 I welcome the Audit Scotland's recommendations that were set out in their recent annual overview of the NHS. Indeed, we have already been taking decisive action to deliver them. They highlight the challenges that are faced by our health service, similar to the challenges that are faced by health services across the UK and beyond. Importantly, the report acknowledges that our committed workforce has continued to deliver high-quality care, and I pay tribute today to all our health and social care staff who deliver outstanding services day in and day out. As the Auditor General recognised last week, demands on the service from Scotland's ageing population are growing. Since 2013, for example, we have seen 13 per cent more cancer patients receiving treatment under the 62-day referral standard, an increase of 26 per cent in CT scans, an increase of 34 per cent in MRI scans and an increase of over 15 per cent in CAMHS patients. A small snapshot of the additional demand that our health service is coping with. In addition to demographic change, we also face price pressures and rising expectations. However, as the First Minister said last week, the task for us is not just to describe the challenge, it is to put the solutions in place, and that is exactly what the Scottish Government is doing. On 4 October, I published the medium-term health and social care financial framework to give more detail on how the potential approach required to deliver a financially balanced and sustainable health and social care system now and for the years ahead. Last week, I published our waiting times improvement plan. That will see more than £850 million of investment through phased, focused and decisive action to secure substantial and sustainable improvements to performance. Solutions will be different in different areas of the country and in different specialties, but the drive for improvement is national in scope, requiring a focused, intense programme of work that accelerates action that is already under way. From my statement of 4 October, members will be aware of my commitment to facilitate a new planning and performance cycle for all NHS boards. Audit Scotland has recommended that this is supported by a robust and transparent financial management system, and that is exactly what we intend. Further detail on the new approach will be provided as part of the 2019-20 budget. The new arrangements will require boards to deliver a break-even position over a three-year period, rather than annually, as is the case currently. In each year, boards will have 1 per cent flexibility on their annual resource budget to allow them scope to marginally underspend or overspend in that year. Audit Scotland recognised in the report that there was a range of work under way to strengthen governance arrangements, including piloting a standardised review of corporate governance across all boards. The review of NHS corporate governance carried out by John Brown and Susan Walsh will enable us to pursue the adoption of good practice across all boards. Yesterday, I met our NHS board chairs and tasked them with implementing those recommendations by the end of this financial year. Our review of progress with integration will report in the new year and will consider areas where integration is working well, along with any where governance and accountability can be improved. We are also committed to ensuring that all non-executive members of boards have the necessary training, skills and expertise to fulfil their roles effectively. In terms of addressing leadership positions, project lift is a new approach to recruit, retain, develop and manage talent within the NHS in Scotland to ensure the very best and most able leaders reach boardrooms. In terms of capital investment, Audit Scotland's report recommends the development of a national capital investment strategy. I agree. Members will again be aware from my statement on 4 October of my commitment to bring a capital investment strategy to Parliament by the end of this financial year. This new strategy will create a framework considering necessary investment over the longer term and will accompany the medium-term health and social care financial framework to create an integrated overview of the funding needed across Scotland's health and care system. That will include important investment in primary and community care projects, which will be key in delivering the emerging health and social care integration agenda and in shifting the balance of care from hospitals to local facilities and people's homes. Audit Scotland recommended that a clear understanding of demand and capacity should inform workforce planning. Again, I agree with them. Our fully integrated health and social care workforce plan, which we will publish by the end of this year, will encourage all health and social care providers to adopt a comprehensive approach to workforce planning in order to ensure that workforce resources are deployed as efficiently as possible. Lastly, I welcome Audit Scotland's recommendation about publishing clear and easy-to-understand information on how the health funding system works, including information about levels of spending. The Parliament knows that we are committed to ensuring transparency on health funding and that we have recently introduced regular reporting of the financial position