more people working in our national health service today than was the case on day one of this Government-taking office. There are 10,500 thousand more people working in our NHS today than was the case in 2007. That is more doctors, it is more nurses, it is more allied health professionals, it is more support staff in our national health service. That is the response of this Government to the challenges that we know about in our health service, changing demographics, the demands of changing technology in many ways, all good developments in our society. That is why, as well as making sure that our health service is equipped to meet those challenges, the health secretary has. I think that I thought that there was agreement across the chamber. It said very clearly that we do need to have an open debate about how we make sure, not just in the short term, but over the longer term we equip our NHS to deal with those changes in our society. We will continue to do the hard work supporting our national health service, and I would hope that people across the chamber would support that. Ruth Davidson Thank you, Presiding Officer. The First Minister's good intentions aside, let's look at what she's not saying. Since the SNP came to power, the number of hospital beds in Scotland is down by over a thousand, with nearly half the drop in the Glasgow region alone, and that's before the latest reorganisation is counted. At the same time, the number of consultant vacancies across all specialties has risen from just over 100 in 2010 to over 400 in March of this year. Over that same timeframe, the number of nursing vacancies has shot up from over 500 to nearly 2,000. Dr Nicky Thompson, who chairs the BMA Scottish Consultants Committee, has said that the number of vacant consultant positions was, and I quote, extremely worrying. Theresa Fife, the director of the Royal College of Nursing, says that the boom and bust approach to Scotland's nursing workforce simply isn't working. Fear beds, more vacancies, audit Scotland alarms, criticism from consultants and warnings from nurses. The Scottish Government has sent a hit squad to the southern. Fine. But what about the rest of our NHS? Let me take those points in turn. In terms of staffing, health boards will have vacancies that they need to seek to fill on an on-going basis. That is in the nature of managing staff in the national health service. Ruth Davidson mentioned consultants. There has been an increase of 1,363 whole-time equivalent consultants between September 2006 and March 2015. Even taking account of what she said about vacancies, there are more consultants working in an NHS today than when this Government took office. Qualified nurses and midwives up 5.7 per cent in numbers in our hospitals. That is 2,357 whole-time equivalent, more qualified nurses and midwives now than was the case when this Government took office. Ruth Davidson will be aware of what we are seeking to do, which is what the previous administration was seeking to do, which was to shift the balance of care from acute hospitals to the community. If you look at the number of acute medical beds in the last year, the number of acute medical beds has increased an increase of 4.3 per cent. We are doing the hard work to support our national health service. Ruth Davidson again mentioned South Glasgow and seemed to suggest that somehow the reorganisation of hospitals was reducing the number of beds. That is simply not the case. Pre-migration to the new hospital, there were 3,100 staffed adult acute beds in Glasgow. Post-migration to the new hospital, there will be 3,060 acute beds plus 88 intermediate care beds. The South Glasgow campus alone, there are marginally more adult acute beds than in the three hospitals that have been replaced by the new hospital. Let's get our facts right in all of these things. Yes, let's together say that we need to make sure that we collectively support our national health service, not just today and tomorrow, but in the five, ten, twenty, fifty years to come. I hope that the other parties will be a constructive part of that, because, as a Government that wants to listen, we will listen to any suggestions for how we do that that they want to put forward. I have a number of important constituency questions that I really would like to take. I would appreciate your co-operation with brief questions and brief answers. The First Minister will be aware of a serious Scottish water incident in North Lanarkshire where several communities have been advised not to use tap water. Is the First Minister able to offer an update on the situation and advise of any support that the Scottish Government can give to the communities affected by this incident? I have assurances that all necessary steps have been taken to return the situation to normal as quickly and as safely as possible. Scottish water is working closely with relevant agencies to ensure that alternative water supplies are available to those affected and making available additional support to any vulnerable people. The Scottish Government and the Drinking Water Quality Regulator are monitoring the situation closely and will ensure that any need for additional support is co-ordinated efficiently through established Scottish Government resilience response arrangements. I know that this will be a matter of great inconvenience to those affected and I hope that those reassurances will be welcome. The First Minister will be aware of the proposed strike action by CalMac staff. Can I ask what discussions she has had with the RMT on CalMac and what steps she has taken to alleviate CalMac staff fears and shared by the wider community with regard to the privatisation