 29.263—Gyfneyd diwethaf— 39.001—Glas 39.003—Glas 39.003—Glas 39.003—Glas 39.003—Glas 40.005—Glas 43.006—Glas will be aware that greater Glasgow and Clyde health board is considering changes to breast cancer services. At the weekend, the Greenock Telegraph reported on a freedom of information request by Martin McCluskey, which showed that not a single patient from Inverclyde was consulted on the proposal to close the breast cancer services at the IRH. Can the health secretary reassure local campaigners and confirm that breast cancer services at Inverclyde Royal will remain open and that those proposals will be shelved for good? Jeane Freeman. I thank Mr Bibby for his supplementary question. As I understand it, what greater Glasgow and Clyde is doing in terms of their review of acute and critical care under the banner of moving forward together is, at this point, no specific service proposals are included in that. As Mr Bibby knows, should the health board want to make significant changes to service provision in any part of its remit or its geography, those significant changes require to have significant public consultation. I am keen to ensure that that is genuine engagement. Of course, those proposals then come to me, as cabinet secretary, to reach your viewers to whether I concur with them. I hope that that is sufficient assurance for them at this point about the process that we will go through. My understanding is that there are, as yet, no specific proposals at all, and they would need to be subject to due public consultation. I will take two supplementaries, and I would ask you to be quite quick with them. Stuart McMillan, followed by Annie Wells. The right to raise genuine concerns about the health board are pivotal in holding both the Government and the health board to account. Acting responsibly is also crucial in that area, and Labour Party continually fails at it with its constant negativity and talking down the NHS and the services in the IRH. I agree that it is important, and I have said it before in this chamber, that it is important that we discuss our national health service and where there are challenges and where Opposition members have criticisms of this Government, then they should absolutely raise those, but we need to do that in the overall context of recognising that our health service is performing well, notwithstanding significant challenges that we have to meet. What we need to be able to do is not take single bits of information out of context and then make assertions and claims on the back of those. I am not casting aspersions anywhere across this chamber. I think that that is an important lesson for us all to learn and an important approach for us all to sign up to. Annie Wells Thank you, Presiding Officer. Latest statistics revealed that less than 80 per cent of cancer patients in NHS Greater Glasgow and Clyde received their first treatment within the 62-day Scottish Government targets in the last quarter. I appreciate the cabinet secretary's spoken waiting times yesterday, but what action will be taken in the immediate months ahead to reassure cancer patients that they will not be waiting longer than the treatment time guarantee? Jeane Freeman Grateful to Ms Wells for that question. Before I answer it, it is important in terms of context to say that the 31-day target is being met across our health boards. Ms Wells is absolutely right, though, to raise very poor performance in terms of the 62 days and in the plan that I published yesterday. That covers our intention to work towards meeting that target date. That is particularly with respect to diagnostics and the specific actions that I outlined initially coming on from this month at Golden Jubilee in terms of MRI and other scanning technologies will increase the diagnostic capacity available to Greater Glasgow and Clyde. In addition, as we now work towards driving on that waiting times improvement plan, we are looking at each board and asking them very specific questions about what they are going to do and how they will make best use of those additional funds that I also announced. Jamie Halcro Johnston To ask the Scottish Government what action the health secretary is taking to support those who are most vulnerable to the effects of winter weather. Jeane Freeman The Scottish Government has invested an additional £10 million to support boards and their partners to develop their winter plans. The winter plan should ensure adequate staffing cover in place across acute primary and social care settings. Patients are discharged as soon as they are ready on weekdays, weekends and public holidays. With their partners put in place steps to avoid unnecessary admissions and ensure that elective procedures are protected as far as possible so that they continue throughout the winter period. Those plans, once they are approved, will be published shortly. I also launched this year's flu vaccination programme on 1 October, targeting more than 2 million Scots and have recently been seeing for myself some of the work that our front-line health staff are doing in order to encourage their peers to be vaccinated. Jamie Halcro Johnston I thank the cabinet secretary for that answer. Recently released figures show that last winter saw the highest recorded increase in winter deaths in Scotland in 18 years. It is only October that, yet across Scotland, we have already seen a shortage of flu vaccination in many pharmacies. In