of NHS boards and integration authorities. That is essential in providing the clarity necessary for the important discussion that we will need to have about the future shape of our NHS and social care services. Our financial framework was predicated on what I described in an earlier statement as the perhaps bold assumption that the UK Government will honour its commitment delivering the consequentials as a true net benefit. I regret to tell the Parliament that the UK Government has failed to keep that commitment. I am very disappointed that yesterday's UK autumn budget confirmed that the UK Government would shortchange Scotland's NHS by a total of £54.5 million next year and by more than £270 million over the period to 2023-24. That the UK Government has shortchanged our health service by £54.5 million compared to the claimed level of consequentials in the summer is an insult to our NHS and the people who depend on it. In addition, the UK Government has not set out the consequential funding that will be delivered beyond next year, leaving open the possibility of the NHS funding commitment being further eroded. Not least, as the Chancellor has more than hinted at the potential of a totally revised budget from the UK Government as a result of them crashing us out of Europe with a no-deal Brexit. Notwithstanding that disappointing but regrettably not surprising step by the UK Government, the Scottish Government remains committed to channel every penny of health consequentials into Scotland's health service. I can assure members today that, despite the actions of the UK Government, we remain committed to our programme for government promises and our recently announced waiting times plan. Returning to the Audit Scotland overview report, it is understandable that, due to the timing of the report, Audit Scotland was not able to fully reflect that the framework sets out additional funding for the health portfolio of £3.3 billion by 2023-24. That expected increase would mean an annual growth for the health portfolio of 2.9 per cent in real terms. As Audit Scotland's report says, the Fraser of Allander Institute predicts that the health resource budget is likely to have to increase by around 2 per cent per year to stand still. That is a vitally important point about funding and sustainability, which is not again understandably but is not reflected by Audit Scotland in its report. In conclusion, I welcome this annual contribution from Audit Scotland. I accept the recommendations in full. As I have set out in this statement, I am taking the steps that are necessary to ensure that the challenges are addressed. We have a record number of staff, record funding in excess of £13 billion this year and even more investment planned by this Scottish Government. Although essential, that will not be enough and we must continue to follow our twin approach of investment and reform. I now look forward to working together across this chamber in a responsible and mature manner to deliver this and to ensure a balanced and sustainable health and social care system for the years ahead. I commend this statement. We move now to questions starting with Brian Whittle to be followed by Monica Lennon. I thank the cabinet secretary for advance notice of her statement. Another week, another ministerial statement on health, perhaps the cabinet secretary and the Scottish Government are waking up to the fact that I have been failing the NHS over the 11-year tenure. The Scottish Government had been paying attention to the day job, the cabinet secretary's statement, that we have an ageing population that would hardly have come as a surprise. However, we have a shop hall in the GPs of some 850 across Scotland. Last week, the cabinet secretary announced an extra 400 training places, training that takes seven years to complete. My third cabinet secretary, that still remains a shop hall, hardly prudent workforce planning and it does not even take into account any future trends. In fact, such a high proportion of our nursing staff are approaching retirement age, which is hardly difficult to work out and plan for, yet in 2012, the then health cabinet secretary, Nicola Sturgeon, cut training places for our nurses and midwifes, short-sighted and we are seeing the consequences on the work today. The cabinet secretary used to say that there is a record investment in our Scottish NHS. What he conveniently failed to mention is that it is a direct result of Barnett consequentials. Yesterday, the Scottish Government was handed nearly £1 billion extra, which can have complete autonomy to spend as they see fit. We know that the Scottish NHS will get £214 million extra this year, with a further £720 million next year. Therefore, following the damning Audit Scotland report on the state of the NHS finances, which stated that, after 11 years of SNP Government, meeting key targets on a downward spiral because its current model is not financially sustainable, will ensure that the funding boost from the UK Government will go directly to the NHS or will continue to follow the Scottish Government's usual pattern of finding a grievance for every solution. I thank Mr Whittle for his comments and questions. I am always happy to come to this Parliament and talk about our health service. It is indeed a successful service and an excellent track record on the