 Good afternoon. The first item of business today is consideration of business motion 8101 in the name of Jofits Patrick on behalf of the Parliamentary Bureau setting out a revised business programme for Thursday. I would ask any member who objects to press their request to sweep button now. I call on Jofits Patrick to move motion 8101. Formul moved. Thank you. No member has asked to speak against the motion. The question therefore is that motion 8101 be agreed. Are we agreed? The next item of business is portfolio questions, and we start with question number one from Gordon Lindhurst. To ask the Scottish Government what role sports clubs and leisure centres play in maintaining a healthy lifestyle. Sport clubs and leisure centres play an important role in helping people to maintain a healthy lifestyle. People of all ages and abilities can benefit from participating in sport and physical activity to improve both their physical and mental health. Gordon Lindhurst, I thank the minister for that answer. The Barclay review has floated the recommendation of ending rates relief for arms length external organisations such as Edinburgh leisure. That would potentially foot them with a bill of millions of pounds. If the Scottish Government decides to go ahead and implement that recommendation, is the minister concerned about the potential effects on health if public leisure facilities are stripped back or made more expensive as a result? I am well aware of some of the good work that Edinburgh leisure carries out. I cannot remember when I met them, however I did meet them to see first hand some of the really interesting and innovative work that they were doing to try and get the inactive active. Of course when the Cabinet Secretary for Finance made his statement on 12 September, he accepted the majority of the recommendations, but there are certain recommendations and points of detail that he is now considering further and engaging with relevant stakeholders ahead of publishing an implementation plan by the end of the year. We will continue to further engage with members on that point of interest. I am happy to meet the member if he so wishes, but the cabinet secretary is still considering specific points in his recommendations from Barclay. Would that be one of the areas that he is giving further consideration to? The minister will be aware of the great success of the Gladiator Weightlifting Club, based in Easterhouse in my constituency, who won gold and bronze medals at the recent Commonwealth Youth Championships in Australia. The minister will also be aware that the young medal winners and their teammates had to fundraise themselves to pay for the trips because no official funding was available. Can the minister ask what steps are being taken to ensure that funding for sports find its ways to grass-root sports clubs such as Gladiators and others such as Phoenix and Easterhouse and other socially deprived areas of the country to ensure that the Commonwealth Games legacy delivers increased sports opportunities for young people who might otherwise be unable to participate? One of the big planks of the Commonwealth Games was around appropriately planning for legacy to be felt not just across the city but across the whole of the country. Ensuring legacy reaches areas of deprivation is absolutely an important concern. Via Sports Scotland, clubs from across Scotland are able to access support through various different funding streams, direct club investment, awards for all and their facilities fund, as well as that. Sports Scotland is also committing additional support to the seven community sports hubs that are based in the areas of highest deprivation. With regard to the weightlifting of the specific question from Ivan McKee, I am happy to meet with the member to discuss specifically the support for weightlifting clubs in his constituency. Of course, that aside, I absolutely commend the weightlifting club based in Easterhouse, who won that gold medal and bronze medal at the Commonwealth Games, but I look forward certainly to meeting with the member to discuss those wider issues. To ask the Scottish Government what role NHS boards can play in ensuring that young people receive information at school that will reduce their risk of contracting HIV. Relationships, sexual health and parenthood education is key for ensuring that all young people across Scotland can make healthy choices regarding their sexual health. That includes knowing how to protect themselves from HIV. NHS boards work with local authorities and other partners to support the delivery of high-quality, consistent and inclusive RSHP education in schools across Scotland. NHS boards can have a role in supporting the training of teaching staff, delivering RSHP education, ensuring that schools are aware of NHS services for young people in their area and by directly participating in the co-delivery of teaching sessions by NHS staff. NHS boards are also currently working with local authorities to produce a national RSHP resource to support effective RSHP teaching. This new resource will cover a range of issues, including consent and healthy relationships, impact of digital technology, and will also be fully inclusive of LGBTI issues. Ruth