 Llyr Gruffydd yn cwrdd, Cymru. Gywed y dyfodol sydd gyfwylwyr gyda geniwyr yn ein bydd pethau. Yn ystafell yng ngryffydd, Alex Rowley, ystafell y cyffredinant pan yn ganod? Rwy'n gallu byr amdall y fawr oedd yr aelodd checkedbox gan gyflwrm yng Nghymru mae'r cyffredinant yn gyffredinant gyda'r bydiau. Rwy'n gallu byr i'r bydd yn trei i thawr yn gyffredinant gyda'r bydd gŷfodol sy'n arweinyddol. The opening budget deficit dating from the establishment of the IJB in 2016-17 has reduced to just under nine million since that time. Further progress will be made on this over the coming year. This is a deficit that needs to be addressed by NHS Fife and Fife council and together with COSLA we are engaging with them and the IJB to support their plans to systematically reduce the deficit without reducing capacity by redesigning services and delivery and investing in quality sustainable care?" I really say to the health secretary that that is not an acceptable position for us to be in. The bottom line is that the chief director for NHS Five wrote to me just last week and he says, and I quote, we move into 2019-20, gyda'r yw fodfodol, mae'r ysgolion o ganuniad o'r 15 miliweisio gobl ar bod hiad gwaith. Rydw i'n hoffi'n eu hun sgolfydig i Gwylianne Dunydd, ac mae'n ddim yn tynnu'n tynnu'n refertau cael eu ddefnydd i Gwylianne Dunydd. Pryddoch chi eisiau bod y cwrnod ysgolianedd hynny oedd y NHS Fife Cwysol i Gwylianne Dunydd i Gwylianne Dunydd i gael ai ddarlwyno'n ei gael i grun i gael i Ysgolffydig i Gwylianne Dunydd, ac wTooil pob gwirio iawn i'w w程lltu gael z nicelyade ni beth yn인od a ddim diem ni oeddyntau? Felly mae hynny oedd wedi gwneud gafodd gyda ni'ch hunain sellsol sy integer i IP MS 5. Beth einawr i gyd yn ym rigavol y dysti, mae nid i gael gyflydd yn ni, ddolygon i Fife Cwn threaded greu i gwael maef i gyd Felly, we are trying to get them to stop telling the IJB to cut services. Recognise that the IJB has the statutory responsibility and therefore the decision making power for commissioning and planning those services. Use the funding that both the NHS Fife and the council have, including the additional funding for integrated joint services, to plan systematically to get them to cut services. To reduce what remains of that legacy deficit over a period of years, let's say the three years that I have given health boards to plan their finances and allow the IJB to work within the budget that it's got without trying to repay a debt that belongs actually to NHS Fife and NHS Fife Council in the first place. Alexander Stewart will be following Mark Ruskell. With Fife health and social care partnership looking to tackle the budget gap, daycare services and care home closures are being considered. How will the cabinet secretary ensure that vital care for the elderly in the area will not be seriously affected? We are having a bit of an irony bypass this morning, because I remind the member that the additional funds to NHS Scotland, to our local authorities and including an additional £160 million for integrated health and social care are funds that he and his party sitting over there voted against. However, on those benches, we take our responsibilities seriously, even if our Scottish Conservative colleagues do not. What we are doing is directly, my officials and COSLA officials are engaging directly with the council, the health board and the IJB to resolve this legacy debt bequeath to the IJB without reducing capacity and cutting services. That is what we are doing, and it would be very helpful to have members across the chamber engaged with us in supporting that in whatever manner they might wish to, rather than trying to score cheap political points off the back of it. Mark Ruskell. Cabinet secretary will be aware of the redesign of GP out-of-hours services that is currently under way by the Fife health and social care partnership. There is a new multidisciplinary model that is emerging that could save the services that we have all been fighting for, but it will require additional resources. Will she commit to providing additional funding for training, prescribing pharmacists and advanced nurse practitioners to deliver this new modern model for out-of-hours delivery across Fife? I am grateful to Mr Ruskell for that contribution. I am aware of the proposals that are in hand. We have additional funds available to help prescribing nurses and pharmacists in those matters, and we will look at that proposal when it comes to me specifically. To ask the Scottish Government what discussions it has had with the DWP regarding progress with changing state pension age for women in Scotland born in the 1950s. We have raised the issue with the UK Government on numerous occasions and made clear our position that it should take responsibility for the mishandling of this policy and provide transitional protection for those affected. Those women have been badly let down by the UK Government and it is disappointing that, despite the overwhelming evidence of the devastating impact that those changes have had, nothing has changed at the UK Government