of those ferry services? Keith Brown and Derek Mackay have met the trade unions on a number of occasions and provided assurances that a fair, affordable and sustainable pension scheme will be written into the new Clyde and Hebrides ferry services contract. CalMac and the unions are meeting I think today to discuss both pensions and terms and conditions and I would encourage both parties to continue to engage and have a dialogue with a view to reaching a satisfactory outcome. I will say very clearly that the services are not being privatised. Bidders are required to deliver services to a detailed specification based on our ferries plan and subject to strict contractual conditions. Scottish ministers will retain public control of the ferry services throughout the contract period, regardless of the ownership status of the successful bidder, the vessels and ports currently in public ownership will remain so. We require to put these services out to tender because of European law and of course the current contract was awarded to CalMac in 2007 following an exercise, a similar exercise to the one under way right now, initiated by the previous Labour Liberal administration. Does the First Minister agree with the Scottish Fishermen's Federation who have said that protecting the marine environment is vital? However, her government's proposals for marine protected areas are, and I quote, a piece of overt political posturing. What is she going to do to fix that before 1 October when these plans are due to be implemented? First, I do not agree with that characterisation. It won't surprise Tavish Scott to hear, but I do think that it is right that we listen very carefully to fishermen as we take these decisions forward. Richard Lochhead, as Tavish Scott will be aware, has been looking very carefully and consulting all those with an interest in the arrangements that we are making for marine protected areas. Richard Lochhead will be very happy to meet with Tavish Scott to discuss any remaining issues and concerns that there are, and we will do our best to make sure that we can address those issues in a constructive way. To ask the First Minister what impact the UK Government decision announced this morning to close the renewables obligation support for onshore wind a year early will have on business confidence, consumer bills and climate change targets? The decision is wrong-headed, it is perverse and it is downright outrageous. I think that it severely undermines any Tory claims to be pro-business. Scottish renewables estimate that Scotland could lose £3 billion of investment because of this decision. Scottish power estimate that ending onshore wind support could cost consumers £2 billion to £3 billion, as more expensive generation will be required instead. Do you know what makes this worse of all? The decision comes despite the UK energy secretary admitting on radio this very morning that onshore wind is one of the most cost-effective ways of developing renewable energy. As for climate change targets, cutting support for low-carbon energy is a terrible example to set to the rest of the world as we run up to the Paris climate talks, so I think that this decision is completely and utterly wrong-headed and wrong, and we will do everything in our power to persuade the UK Government to see sense and change it. To ask the First Minister what issues will be discussed at the next meeting of the cabinet. Matters of importance to people of Scotland. Primary healthcare in Scotland is heading towards a crisis 2. Doctors are retiring early or going part-time, leading to a major shortage. How has the Government allowed this to happen, and what is it going to do to address this looming crisis? I do not accept that characterisation, and I do not think that it is a fair characterisation, either of the Scottish Government, if I may say so, but more importantly of the services that are being provided across the country. Primary care is one of the keys to making sure that our national health service is equipped for the challenges of the future. The Scottish Cabinet had a discussion on that very issue at its meeting this week. We need to make sure that we are equipping primary care to do more in primary care, which is the way to relieving pressure on the acute services. It is also, frankly, a better way of treating people with long-term conditions in particular. That will be part of the discussion that we take forward over the summoner. However, we reconfigure our health service, not because it is in crisis to use the word that the member uses, but to make sure that, as the demographics of the country change, as the nature of the demand on the health service changes, we are equipping the health service to do that job and to do it properly and well, as it has always done in the past. I thank the First Minister for the answer, but among all that, there was no exploration as to how this Government has allowed this to happen. It is not all fine. Twelve medical practices in Fife are short of GPs. A practice in Aberdeen has slashed a number of appointments. Elderly patients in Edinburgh have been told to go elsewhere because their medical centre cannot cope. There are shortages reported in Forth Valley, Dumfries and Galloway, Lothian, Fife, Grampian, Highlands and many other areas as well. The First Minister needs to recognise that this is a crisis because that is exactly what it is. The Royal College of GPs and the BMA have been specifically warning about this for a long time. When will this Government end the complacency, change its approach and sort out this crisis? The First Minister raises a number of specific parts of the country. Let me just give