Gilgour. HIV Scotland, where today announced as the winners of a prestigious BMA award for improving HIV healthcare, its recent report on HIV and education guaranteeing lessons for all highlighted that two young people every month are diagnosed as being HIV positive. Is it time to ensure stronger partnership working between health boards, local authorities and the third sector to ensure that young people receive the best information on how to lead long and healthy lives? Does the minister agree that this is a public health issue? Thank you. I would certainly want to commend HIV Scotland on winning that award and commend the work that it does in this area. I also welcome HIV Scotland's report, as the member highlights. HIV prevention remains absolutely a public health challenge, and NHS boards will continue to work with schools and local authorities to deliver change and stage appropriate RSHP education on the risks of HIV. There is real opportunity on the work that is currently being taken forward by boards and authorities to produce that new RSHP resource. We need to consider wider opportunities around the administration of PrEP to properly engage with people around safe sex messages. We should consider all those opportunities but certainly build on the good work of HIV Scotland and the work that is currently under way across authorities and NHS boards. Tom Arthur. This year marks the 30th anniversary of the first broadcast of the age don't die victims public health advert, which, with its macabre imagery and alarming tones, cemented in the minds of a generation the idea that an HIV diagnosis meant almost certain death, and the de-disunfotlant still informs perceptions to this day. However, given that HIV has not been the death sentence that it once was since the introduction of highly active antiretroviral therapy in 1996, does the minister agree that ensuring that young people are aware that HIV is now in manageable medical condition is essential to tackling the HIV stigma that still persists to this day? Thank you, Presiding Officer. Tom Arthur articulates just exactly what many of our memories will be of the 1980s campaigns around HIV. While I agree that we need to continue to raise awareness of HIV risks, prevention and treatment, we also need to be looking at tackling the stigma and discrimination that is all too associated with contracting HIV. Again, I think that there was a cross-party group in this Parliament where that was the specific ask around making sure that we do not lose sight of the stigma that many people who have HIV still continue to face in our country. Across parties, we agree that we need to be resolute in tackling and tackling that discrimination that too many people face. Linda Fabiani To ask the Scottish Government when it will next meet with NHS Lanarkshire. Maureen Watt Ministers and Scottish Government officials regularly meet with representatives of all health boards in clonic NHS Lanarkshire to discuss matters of importance to local people. There is an important issue that I feel should be raised at the next meeting with NHS Lanarkshire. Is the minister aware that cobride hospice opened some time ago to day patients but, despite having inpatient beds, those are not being utilised? This is really frustrating for all the volunteers and local residents who worked to bring this hospice to East Cobride and Lanarkshire. Will the minister intervene and raise this matter to bring clarity to the situation and, indeed, I hope, provision of hospice in patient beds in UK and South Lanarkshire? Maureen Watt I have been made aware of this situation and I am happy to meet the member to discuss it further if she wishes. She knows that South Lanarkshire and North Lanarkshire health and social care partnerships are currently working together to agree how to make best use of local palliative care services and supports to meet the needs of their populations. Earlier this year NHS Lanarkshire established a short-life working group on how best to do this. I understand that the group will be sharing its recommendations shortly with a view to engaging further with stakeholders in the near future. Following the proposed way forward, we will be presented to North and South Lanarkshire integration joint boards, hopefully before the end of this year. Brian Whittle In 2009-10, NHS Lanarkshire spent £13,000 on agency nurses, but by 2016-17 it had rocketed to more than £1.8 million. Over the same period, the number of unfulfilled nursing in Manwifery vacancies in Lanarkshire increased from 18 to 254. Does the cabinet secretary agree that a major contributory factor was Nicola Sturgeon's decision to slash training places for nurses when she was health secretary? What will the cabinet secretary do to rectify the situation and ensure that Lanarkshire hospitals are not chronically understaffed? As the member knows, NHS spend is an extremely small part of the overall health budget. As the member also knows, we are currently working on NHS workforce planning. Perhaps the member in relation to Linda Fabiani's question would like to join me in congratulating nurses in the field of palliative care and recognise the work of the University of Bath and the lead author of a report who says that Scotland