level. It is time for the UK Government to accept their responsibility for the hardship that they have created. I thank the minister for that response. There have obviously been changes coming across. In light of the UK Government's punitive changes, which I have just mentioned, to pension credit, waspy women are again being penalised. Can I ask the minister to call on the UK Government to put in place fair transitional state pension arrangements and to halt the reforms to pension credit, which will hit those who are most in need? In February, I wrote to the pensions minister about the recent changes to pension credit eligibility. I urged him to consider the impact of those changes, particularly on waspy women, who are part of a mixed-age couple and who will now find themselves doubly disadvantaged because of the UK Government policies. He did not address my points regarding the plight of the waspy women in his reply, and we will continue to raise those issues with the UK Government. The strength of support from all parties, with the exception of the Scottish Tories, was evident in last night's members' debate, led by Sandra White. I commend Sandra White and others involved in the cross-party group for their continued support of the waspy women in their fight for justice. To ask the Scottish Government what it can do to help NHS Ayrshire and Arran to reduce waiting times for treatment for mental health problems. Since 2016, the Scottish Government has invested £1.8 million in NHS Ayrshire and Arran for capacity building and workforce development to improve mental health waiting times, with more than £770,000 to come. That funding is currently paying for 8.8 whole-time equivalent staff with another in recruitment. Alongside that, the board is receiving support from the mental health access improvement team to deliver front-line improvement projects to improve access to treatment. The Scottish Government is also investing an additional £4 million in CAMHS staff across Scotland, who will be instrumental in supporting new services and reducing pressure on the system. John Scott. I thank the minister for her answer. She will be aware of the difficulties in accessing the CAMHS service, particularly in South Ayrshire, as well as the long waiting time for an appointment with a consultant psychiatrist. She will know as suicide numbers are rising, particularly in young men, but across all age groups regrettably with loneliness and isolation on the increase, what additional measures can the Scottish Government take to address those growing problems? I thank Mr Scott for his answer. He might be interested to know that the latest figures show that NHS Ayrshire and Arran, 95 per cent of CAMHS and 82 per cent of psychological therapies patients were seen within 18 weeks, with an average weight of seven weeks and five weeks respectively. However, the Scottish Government recognised that some people are still waiting too long, and we are determined to meet the waiting time standards across Scotland. That is why we set up a new mental health delivery board, which I chair. It had its second meeting this week. This will oversee improvement and activity and track performance. Boards have been asked to put in place improvement plans by April, setting out clear milestones over the next two years. Monica Lennon. The minister will be aware that Labour-led North Ayrshire Council is the first local authority in Scotland to have a dedicated mental health counsellor in each of its secondary schools, but the leader of the council, Councillor Joe Cullinan, has told me that demand for the service is so high that some schools already have waiting lists and he has raised the issue of support out with the school day. What action will the minister take to ensure that every secondary school in Scotland has the dedicated mental health counsellor, like North Ayrshire, and what resources are available to make sure that the service is sufficiently resourced and that support does not end at the end of the school day? Monica Lennon, thank you very much for that question. You will be aware that we have committed to school counsellors in every high school across Scotland. We have also, as I said in my previous answers, Mr Scott invested £4 million in CAMHS, which will deliver 80 additional staff, which will ease pressure across the system across the country. We have also committed to 250 additional school nurses and to rolling out mental health first aid training for teachers across all local authorities. Those measures, I believe, will help to ease some of the concerns that she has raised across Scotland, not just in Ayrshire. Stuart McMillan, thank you very much for that question. To ask the Scottish Government what its response is to Silverline Care Caledonia, derechonising GMB Scotland as a trade union, representing the staff and six of its care homes. Minister Jamie Hepburn. The Scottish Government's Fair Work Action Plan recognises the important role of trade unions, and we are committed to supporting strong trade unions for the benefit of workers and our