some information on the areas that he raises. NHS Grampian, the board there is taking over the running of the brimond medical practice. NHS Forth Valley is taking over the running of Bannockburn, making sure that service is delivered with directly employed GPs. NHS Lothian has that option open for leaf, but the 2,000 patients affected by that practice have been reallocated to alternative practices already. Those are the things that happen when there are issues with GP practices because the board has a responsibility to make sure that all patients have access to a GP. In terms of the action that this Government is taking, it may or may not come as a surprise to Willie Rennie to know that we have invested an additional £10 million in general practice this year. We are also working jointly in Scotland with GPs to redesign the GP contract for implementation from 2017, which is focusing specifically on addressing workload pressures and supporting and sustaining general practice for the future. We have already introduced measures to increase the number of former GPs who are returning to practice. We have given practices contractual and financial stability while we look at the changes to the contract, the first time that that has happened anywhere in the United Kingdom. There is a theme emerging here today, and it is this one. The Opposition likes to come to this chamber with problems. This is the Government that focuses on finding the solutions. To ask the First Minister what the Scottish Government's response is to Diabetes Scotland's finding that diabetes levels are at an all-time high. First Minister. Well, this is Diabetes week, of course, and I would like to take the opportunity to recognise the good work that groups like Diabetes Scotland do to raise awareness of this condition. The Scottish Diabetes Survey shows that in 2014, 2014 was the lowest annual percentage increase in diabetes since 2008, but it also suggests that people are now living longer with diabetes rather than there has been a marked increase in the number of new cases. Through our Diabetes Improvement Plan, we are committed to helping to prevent diabetes with the promotion of healthy lifestyles, supported self-management of the condition, and through structured education, we are looking to improve self-management and also improve diabetes care in acute settings. The First Minister for her answer has strongly agreed that the development of structured education is vital in efforts for self-management of diabetes, but with regard to care in acute settings, the First Minister will be aware of Healthcare Improvement Scotland's Think Check Act pilot. Does she agree with me that the benefits of that programme should be shared widely to help to improve acute diabetes care? Yes, I agree with that. The Minister for Public Health visited the western general and Edinburgh this morning, which has one of the 12 wards across four health board areas that are participating in the Think Check Act pilot. That pilot has seen a 20 per cent reduction in the incidence of hypoglycemia, which is a potentially dangerous drop in blood sugar, and I know that Maureen Watt will be ensuring that lessons from the pilot are shared across the NHS in Scotland. Will the First Minister undertake today to revisit introducing a high-risk screening programme for tight-two diabetes for those most at risk in our most disadvantaged communities? Obviously, we will consider any suggestions that are put forward. Obviously, we follow expert advice when it comes to any screening programme, and we will continue to do that. We are absolutely focused on making sure that we prevent diabetes. I think that there are many examples to tell us that good lifestyle, healthy choices in our lifestyle can reduce the incidence of diabetes and sometimes clear people of diabetes. We also need to make sure that services are there and that we will continue to focus on both of those issues. Thank you, Presiding Officer. To ask the First Minister whether the Scottish Government will introduce cervical screening for women over 60. Following the report of the Scottish expert review group into the age range and frequency of cervical screening and in accordance with the recommendations of the United Kingdom National Screening Committee, as of 1 April 2016, the Scottish Government will introduce cervical screening for women up to the age of 65. I thank the First Minister for her answer and welcome the raising of the age limit to 65. However, the British Medical Journal recommends that the age for routine screening should be raised to 70, given that half of the deaths from cervical cancer occur in women over 65. Would the First Minister give consideration to the recommendation by the BMJ, not the least because 70 is the new 60, and I can attest to that? I am probably safer not to say anything in direct response to that last comment of Christine Grahame. We will always consider expert evidence in taking these decisions. These are decisions that have to be, for obvious reasons, taken on the basis of expert advice. When it comes to screening programmes, we follow the recommendations of the UK National Screening Committee. I hope that all members agree that that is the right thing to do, and the decision that we have taken to increase the age range to 65 is one that has been taken in line with the recommendations of that committee. We will continue to make sure that the decisions that we take are rooted in the evidence and in the views of experts in this issue. Thank you for that answer, First Minister's questions. We are now moving on to members' business. Members who are leaving the chamber should do so quickly and quietly.