is leading the way with ambitious targets in palliative care and reorganisation. It is a place to come to in terms of leading in palliative care. Monica Lennon I just say for the record that I wholeheartedly agree with Linda Fabiani. I know that the Lyons family, who lost a much-loved father and husband Frank Lyons, an MND campaigner, would really appreciate that being followed up. Is the minister aware that ward 18, which is the cure of the elderly ward at Hirmire hospital in East Kilbride, has been closed to new admissions? Is the minister able to clarify if that has resulted in a reduction in the number of available beds for elderly patients at Hirmire and if that measure is a permanent one? I'm happy to investigate the issue that the member raises and write to her further on that. I'm not aware of that particular issue about ward 18, but I'm happy to send information to her. Liam Kerr To ask the Scottish Government what plans it has to review the NHS resource allocation formula. The national resource allocation formula is updated every year to take account of changing demographics across Scotland. The most recent major review relating to morbidity and life circumstances adjustment for the acute care programme was reflected in the NRAC shares issued for 2017-18 onwards. Liam Kerr I thank the cabinet secretary for that answer. Vacancies and long waiting lists are leading to NHS Grampian patients being potentially sent as far as newcastle for surgery. Under the allocation formula, NHS Grampian receives only 89p per head compared to the national average of £1, a smaller share than a decade ago and lost £15 million in the last financial year. Does the cabinet secretary accept that it is funding decisions made by this Government that are causing delays and crisis in the north-east? When will the Scottish Government fund NHS Grampian at the level that its allocation formula requires? Liam Kerr To Liam Kerr, NHS Grampian's resource budget for 2017-18 has increased to £898.6 million. That includes an additional £3 million of NRAC priority funding, which ensures that all boards are no further than 1 per cent from their target share of funding. I can also say that, since 2015-16, NHS Grampian has received an additional funding of £47 million for the specific purpose of accelerating funding parity in line with the NRAC formula. Grampian has been one of the biggest gainers from the NRAC formula over recent years. On patients being sent to newcastle, that is clearly an arrangement that is part of a process of boards helping one another. Glasgow and Edinburgh are the first port of call for patients from Grampian in order to support Grampian while they are able to recruit and work their way through some of the difficulties that they have. Newcastle is the third option. I am sure that Liam Kerr and no-one else in this chamber would suggest that we should not utilise resources wherever they are offered from. It is not the first time that mutual aid has been given north and south of the border, and I think that it is something to be welcomed. I would certainly applaud Grampian's efforts in making sure that they do that while they sort out their own recruitment issues in the Grampian area. The health secretary needs to recognise that resource is not making demand in the NHS, with health boards telling us that they are having to make over £1 billion of cuts over the next four years. That is having devastating consequences on the workforce and on patient care, too. Just one shocking example of that is the revelation that women in Glasgow who suffer a miscarriage are having to wait up to five weeks to have a surgical removal of the fetus. That is a shocking and heartbreaking revolution. What will it take for the cabinet secretary to wake up and realise that there is a problem in the NHS and give patients and the NHS staff the treatment that they deserve? Anasawa raised two very different issues. Let me take the first one first on the resources to the NHS. Anasawa will be aware that there are more resources going into the NHS than ever before. Of course, under the Labour proposals in the manifesto for the 2016 election, there would have been less money going into the NHS than it has been delivered. However, he makes a point that I agree with. That is that demand for the NHS continues to grow and puts pressure on services, which is why we need to reform and change the way services are organised, which is why we are working through the integrated partnerships to ensure that more people are kept out of hospital and avoid admission to hospital in the first place, which is very important given the growing frail elderly population. He also raised a very serious case in Glasgow and Clyde that has been raised over recent days. What I can say is that there is a full investigation going on. I understand that there has been a complaint raised about this case. I have asked the chief medical officer to look into this in Glasgow and the rest of Scotland. The initial indications are from Glasgow and Clyde that it is an isolated case, which is totally unacceptable. I am absolutely determined that that standard of healthcare is not something that we would absolutely not accept for anybody anywhere in Scotland, but it is