my region, many older people in Orkney and Shetland are already struggling to keep their homes warm because of high rates of fuel poverty. In Murray, my colleague Douglas Ross MP raised the case of an expectant mother who is forced to endure a 60-mile trip to Aberdeen to deliver her child due to the downgrading of a maternity unit at Dr Gray's hospital in Elgin. Given that we know the extensive pressures that are already faced by the NHS across the highlands and islands, is the cabinet secretary confident that, as winter approaches, all NHS boards in Scotland are ready to meet the challenges that are faced by winter weather? Jeane Freeman As I mentioned, winter plans are precisely there to provide me with that degree of reassurance and to let me question where I do not think that boards have sufficiently planned based on the lessons learned from last winter, which was, of course, one of the most severe on record. Those plans, when I said, once approved will be published shortly, are coming to me in order for me to look at those. On the deaths that Mr Halcro Johnston referred to, of course, those are rose as a result of that severe weather from flu, respiratory infections and others. The plans are designed to ensure that we are as prepared as possible for that worst winter. The question about flu vaccination and the supply of vaccinations, what we have experienced is what happens is that you order on the basis—you get a number of delivery drops of the flu vaccines—you order on the basis of what the take-up was the year before and you order each of those delivery drops on the basis of that data. In this year, the first delivery drop has not been adequate to the demand that has come through. That does not mean that we are wrong about the demand, it just means that more people have come forward early. Therefore, we have not had all the supplies, but the supplies are coming through as we anticipated them to be and we will have sufficient vaccine for everyone. Two final points, given that there were a number of points to Mr Halcro Johnston's question. In terms of Dr Gray's, members will be aware that I have asked for a very detailed plan about how we will begin to move back towards the reinstatement of all services at Dr Gray's. The first plan that I received was insufficient in my view in terms of its timeline and its content and I would hope in the course of the next 10 days or so to be able to approve the additional work that I think is necessary in the short to medium term to move back towards full services at Dr Gray's. The last point that I will make with respect to the question on fuel poverty, obviously other portfolios carry that responsibility, a great deal of work is being done across his Government, but I cannot sit down without making the point that if the UK Government paid proper attention to what is required in terms of benefits and support to our most vulnerable citizens, then we would see a great deal less in the way of poverty as a whole and fuel poverty included. supplementary from Liam McArthur Thank you very much. The cabinet secretary will be aware that longer, harsher winters are just one of the reasons why Orkney has the highest levels of fuel poverty anywhere in the country and the health impacts that come as a result of that. Can she therefore redouble efforts to press upon her colleague, the housing minister, to ensure that the fuel poverty legislation makes specific reference to the rural minimum income standard for the criteria for assessing fuel poverty and directing support to where it needs to go? Jeane Freeman I am grateful to Mr McArthur for that question. As he knows in a previous role, it was a subject that I took a great deal of interest in with my colleague Mr Stewart. I understand the issues that he is raising in terms of my portfolio and health. We have made sure that Mr Stewart is aware of those matters, particularly in our remote and rural communities. I am confident that he is giving them all due and proper consideration. Jeane Freeman I remind members that I wish to take supplementaries, but questions and answers have already been fairly long. Unless members are willing to cut that down, we will not get through nearly so many. Question 3 has not been lodged. Question 4, Kezia Dugdale. Jeane Freeman I ask the Scottish Government what plans it has to introduce a right to rehabilitation for patients with chest, heart and stroke conditions. Jeane Freeman Early assessment and provision of rehabilitation in the first few days following an acute stroke by multidisciplinary working achieves the best outcomes for the person and is therefore a priority within the Scottish stroke improvement plan, with each NHS board reporting on progress as well as sharing good practice. We also recognise that pulmonary rehabilitation is an important element of respiratory care, and it is a key recommendation in our national clinical guidelines that boards are expected to follow. Access to pulmonary rehabilitation will form an important part of our respiratory care action plan for Scotland. Kezia Dugdale With respect, I asked whether people would have an automatic right to it rather than access to it. Can I remind the health secretary that there are 9,000 people across the Lothians who would benefit from pulmonary rehab, but there is only capacity for 1,100 people to actually get it? Without a right to rehab, how can my constituents expect to see that gap closed? Jeane