economy. It is therefore regrettable when an employer chooses to derechonise a union. I would strongly urge both parties, in this case, to come together to reach an agreement. Does the minister consider that the decision is concerning development at a time when care home staff across Scotland may feel undervalued, despite providing some of the most valuable services in society? Let me agree with the Stuart McMillan our care home workers and our social care workers more generally. It provides an essential service, and I think that that should be a very strong message from this place that we recognise their great value to our economy, to our society. In relation to the specific circumstances, the Cabinet Secretary for Health and Sport is aware of the situation, closely monitoring the situation. We will be willing to offer any support required, but the matter is being dealt with by ACAS right at this moment. I would reiterate my message that we would strongly urge both parties in this situation to come together to reach an agreement through ACAS if necessary. Neil Findlay. The derecognition of the GMB at Silverline comes on the back of the derecognition of unison at Cornerstone. That appears to be a deliberate anti-union stance that is emerging in the care sector. What is the Government doing to stop that from becoming a growing phenomenon in the care sector? Has the minister met the companies and trade unions concerned to try to end the derecognition movement? I have not at this stage. I will be willing to do so, as is necessary. The Cabinet Secretary for Health and Sport is monitoring the situation. Clearly, it would be preferable if the parties could come together to resolve it. If it requires our further involvement, we will consider that. ACAS is actively involved and I hope that both parties can come to an agreement and can come to an arrangement. I would reiterate the point that I made. We greatly value the work of trade unions. We are working with trade unions, and I consider that a matter of the utmost regret in any circumstances where an employer actively derecognises a trade union. 5. Gail Ross To ask the Scottish Government what steps it plans to take to re-engage the rural GP association with its remote and rural general practice working group. The rural group chair Sir Lewis Ritchie met the new chair of the remote and rural GPs association on 3 April. I understand that the meeting was productive for all involved. Sir Lewis has acknowledged the concerns raised by RG Pass members and has agreed to hold further discussions in due course towards the continuing involvement in implementing the contract in our remote and rural communities. I have had discussions with Sir Lewis just as recently as last week and will continue to keep in touch with him as this progresses. 5. Gail Ross Thank the cabinet secretary for that answer. Indeed, it is very welcome to hear that there is a perception that tangible progress is not being made in the short life working group. Will the Scottish Government commit to taking that feedback into account and refreshing the aims and objectives of the group with her view to reflecting the desire for the group to be more proactive? I am grateful to Ms Ross for that additional question. I am aware of that perception. I do not think that it is entirely fair but, nonetheless, it needs to be taken seriously. Indeed, that was part of the discussion that I had with Sir Lewis. We will now take that feedback very seriously. Indeed, continue those discussions and look to see what more can be done so that the group can become more proactive in the work that we need to take forward. Miles Briggs I agree with Gail Ross's sentiments there, because as much as the cabinet secretary tries to address that up, the association of rural GPs resigned because of a due to the lack of progress that has been made to take on board rural GPs' concerns. Will she agree to meet with a cross-party delegation on that to take forward the real concerns to make sure that we get the GP contract right for every community in Scotland? I think that it would be very helpful if we wait to see how Sir Lewis' discussions with the new chair of that group progress. Following that, that should be in a very short timescale because I am keen that we make progress on this and that we continue to engage that particular association in this work. Within a very short timescale of understanding how that progress has been made, I am content to meet members to see what more might be done. Rhoda Grant I am sure that the Rural GPs Association will re-engage if it is clear that its concerns are being heard and acted on, because there are real concerns about the contract. It flies in the face of health inequalities and it certainly does not value the work of rural GPs. It also lags oversight by the technical advisory group on resource allocation. I would ask the cabinet secretary if she will make sure that oversight is in place so that the contract can be in keeping with other health services. Cabinet secretary, I am grateful to Ms Grant for that. Of