not reflective of the rest of the service in Glasgow and Clyde. However, the chief medical officer is seeking assurance about that, not just in Glasgow and Clyde but elsewhere. I want to make sure that women across Scotland will get the highest level of care, particularly in very, very sensitive circumstances like this. Mike Rumbles 5. Does the minister not see that, with 3,500 fewer planned operations, the second worst waiting times record, hundreds of cancelled— Mr Rumbles, you have to read the first question first. I think that you are on your supplementary. To ask the Scottish Government what its position is on the number of planned operations that have been cancelled on the NHS Grampian. Cymru sefydliad. Decisions to cancel a patient's operation is never taken lightly. All boards, including Grampian, work very hard to keep cancellations to a minimum, and we continue to work with them to see sustained improvements. It is important to remember that there is a small percentage of the overall number of planned operations taking place. The latest cancelled operations figures for the months of August show that in Grampian, 1,947 operations were carried out, with 83 operations cancelled due to capacity or non-clinical reasons. Cabinet Secretary, 3,471 fewer planned operations, the second worst waiting times record of any NHS board, hundreds of cancelled operations for non-clinical reasons and, most recently, specialist veteran services pulling down the shutters through lack of funding support from NHS Grampian. I am not the only Grampian MSP who is raising this issue. Does she believe that now is the time to fund NHS Grampian properly? Because it has only got 89 per cent of the average head of population. It is not the amount of money specifically that the cabinet secretary has mentioned, it is the share of the budget that needs to be addressed. As I answered to Liam Kerr earlier on, the issue of NRAC funding has been an important element of the funding that Grampian has received in recognition of the challenges that it has. That is why, since 2015-16, it has received additional funding of £47 million for the specific purpose of accelerating funding parity in line with the NRAC formula. As I said in my initial answer, there are a very small number of operations that are cancelled due to capacity or non-clinical reasons. For August, that amounts to 2.8 per cent of operations that are cancelled due to capacity and non-clinical reasons. Obviously, a number of other operations are cancelled for clinical reasons because patients are not fit to have the procedure or by patients themselves, but for those who are cancelled due to capacity and non-clinical reasons, it is 2.8 per cent. The vast majority of operations go ahead. Mike Rumbles also mentioned the veteran services, and that has been important. We have supported boards to continue to provide veteran services in a very difficult backdrop. Obviously, those services were previously funded through the LIBOR money, as Mike Rumbles will be aware, and that money was withdrawn. We have tried to help boards to sustain those services, and we have offered boards a partnership arrangement for funding, but it would be up to those boards to either accept or not accept. Most have, but there are a small number of boards who have not decided to go down that route, and that is a local decision for those boards. Can I ask the cabinet secretary what measures have been taken by NHS Grampain in conjunction with local universities and colleges to train more theatre staff for Aberdeen Royal Firmary to address staffing issues? The member touches on a very important point, because one of the key issues here for Grampian is the ability to recruit and retain staff. One of the key issues there is theatre staff for Aberdeen Royal Infirmary. The board has taken a number of important measures to plan and sustain its theatre workforce. For example, it is one of a number of boards who have piloted a new approach to developing the theatre workforce. They are working in partnership with the north-east of Scotland colleges to develop and deliver a professional development award in perioperative practice, which has enabled existing theatre staff to further develop their skills and experience, ensuring a clearer career pathway and helping to attract and retain theatre staff. A lot of work is going on, and they have restructured entirely the way that organiser theatres in Grampian. I am confident that, over time, they will be able to build up their capacity again and be able to sustain and provide quicker access to procedures than they currently are. We have heard from the minister a lot of information about how much extra resources are going in and the partnership arrangements with Newcastle, Glasgow and Edinburgh. We have not heard from the same thing about how long it is going to go on for, because it has been going on for several years so far, and how it can give to the north-east of Scotland a promise as to when things will normalise itself and there will not be cancellations, and the waiting list will come down to what can be considered at a normal level. The arrangements for cardiac patients are a new arrangement. That has not been going on for years. They have had to