Freeman I am grateful to Ms Dugdale for her supplementary question. I understand that in a recent meeting with Chest, Heart and Stroke Scotland, we began the discussions on their campaign 1-5. We will continue those discussions and see how we can move towards the end result that Ms Dugdale is looking for. At this point, the right thing for me to do is to continue those discussions to then be able to ensure that, if we make a commitment, it is one that we can meet. Bob Doris To ask the Scottish Government how it ensures that people who are homeless are not disadvantaged from accessing a GP. Jeane Freeman The Scottish Government published a guide for healthcare providers of general medical services on 20 September this year. The guidance clarifies that the inability by a patient to provide identification or proof of address is not considered reasonable grounds to refuse or delay registering a patient. The guidance clarifies that practises can use agreed addresses such as a homeless centre, a practises own address or no fixed abode to register a patient and that street homelessness can be considered residence in a practised area. Bob Doris I thank the cabinet secretary for that answer. My constituent who is currently homeless is two children staying temporarily with a friend. When our youngest child needs a GP's appointment, this is refused, with homelessness cited as a reason. My office's intervention secured an appointment and I have not named a practice publicly because I would rather promote improved practice rather than shame them in this case. However, I ask that while the vast majority of GP's practices fulfil their obligations, how can the Scottish Government yet again remind GP's practices of their responsibilities and are there any actions that can be taken regarding GP's practices that behave in such ways? Jeane Freeman We not only published a guidance, but we asked that boards ensure that that was circulated to all GP practices and that boards would follow that up. In addition, we have a primary care performance improvement plan coming forward. I would be looking to ensure that GP practices in those primary care areas understand what the guidance is and I am making sure that they abide by it. I would ask if any member has a situation, as Mr Doris has described, that they bring that to our attention as quickly as possible so that we can ensure that it is addressed as quickly as possible. In addition, through the health and care social partnerships in our work with COSLA, I intend to raise with them to ensure not only that GP practices know that that is our guidance, but that teams working with those who are homeless, whether they are street teams or in whatever other fashion, are aware of that guidance and can advocate on behalf of those individuals' rights. Mary Fee Given the links between transmittable diseases such as tuberculosis and homelessness, how will the Scottish Government ensure that homeless people, including destitute and homeless asylum seekers, can reach out to health services and prevent the spread of transmittable diseases? Jeane Freeman I am grateful to Ms Fee for that question. It is a very important one and I would draw her attention not as a complete answer but as part of an answer to practice here in this city that I visited very early on as Cabinet Secretary, where in that practice team they have street homeless workers, housing, GPs and other addiction workers and other support staff, all working as one single team shortly to move, I am pleased to say, to new and more bespoke premises. That example for me is an example of what we should see in other areas where we have significant numbers of homeless people and it is one that I am raising and trying to ensure is adopted elsewhere as part of the other work that I am talking about which is about raising the pace and spreading good practice where we expect to see it. Emma Harper Question number six has been withdrawn. Question number seven, Emma Harper. Emma Harper Thank you, Presiding Officer. Fair members to my register of interests as the long health cross-party group convener to ask the Scottish Government whether it will provide an update on the work of the respiratory improvement task force. Jeane Freeman As I am sure Ms Harper knows, in Scotland respiratory managed clinical networks exist in most health boards working to improve respiratory health and quality of life for patients. The national advisory group is the overarching group and they began the work on the task force that Ms Harper refers to. They are currently at the final stage, which is what they describe as the task and finish group, which will set up a respiratory action plan in Scotland. Emma Harper I agree that a great deal of work has already been undertaken by the national advisory group. I understand that the group, now led by Tom Fardden, has a key aim to publish an improvement plan. Can she provide an update as to when a draft or a final plan will be presented on this important work? Jeane Freeman My understanding is that we are expecting the plan to be published in mid to late 2019. Miles Briggs As to the Scottish Government how the extra funding that it announced in July 2018 to support breastfeeding services has been distributed. Joe FitzPatrick The Scottish Government has provided additional funding to health boards, third sector and other partners to meet the costs of local quality improvement projects and initiatives aimed