part of this Government. I am disappointed, however, that Mr Whittle is surprised that we have an ageing population. We have been talking about that for some time and have taken the steps. I outlined them. It really is a pity that people do not listen and read and pay attention. I have taken steps already on the back of the Government's track record to further address the challenges that the ageing population and other challenges place on this health service and on health services across the UK. What is different is that it is this Government that has plans in place and action already under way to address those challenges. Mr Whittle and I have said—my colleague Mr Mackay said it—that every single penny of the consequentials for health will be invested in health by this Government. That increased investment of our health service over the track record of this Government over many years is about political choice. It is not thanks to the UK Government continuing to cut the overall budget that is delivered to this Parliament and to this Government. It is about the political choices that this Government makes, which are so much more in tune with what the people of this country need than a Tory Government ever will be. Monica Lennon, to be followed by Alison Johnson. Audit Scotland has delivered a damning report on 11 years of SNP mismanagements of our NHS. It should shame this Government. Under the SNP, the future of our NHS is not financially sustainable. The SNP cut the health budget in real terms last year, despite rising waiting times and rising staff stress levels. Audit Scotland's Cabinet Secretary for Finance read the report. The serious challenges facing our NHS requires action, not more of the same broken promises from this SNP. Jeane Freeman's grand plan to improve waiting times will continue to break the law for years to come. It hardly inspires confidence. Today's statement does not reveal a plan for the future of our NHS. It is damage control. Jeane Freeman herself said last week that her predecessors Nicola Sturgeon and Shona Robison failed to keep their promises on the NHS. Why should the people of Scotland believe that this Cabinet Secretary is any different? I am grateful to Ms Lennon for her questions. Can I start by clarifying that Audit Scotland did not say that this Government had cut NHS investment? It really is important. I am genuine when I have said since the day and hour that I was appointed as Cabinet Secretary for Health that I look for a mature and responsible discussion. The starting point for that has to be accuracy in what we are saying. I am disappointed too that the medium-term financial framework appears not to have been read. It came, as I made the point, as Audit Scotland itself recognises after the time that Audit Scotland could take full account of it. That medium-term financial framework shows clearly the intention to invest in the NHS in Scotland beyond the anticipated amount from Fraser of Allander that is required simply to stand still. The medium-term financial framework also makes clear that what we need is investment and reform. We already have reforms under way, we have significant investment under way, we have undoubtedly challenges, and I have been very honest in recognising those and setting out to deal with them. The big difference, Presiding Officer, be between those of us who sit on those benches and those who sit elsewhere in this chamber, is that we face up to those challenges and have a plan in place. What we do not have are manifesto commitments that would cut our budget for the NHS, reduce the number of nurses and a current non-commitment from the Labour Party at UK level not to reverse the tax cuts for the rich that the Tories want to impose. If we are looking to see who will, I believe that they will put their trust in us as they currently do as a Government that delivers because we understand the reality of the situation that we need to deal with and we have the plans in place to deal with them, not the slogans that we get from either side of this chamber. Alison Johnstone, before by Willie Rennie. The increase in agency staff costs over the past five years has been staggering an unsustainable 38 per cent increase, with almost £166 million spent last year alone. That is not a new problem and we cannot wait until 2020, spring 2020, for the Government's framework for recruitment. I would like to understand what the Government is doing now. What does it intend to do in the immediate future? My thanks to Ms Johnstone. She is, of course, correct that agency costs to take up too great a proportion of our budget. That is why the workforce recruitment exercises that we have begun are so important. Why, for the sixth successive year, we have increased the numbers of student nurses and midwives in training. Why we have only recently announced a significant increase to the non-means-tested bursary for student nurses and midwives, unique here in Scotland compared to the NHS in England. And why we have, for example, undertaken and supported other initiatives in terms of nursing, the return to practice, which we would intend to increase, the transfer course with universities of the Highlands and Islands, the increase in the number of radiographers in training and the new ScotGem course with the University of St Andrews and Dundee. That is a