come to those arrangements because of the particular issues of not being able to recoup to those specialties within Grampian. It is important to ensure that cardiac patients within the north of Scotland and the Grampian area get access to the cardiac specialist that they need to get access to, so that is why they have come up with the very important arrangements with Glasgow, Edinburgh and Newcastle, although they have not had to utilise any capacity in Newcastle so far. The most important people in all of this are the cardiac patients. I know that they would want to get the treatment as quickly as possible, and if that means travelling from outwith Grampian, I am sure that that is what they are prepared to do. Meanwhile, Grampian is working very hard to try to recruit those specialists to Grampian, so that they can get their own service back up and running to be able to meet their own demands from the Grampian area. To ask the Scottish Government what action it is taking to increase access to new medicines. In December 2016, Dr Brian Montgomery published his independent review on access to new medicines, which recognised that the Scottish Government has made significant reforms and investment to improve access to newly-licensed medicines in recent years. The review found that, following our previous reforms, the Scottish Medicines Consortium acceptance rates had markedly increased. We are committed to continuing to build on those improvements and are taking forward the recommendations set out in Dr Montgomery's report. We are working in collaboration with stakeholders, including the SNC, NHS Scotland and the pharmaceutical industry, to implement the recommendations as quickly as possible. We would also encourage drug manufacturers to make reforms, too, so that they bring forward medicines at a fair price. Sandra White I thank the cabinet secretary for replying certainly about the pharmaceutical and the fair price, but I just want to ask the cabinet secretary and I know that she will be aware of members and probably the public as well. Cross-country working is very important when you are looking to access new medicines. Therefore, what impact will leaving the single market have on accessing new treatments and medicines? That is an important issue. Should the UK choose to take us out of the single market and withdraw our membership of the European Medicines Agency, there is a clear risk that pharmaceutical companies could be less committed to the UK market than to the larger attractions of the EU and the United States, meaning that patients in Scotland and the wider UK could face delays in accessing medicines that they need in comparison to the timescales that we currently enjoy as a full member of the EU. I am also concerned that medicine manufacturers could be negatively impacted by additional costs as a result of having to work separately with the UK. That might mean that some manufacturers choose not to do so at all as a result or could increase the cost of our medicines. In the light of all that, I wrote to the Secretary of State for Health, Jeremy Hunt, in July seeking clarity on the UK's future relationship with the European Medicines Agency and have requested the full and regular involvement of the Scottish Government in these crucial discussions and decisions. Miles Briggs, can the cabinet secretary give an update to constituents of mine and those across the Parliament here what steps the Scottish Government is taking to allow cystic fibrosis patients who are campaigning for access to the drug or can be? Yes, I can say to Miles Briggs that he will be aware that decisions made by the SMC have and continue to be independent of ministers in Parliament and are based on clinical and cost effectiveness at a national population level for all of Scotland. I wrote to Vertex Pharmaceuticals in March to encourage them to take forward discussions about the cost of our campaign with colleagues in the national health services Scotland division, who are best placed to advise them on pricing approaches and a fair price that could support the securing of a positive recommendation from the Scottish Medicines Consortium for the prescribing of those products in the NHS in Scotland. Those talks are under way, and I am sure that the member will appreciate that we should allow those talks to continue. Through those discussions, I would certainly hope that the manufacturer will make its best offer on price and indicate that it will resubmit an application for our camera to the SMC at the earliest possible opportunity. Pauli McNeill Will the Scottish Government consider funding that sat-effects a cannabis-based medicine as NHS Wales have done? Drugs such as Sabotex can help treat MS arthritis and other musculoskeletal conditions. Tony Wiggins, chairman of the Cardiff and Veal MS Society, has trailed Sabotex and called it a tremendous step forward. He said that it is good for spasms for other effects of the MS, and it does work. I realise that it is not authorised by the Scottish Medicines Consortium. However, the cabinet secretary will be aware that doctors are able to prescribe it should they wish to, but I wonder if she would consider going down the same road. Pauli McNeill has said that whether the