at improving the breastfeeding experience for women across Scotland. Miles Briggs I recently met mums here in Lothian who told me about training of peer support group network. Specifically, they asked me to raise the issue that the £2 million that the minister mentioned has not provided funding to help support that. Specifically, if he is willing to investigate the establishment of a breastfeeding peer support fund for the NHS boards across Scotland to develop this vital network and the delivery of training and resources for peer support across Scotland. Jeane Freeman Joe FitzPatrick The peer support is an important aspect and is one of the areas that I expect our funding to support, as well as directly funding boards and other organisations that we have funded include the breastfeeding network, the national childbirth trust, the LLL, the BBF, Napa University and UNICEF BFI. I will come back to the member with a specific point as to whether peer support is not supported in Lothian. I know that my officials have a meeting with NHS Lothian to discuss their review of breastfeeding services across Lothian, so I will come back to the member after that meeting. Daniel Johnson One supplementary. Daniel Johnson The changes to the referral system mean that breastfeeding clinics that originally served up to 60 women a week are now only serving 12 in NHS Lothian. Indeed, information that they have provided shows that attendance at specialist breastfeeding clinics has dropped by more than 50 per cent in the past year. Does the minister agree with the changes that have been made by NHS Lothian? If not, what will he do about it? Joe FitzPatrick As I said to Mr Briggs, my officials will be meeting with NHS Lothian soon to discuss the changes to make sure that they are meeting the needs of the small number of women who experience problems that impact on their breastfeeding journey. I am happy to continue to update the member, along with Mr Briggs. 9. Angus MacDonald To ask the Scottish Government what support it has provided to ensure that there are more changing places toilet facilities throughout Scotland. Joe FitzPatrick We are committed to increasing the number and locations of changing place toilets in Scotland. There are currently 178 changing place toilet facilities across Scotland and 1 Pamilw, a portable changing place toilet. Angus MacDonald I thank the minister for his reply. I welcome the progress that has been made so far as a result of the campaign by Pamis and others, who I know greatly appreciate the support that they have received from a number of ministers and cabinet secretaries in the Scottish Government. The announcement prior to summer recess from Minister Kevin Stewart confirming that he intends to introduce changing places toilets into Scottish building regulations for certain types of new buildings was good news for the campaigners. Although it is very welcome indeed, can the minister advise if the Government will encourage Scotland's NHS boards and other public bodies to retrofit changing places toilets in the premises to lengthen breads of the country? Joe FitzPatrick The member mentioned Pamis and the Scottish Government continues to work closely with Pamis, the organisation that campaigns to ensure that in Scotland people with profound and multiple learning disabilities and their families have access to changing place toilets where they need them in the community. We are very confident that the proposed requirement for changing place toilets in certain types of new large buildings through the review of the Scottish building regulations, which the member mentioned, will significantly increase the availability of changing place toilets in buildings, but I commit to continue to work with Pamis and others to make sure that we have those changing place toilets where they are needed. Monica Lennon I welcome the commitment to support the increase of changing places toilet facilities, but the question comes at a time when public toilets are vanishing from our communities. Can the minister advise what work has been undertaken to assess the public health impact of those toilet closures? Joe FitzPatrick Obviously, many of the decisions that I know that some members from across the chamber have concerns about decisions that local authorities have made to close public toilets. I would encourage any local authority to consider carefully the implications when they are changing any service going forward. I know that it is something that has been of particular concern to members from the Highlands and Islands area, but I do not think that the member would expect me to stand here and tell local authorities what to do. However, I hope that, going forward, they take account of the needs of their residents when making any service changes. Mark McDonald It was great to see the changing places toilet being opened at Aberdeen airport in my constituency as part of the terminal redevelopment. Further to the point that Angus MacDonald made about retrofitting, it is very welcome that new buildings will have a requirement introduced. Will the minister undertake to have discussions with his colleagues about what requirements could be placed where refurbishment and redevelopment are taking place, which would not be categorised as new build, but nonetheless might open up opportunities for changing places toilets to be installed? Joe FitzPatrick The member makes a good point. Clearly, it is much easier