postgraduate course of a shorter duration, clinically approved and safe, but particularly focused on GPs in remote and rural areas. All of those and more are actions that we are currently taking in order to address the particular pockets of recruitment difficulty that we have in our workforce, notwithstanding the fact, as Audit Scotland recognises, that the workforce numbers in the NHS in Scotland are higher than they have ever been. Willie Rennie to be followed by Willie Coffey. Why is it that when it has been two weeks since the worst NHS report by Audit Scotland, there is very little new in the Government response today? Workforce planning has been a major long-standing weakness for the Government, so why do we have to wait still longer before we see this workforce plan published? We have already published three workforce plans. The workforce plan that I am talking about is the one in which we integrate all those so that we make absolutely certain that we are taking a whole-system approach. I do not understand why Mr Rennie does not recognise that. We appreciate that workforce planning is a critical element of what we have to do. It is one of the pillars on which our work carries forward. The medium-term financial framework is one, the waiting times improvement is the other, and the fourth is, of course, the move towards integrated health and social care. By the end of this Parliament, over £0.5 billion annually will be invested from the front-line NHS budget into that integrated health and social care. I would never underestimate the challenges that we face and I would never say that there is not more that we have to do, but the starting point that we have to all go from is an accurate reflection of exactly where we are, and we already have three workforce plans on the socks. There are nine more questionnaires if we get a chance to get through them all. Willie Coffey, followed by Edward Mountain. I ask the cabinet secretary given that the Tory UK Government has short-changed the health service in Scotland by almost £55 million next year. Has the UK Government given any indication as to when it will confirm all the health consequentials that they have previously claimed through to 2023-24? Thank you to Mr Coffey for his question. No, the UK Government has not confirmed when the rest of those consequentials will be announced. I understand that that may happen in a spring budget, but the uncertainty around the spring statement or budget, however the UK Chancellor wants to frame it, is whether or not we are crashing out of Brexit with no deal or crashing out of the European Union with a deal that none of us understand and is totally unclear. At the moment, a few short months away from that, that level of uncertainty for our health service and particularly for our workforce in health and social care is of a matter of considerable concern, but at this point we have no confirmation at all on the rest of the consequentials. Thank you, Presiding Officer. I am pleased that the cabinet secretary has mentioned governance and leadership, two areas where your advisers, John Brown and Susan Walsh, have already documented the failures of NHS Ireland. I welcome the meetings that you and I have had, cabinet secretary, to discuss this. Perhaps you could explain to me how will the Scottish Government ensure that the new chief executive of NHS Ireland, the chair of the board and the similar appointments across Scotland provide the charismatic and positive leadership that our excellent doctors and nurses deserve? I am grateful to Mr Mountain for his question and also for those productive discussions that we have so far had on NHS Ireland, and I am sure that we will continue to have those. There are two particular ways by which we have changed how we undertake recruitment, not only in terms of non-executive members of our health boards but also for those key leadership positions. That is what is described as a value-based recruitment exercise, which looks to have more than, if you like, more than one dimension of an applicant before the decision-making panel. It is an approach that has been successfully undertaken in the Golden Jubilee national board over many years and is being picked up in other boards. It ensures that those who apply for posts that consideration is given not only to their previous experience and what they say in the CV and how they answer questions in an interview but also to how they perform in other situations so that you have a better and more rounded, if you like, perception of the applicant and therefore can make more informed choices. That alongside the governance work that, as you rightly said, John Brown and Susan Walsh undertook and my requirement of NHS board chairs that they have implemented that by the end of this financial year, together with the ministerial reviews of boards, which are about to begin, where all territorial boards will have a ministerial review where we will look directly at their governance issues and where we expect to see them improve at their performance and at the challenges that they may face and how we might further assist those. All of those taken in the round, I believe, will see us reach the level of leadership that we require across our NHS, in our chief executives and in our boards, who have the critical and vitally important role of scrutiny