SMC decision is not to accept a medicine for routine use, the clinicians are still able to request access to medicines for their patients on an individual case-by-case basis, where they feel that it would be of significant clinical benefit to do so. That is currently done through the individual patient treatment requests. That is being changed to the new peer-approved clinical system, which is going to improve consistency and ensure that patients get access to the right treatment at the right time. There is obviously going to be a national appeal panel to help to ensure that there is more equity of access. That would be the suggestion to the patient that Pauli McNeill is talking about, and they could make a further submission to the SMC. I am not sure in the specific case whether they are planning to, but I could certainly write to Pauli McNeill with that information. To ask the Scottish Government how much of the £1.3 million that NHS Shetland is to pay in local costs in 2017-18 will be used to cover GP vacancies? That information is not held centrally, however, my officials have contacted the board and I understand that over £1 million is available to cover GP vacancies and single-handed GP leave cover in NHS Shetland. The island of Yell used to have two GPs running an independent practice to save money but local cover is now to be replaced by an advanced nurse practitioner. Will the minister accept that this puts a clinical burden on an individual who will have to refer cases to a GP by phone in Lerwick? Is this acceptable or would it not be better to have a GP in the island of Yell? I am aware that there have been challenges and difficulties in trying to recruit to a number of GP posts in the area. There is a lot of work that has gone on to try and incentivise some of those posts. I am sure that the member will be aware of those. There is also, as I understand, a very successful GP training scheme through the Lerwick practice, with four GP registers currently in training that are due to qualify in about 18 months time. They want to stay in Shetland. Whereabout they end up being located is something for discussion. The role of advanced nurse practitioners is important. I know that that is being looked at as a way of supporting the GP recruitment issues. Of course, they are very experienced nurses in their own right. In terms of the clinical backup that they have, that is important. They should have access to that GP support. I am certainly happy to discuss further with Tavish Scott if we can help through the rural medicine collaborative and other incentives. I would hope that NHS Shetland would be taking advantage of all those. To ask the Scottish Government what recent discussions it has had with NHS Dumfussing Galloway regarding the equity and equality of service across its area. The Scottish Government has regular contact and discussion with NHS Dumfussing Galloway. I was in contact last week as part of the board's annual review. This meeting, a range of topics were covered and this included performance, finance and the new £200 million Dumfussing Galloway royal infirmary and the positive on-going engagement with the integration joint board. I thank the cabinet secretary for that response. You will be aware that the cross-party petition that was received widespread support in Sunrar and Wigdanshire seeking a long-term commitment from the Scottish Government for the retention and improvement of the services at the Galloway community hospital. I thank the cabinet secretary for accepting my invitation to come to Sunrar to collect the cross-party petition on the Galloway community hospital and to hear the real concerns of local people. With the never-increasing pressure on hospital bed numbers, does the cabinet secretary agree with me that cottage hospitals play a vital role in transitioning patients from hospital to their homes? Can she confirm that there are no plans to close any cottage hospitals in Galloway in western Fries? I am fully aware of the strength of local feeling in support of Galloway community hospital, not just Finlay Carson, but all local members. In fact, the temporary changes over the summer were taken to ensure patient safety services at Galloway community hospital are now running as normal. I hope that the member will welcome that. The board works hard to overcome some of the recruitment and retention issues around the hospital. The hospital is very valued. It provides a very high-quality level of healthcare services and provides services well beyond those found in other community hospitals. NHS Dumfries and Galloway has given assurances that it will continue to keep local communities fully informed about any changes to services at the hospital, where they are unavoidable for patient safety reasons and are keen to engage with local people and their representatives. They held a public meeting in July to discuss the issues that I understand are productive. Emma Harper Thank you. Remind the chamber that I am a registered nurse. To ask the cabinet secretary, does she agree with me that health boards have a duty to undertake any service redesign in close consultation with stakeholders, including patients and parliamentarians? Cabinet secretary? Yes. Emma Harper has