to make those changes by design in new buildings and retrofitting can pose challenges, but the member makes a very good point that I will follow up on in relation to refurbishment. Willie Rennie To ask the Scottish Government whether it will provide an update on the proposed closure of the primary care emergency service facility in St Andrews. Thank you, Presiding Officer. Fife Health and Social Care Partnership undertook a review of their out-of-hours services in line with the recommendation in Sir Lewis Ritchie's national review on out-of-hours services and undertook an option appraisal exercise between August and October 2017. I understand that there is currently a consultation going on away, which has concluded with consideration of the results of that consultation on wider primary care and other services across Fife coming to the integration joint board at its meeting on 20 September. However, as I am sure Mr Rennie will know, GPs in North East Fife have offered to keep the local service running overnight. I understand that, in the next few weeks, the partnership will continue to work closely with them and on those services to look and see how they can develop proposals in the light of the consultation feedback but also in the light of what those GPs are bringing forward by way of a proposition. Willie Rennie The health secretary will know from her own visit to St Andrews in recent weeks that there is a lot of anger in the town and across East Fife, with more than 6,000 people signing a petition and packed public meetings in opposition to the proposed closure. We have a rural, remote, student population and elderly population. As the health secretary has said, local GPs are prepared to step up and provide a service. I am keen to understand what the health secretary will do if the Fife health and social care partnership proceed with the closure. Will she step in and change her mind? Jeane Freeman Thank you. I am grateful to Mr Rennie for that supplementary question. I do understand the anger and the concern that is being expressed and I also understand, from my constituency apart from anything else, how it is all too often easy to look at a map and think that an area is relatively straightforward to move across in terms of transport without taking account that it is a remote and at times rural air and that it is less easy to do it in practice than it may seem if you use Google Maps or some other device. I completely appreciate the concerns that are being expressed. I would not myself personally want to wait until final proposals are brought forward, but I am actively pursuing being kept up-to-date with the thinking in Fife and in the health and social care partnership about how they will move forward on the wider consultation, of course, but specifically on the matters that directly affect the access that patients have to the care that they need. I hope to be able to update Mr Rennie and other colleagues with an interest in the matter from their constituency perspective over the course of the next few weeks. Mark Ruskell. Does the cabinet secretary believe that the retention of out-of-hours services in St Andrews, particularly at the weekend, would be more likely if the health and social care partnership adopted more of a multidisciplinary approach, which is less reliant on GPs? Jeane Freeman. There are two points. Part of the difficulty that we have with out-of-hours services is that there are two parts to the difficulty. One is that the 2004 contract for GPs specifically said that they did not have to work out of hours. If you couple that with the national pension cap, which makes it more difficult, we have struggled to have GPs wanting to work out of hours. What is important in that respect is that the new GP contract—Soloist Richie's recommendations and the new GP contract—agreed with the BMA makes it very clear that out-of-hours services should be GP-led. That said, the other parts of that GP contract—the new one that has been agreed—absolutely recognise the importance of multidisciplinary teams and place the GP as the local clinical leader, the medical general specialist in an area who is working with those multidisciplinary teams to provide services not only out-of-hours, but for the rest of the time, too. Mr Ruskell makes an important point. It is important for us to understand, at least in part, why we have some of the difficulties with out-of-hours services that we have at the moment, but also to recognise that we are now moving to a situation in which GPs who work under the new contract will be working under a contract that says specifically that out-of-hours services should be GP-led—that does not preclude others, of course. What role the Minister of Public Health, Sport and Well-being is having with its plans to bring the Invictus Games to Scotland, and what discussions it has had with the cultural secretary on that? Cabinet Secretary for Culture and Veterans Minister confirmed the Scottish Government's interest in considering whether Scotland should host the Invictus Games in the future. That can, however, only happen through the appropriate formal bidding process and would be informed by a feasibility study to determine the viability of hosting. We will learn from the current games in Sydney to assist our considerations. Scottish Government commend and congratulate the athletes who are currently competing in this year's Invictus Games. I thank the member for