course we continue to have oversight, but I think that it is worth just noting for the record and also for members' information. It is not a GP contract that the Scottish Government imposed on GPs. It is a contract that was negotiated and agreed with the BMA GP group. A significant number and a majority of GPs across the country voted for that contract and are already working it and seeing the benefit of it, including GPs in remote and rural practices. Nonetheless, there are additional concerns and we are attempting to address those. I am very happy to keep members up to date with the progress that we make in that regard. Kenneth Gibson To ask the Scottish Government in light of the birthrate falling to its lowest level since records began in 1855, whether it will provide details of the steps that it will take to support people to have children, including supporting existing families to have more children. Shirley-Anne Somerville Deciding when and indeed if to have children is a matter of personal choice. The Scottish Government is working hard to create a country that is the best place in the world to grow up through a variety of initiatives aimed at supporting pregnant women, children and families. Our targeted support provided to families includes our best start pregnancy and baby payments, which have already awarded more than £2.7 million, the provision of universal free school meals for every child in P1 to 3 and a school clothing grants supporting approximately 120,000 children. We have also funded 600 hours of early learning entitlement for all, three and four-year-olds and energy-old two-year-olds, rising to 1140 hours from August 2020, and more than 80,000 baby boxes have been given to new parents across Scotland. Kenneth Gibson I thank the cabinet secretary for that answer. In the 20th century, Scotland's population growth is the lowest on earth, and last year of birthrate was a feeble 9.2 per 1,000 people, well below replacement level. By contrast, the northern neighbour of the Faroe Islands has a fertility rate of 2.4 children, born to each woman, one of the healthiest in Europe. Does the cabinet secretary agree with the Scottish Government's own expert advisory group on migration and population that immigration alone cannot address regional or local depopulation and sustain communities? Therefore, what will the Scottish Government do to research the barriers to Scots having children? The decreasing birthrate is not new, nor is it unique to Scotland. A recent report from the national records of Scotland suggested that some of the reasons behind this may be women postponing childbearing to later ages and the economic uncertainty influencing decisions around childbearing. That is why the Government is doing what it can to help to overcome some of the uncertainties and has introduced a raft of new financial sports, some of which I outlined in my earlier answer. We are also taking a wide-ranging action across Government portfolios to tackle poverty by increasing income for work and earning, reducing household costs and maximising income from social security and benefits in kind. That is to ensure that Scotland is not only the best place to grow up but also the best place to have children. Question 7, Donald Cameron. Scottish Government, what action it has taken to support GP practices in rural areas? GPs in rural communities face distinct challenges, so our 2018-19 package of support that we put in place included financial support for recruitment incentives, financial support for relocation costs for GPs, moving to rural posts, support for the Scottish rural medical collaborative, to develop recruitment and sustainability measures, including the £20,000 GP for GP scheme, support for GP recruitment and resilience schemes in the Highlands and Islands, additional support £0.5 million to support rural dispensing practices and £150,000 to support IT improvements to rural health boards. Donald Cameron. A recent survey of rural GPs showed that 82 per cent of its members believe that the outlook for rural healthcare is worse under the new contract and 92 per cent of its members would reject the contract if given an opportunity to vote now. So what reassurance can the cabinet secretary give to rural GPs who are clearly desperate and feel their voices are being ignored by her Government? Cabinet Secretary. Given that that contract was negotiated with the BMA and was passed by GPs, including GPs in rural communities, it is always worth making that point. This is not a contract that this Government imposed on GPs. Nonetheless, we are continuing to work with the BMA, who also need to take account of some of those concerns, working with them. I met them in fact only yesterday to discuss what more we might do in terms of phase 2 of the contract, but also, as I said earlier to my colleague Gail Ross, some of the work that we are taking forward with Sir Lewis Ritchie to take account of those concerns in order to be able to specifically address them in addition to that substantive package of comprehensive support that I outlined.