raised issues on a number of occasions. Of course, boards have a duty to carry out full and meaningful engagement with all stakeholders when considering taking forward any service change proposals in line with well-established Scottish Government guidance. It is also important that they engage not just around any service change proposals, but they engage anyway. One of the issues emerging from the public meeting in July with the board around Galloway community hospital was the need for full information. I think that people appreciate that sometimes there are unavoidable challenges that arise due to staff sickness or other issues that require the board to ensure that services are continued to be provided in a safe way. However, I think that they need to make sure that that information is full and that they make sure that the community is fully aware of any changes. I think that they have learned a lesson from the experience at the Galloway community hospital. Does the cabinet secretary accept that the biggest challenge in delivering equity and equality of service in the rural area such as Dumfries and Galloway is the current NHS recruitment crisis? In the region, there are 150 nursing and midwifery vacancies, 28 allied health professional vacancies and 22 per cent of all posts, and 42 per cent of GP practices have an infilled GP posts. The recent Audit Scotland report on workforce planning revealed that two thirds of interviews in the region for consultant posts are cancelled because of a lack of suitable applicants. When will the Scottish Government take responsibility for letting down patients in Dumfries and Galloway and apologise for 10 years of abject failure in proper NHS workforce planning? Of course, Dumfries and Galloway, as other health boards, have more staff than they have ever had and they have more posts than they have ever had, but there are vacancy issues within certain areas of the country, particularly in more remote and rural areas. That is about us trying to attract staff to come to Scotland and to make sure that we are training enough staff. That is why we have increased over the last five years the number of nursing and midwifery training posts. That is why we are expanding the undergraduate medical courses. That is why we are adding a new graduate medical school and that is why we published our workforce plan back in the summer in order to work with boards to ensure that we have the staff going forward. We are not the only part of the country to have issues with recruitment and retention. It is an issue for all the UK health systems and, indeed, beyond some of those specialties that are very difficult to recruit to. Dumfries and Galloway are no different from that, but we will continue to support them in making sure that they can successfully recruit and retain the staff. The GP issue, as members will be aware, is something that we are working very hard on with a new contract, which I think will help to make a real difference in attracting GPs to come and work here in Scotland and to make general practice an attractive career for the young doctors. I am a registered nurse. To ask the Scottish Government what its position is on the Law Society of Scotland's warning that ending freedom of movement may deter medical professionals from moving here and have implications for people who are already living and working here. Scotland's health workforce benefits enormously from the contribution that is made by staff from across the European Union. We need to retain the ability to recruit freely from the diverse and experienced talent pool. I agree with the Law Society that any restrictions on current free movement arrangements will inevitably pose recruitment and retention challenges for health boards. I have met a number of EU staff directly who tell me of colleagues who have already left Scotland. Staff are understandably anxious and uncertain about the impact of Brexit on their right to live and work in Scotland. We urgently need clarity from the United Kingdom Government on future immigration policy. The Scottish Government has signalled its desire to retain freedom of movement and access to the single market, and we will continue to do so in all we can to protect Scotland's interests in Europe. Thank you for that answer, cabinet secretary. Does the cabinet secretary agree that we need urgent clarity on what the rights of the EU nationals working in the NHS will be after we are taken out of the EU? Yes, we do. A number of members this afternoon have raised issues about recruitment and retention. Of course, it is important that we as the Scottish Government do everything that we can to grow the workforce here in Scotland. We are doing that by expanding training places in nursing within medicine and elsewhere. However, to stop the flow of EU nationals here to Scotland to provide an extremely important part of the workforce in the here and now and into the future is a very retrograde step. We will make the situation here in Scotland much worse. I want to send a message out to EU citizens living here that they are very welcome. We want them to stay, and indeed we want future generations of EU citizens to come and work here in our health and care services. Thank you very much.