giving me the opportunity to put in that record. I thank the minister for his answer. By holding the Invictus Games here in Scotland, it would demonstrate how highly our armed forces disabled veterans are respected here. Would the minister do all that he can to have the Scottish Government bid for the fourth Invictus Games being held here in Scotland? The member makes a strong point on the value of sport for our veterans. I was very privileged to be able to spend some time at the national centre for sport and larchs, which, to see their part of facilities, is the first fully inclusive national sport centre, second to none in the UK. When I was there, I managed to meet with and discuss sport with some members who were being supported by Help for Heroes. They were serving armed personnel who were using sport to help with their rehabilitation. The power of sport is really important. We have fantastic facilities that would be a strong argument for Scotland being a location. There has to be a proper bid process. It is important that we use Sydney Games this year to help to understand the size, scale and delivery of future games here in Scotland as a prelude to a future feasibility study, but my support would be there, along with the cabinet secretary and the minister of veterans, that we should look to Scotland to make that initial feasibility study. 12. David Torrance To ask the Scottish Government what action it is taking to improve access to mental health services for the LGBT plus people. We are engaging with LGBT plus groups to support implementation of our mental health strategy, suicide prevention action plan, every life matters and in the work of children and young people's mental health task force. Up to 2019-20, we are investing £54 million to help boards to improve access to mental health services. Our programme for government also sets out a £250 million package of measures to support positive mental health and prevent ill health. That funding aims to ensure that high-quality mental health services are accessible to everyone. David Torrance The achievements of Gercordie High School's LGBT plus group were recognised at recent COSLA excellence awards. How important does the minister consider groups such as this to be as we continue to challenge prejudice and inequality and improve the confidence and mental health of LGBT young people? Clare Haughey I thank Mr Torrance for his supplementary work. I would like to congratulate Gercordie High School on the work, and I would ask that the member pass on my congratulations to the school. Work like this is vital to ensure that young people are confident in talking about issues that affect them. At each meeting of the children and young people's mental health task force, Dame Denise Coya will share the chair with the member of the youth commission, ensuring that voices of children and young people are kept at the centre of this work. Young people are bringing an LGBTI voice to the youth commission, and as part of its research, the youth commission plans to meet with the LGBT Scotland. Question 13, Liam Kerr. Thank you. To ask the Scottish Government what action it is taking to reach the 60 per cent target of front-line staff immunised with the flu vaccine. Jeane Freeman The chief medical officer wrote to the NHS in August reiterating the importance of the flu vaccine to staff, especially for those directly involved in patient care. We have instructed boards that every effort should be made to offer the vaccine in a way that is accessible to all staff, regardless of location and working pattern. In addition, there are national resources, including a toolkit that can be used by staff to plan their local flu campaign. This year, that includes an edit of our television advert and an interactive app that has previously been used successfully in other parts of the UK and is designed to drive uptake for healthcare workers. Liam Kerr I thank the cabinet secretary for that answer. Recent figures show that 45 per cent of NHS Scotland staff eligible to receive the vaccine have done. In NHS England, that figure is 68 per cent. In England, staff who refuse the vaccine are moved from critical areas if they work with vulnerable patients, which seems eminently sensible. Can the cabinet secretary confirm that NHS Scotland is aware of that and when it will introduce a similar scheme before it is too late? Jeane Freeman I thank Mr Kerr for that answer. We are aware of the situation in England. Indeed, the app that I referred to is one that we know has been successful in driving up the uptake. What we have in Scotland, though, and it is very important in terms of how our NHS works, is that we have a very clear partnership approach with our staff, our unions and our staff side and other representatives of our staff in order to ensure that we work together collaboratively across a range of matters. I would be very reluctant indeed to start issuing dictats about moving staff or not moving staff. Certainly, without the continuing discussion in those partnership forums at national level and individual board levels, to find ways by which we can continue to improve the uptake, it has gone up in the last two years. Our target for this year is, as Mr Kerr said, 60 per cent. I have personally seen a number of innovative approaches by staff to encourage their peers to be vaccinated, not least in RAH, where I visited recently to launch the flu vaccine campaign. To ask the Scottish Government what proportion of HIP operations have been carried out within the 12-week treatment time guarantee in NHS Greater Glasgow and Clyde in 2018. Jeane Freeman. Waiting time information is collected at specialty level and not by procedure. However, that said, in the year to the 30th of June 2018, 48 per cent of orthopedic inpatient and day case procedures were carried out within 12 weeks. I am sure that, as Mr Kelly and I will absolutely agree, that this level of performance is unacceptably low. The health board has begun work to address that by improving theatre utilisation, making full use of capacity at Golden Jubilee national hospital and having additional activity in evenings and weekends. The plan that I published yesterday will provide more investment to this and other boards to increase capacity and improve performance. James Kelly. 8 per cent level of performance is unacceptably low, and it is witnessed by my constituent, Mr Paul O'Brien, who has had to wait almost 18 months to receive an orthopedic appointment. Following numerous scans, he was placed on the waiting list in February and, as recently as September, he was advised that there was still no appointment available for him, and he is off work as a result in suffering constant pain. The NHS board has confirmed to me that it is unable to meet its 12-week time guarantee in orthopedic appointments, because it does not have the capacity. Why should anyone trust what Ms Freeman and the Government say on the NHS when people at Mr O'Brien are waiting years for a HIP operation? Jeane Freeman. I thank Mr Kelly for that supplementary question. I agree with him absolutely that the situation that his constituent has faced is unacceptable and one that I am very sorry for. The plan that I published yesterday is a plan about increasing capacity, precisely to address the issues that have been identified and, indeed, the issues that that health board has raised with Mr Kelly himself. That said, what is clear in Greater Glasgow and Clyde is that the capacity that it did have was not being fully utilised. So there are two parts to this work. One is to ensure that individual boards are fully utilising their capacity. That is part also of, for example, the example that I gave yesterday in Forth Valley, but the other is the significant additional investment that was announced yesterday alongside a clear phased plan to introduce additional capacity and to produce a sustainable service to deal with those waiting-time matters. To ask the Scottish Government what steps it is taking to reduce orthopedic and ophthalmology waiting times in NHS Greater Glasgow and Clyde. Jeane Freeman. NHS Greater Glasgow and Clyde has redesigned a number of orthopedic pathways to increase capacity, for example, in hip and knee post-operative pathways plus foot and ankle community services. That increases capacity in other orthopedic service areas. In addition, the plan, as I said earlier that I announced yesterday, will provide additional capacity to Greater Glasgow and Clyde as a board, but also through the additional use that it will be able to make, along with other boards of the Golden Jubilee national hospital, with the additional CT scanner coming in early next year through put of cataract operations, additional ophthalmology staff and then moving on to the phase 2 of Golden Jubilee's expansion. All of that will, in addition to checking that the capacity that is already there is being fully utilised and looking, as I said in the previous answer, evening and weekend working. All of that is designed to increase capacity and improve performance. Jackie Baillie. I know the cabinet secretary is aware that the Golden Jubilee Scotland's national waiting times hospital is within Greater Glasgow and Clyde on the doorstep of my constituency, yet, despite increasing waiting times of nine months to a year for patients, thousands of them waiting in pain, they send a tiny proportion of cases to the Golden Jubilee. Does the cabinet secretary agree with me that the most important consideration here are the patients and will she tell Greater Glasgow and Clyde to make better use of the Golden Jubilee so that people do not need to suffer any longer? Jeane Freeman. I am grateful to Ms Baillie for her supplementary question on an issue that she and I have discussed many, many times, including prior to my appearing in this place. I do agree that the most important consideration is patients. I would also agree that what is our Golden Jubilee and, as Ms Baillie said, our national waiting time centre is not always utilised by colleague boards as well as it should be. That is something that we are taking an active interest in, but it is a national waiting time centre and it is there to provide that additional capacity for all of our health boards and, indeed, does so for some in our island communities. However, it is because of the success of the Golden Jubilee and the work that it does and the success of patient experience and patient outcomes that the very model that is the Golden Jubilee is the model that will underpin the new elective centre programme and the elective centres and their delivery, which I announced yesterday. That concludes portfolio questions. I would ask members to note that, despite going over time, we still only got to, I think, number 14, so to consider the length of time supplementary questions and answers that are taking for the future.