and challenge. Charisma, I am not sure that I can promise you, but I can certainly commit to all those others. Emma Harper will be followed by Kezia Dugdale. Presiding Officer, in her statement, the cabinet secretary recognised the increased demands on the health service. For example, in my South Scotland region, we have a particularly high-agent population with increasingly complex health and care needs. Can she outline what action is being taken to meet the demand on those needs? In terms of an ageing population, there are two things that I want to say. First of all, in terms of that population, as it presents to us, that is obviously picked up in terms of the additional capacity that the waiting times improvement plan with that £850 million investment brings into the service and the system in order to cope with those additional demands in terms of particularly elective healthcare needs but also diagnostics, that the ageing population largely but also others bring to our health service. However, the other point that I want to make is also in terms of our public health programme and the need that we have to try and do more in the field of working with mothers before they give birth, hence an element of the mental health plan that Ms Hockey is taking forward around perinatal mental health, our understanding of the impact of ACE, our work with mothers and babies and children, our work in schools in order to try and ensure that the generations coming behind us have more healthier lifestyles than we currently have and therefore the demands will change on our health service as we go into the future. That is part of what we talk about as a whole system approach and is part of that investment and reform that I touched on earlier. Audit Scotland reported that NHS Lothian missed all eight performance targets and that six of them were not even close. Given that the cabinet secretary has quietly sent in a rescue team led by the head of NHS Northumbria, can she advise when that task force will report back to Government and when staff and patients can expect to see some significant improvement? I am grateful to Ms Dogdale for her question. The task force is a continuous piece of work. I received regular reports from it on the progress that it is making. I am pleased to say that, albeit that it is only a short time and that I would not overclaim this, but what we have seen is a small improvement in NHS Lothian's performance in terms of accident and emergency. I am very happy to update Ms Dogdale on the work of the task force and other MSPs with a particular local interest in the work of NHS Lothian as the task force continues its work, but there is no particular go-in, look-at-things report and go-away again. It is working with healthcare staff in NHS Lothian and with the management team there to make improvements on the ground, which is where I think is the right place for them to be. On Sunday, the chancellor said that in the event of a no-deal Brexit, his quote was, frankly, we would need to have a new budget that sets out the different strategy for the future. He then promptly forgot about Brexit yesterday, but for the record and for the sake of all those who are working in our national health service, has the Scottish Government given any assurances by the UK Government that, in the event of a no-deal Brexit, their commitment to the NHS spend will be kept and not just thrown away in any new budget? No such assurances have been given, Presiding Officer, and, as I said earlier, all of that simply adds to the significant uncertainty that our staff in the NHS are facing, adding to the uncertainty of those very valuable members of our healthcare workforce who are EU nationals. Along with everyone else, I have little hope that it would be heard, but I urge not only the UK Government but our colleagues here in the Conservative benches to join with us and press very hard for some of this resolution to be given, and they could start by giving us assurances in terms of the consequentials going forward. Bill Bowman, to be followed by Lewis MacDonald. While health boards were able to make savings last year of around £500 million, the Audit Scotland report has said that this was largely thanks to one-off measures like building sales. Further savings will obviously have to be made in the future, and since they cannot come from building sales or creative accounting, as we saw in NHS Tayside, how will the cabinet secretary ensure—how will she ensure—that they do not come from areas that will compromise patient safety and patient care? My thanks to Mr Bowman for his question. I need to make one point about savings that are required from our NHS boards. Where they save money, they keep the money that they save, and they are expected to use that money precisely for patient services and patient care. I have been very clear with all our boards that, as they look at how they make best use of their resources, patient-centred care and quality care have to be the number one priority. As we monitor their use of resources and their spending plans and their own budgets going forward, we will be paying very careful attention to where they are looking to make reductions in costs in order to apply those funds elsewhere. The core answer to Mr Bowman's question is that he focused on quality, quality produces reform, reform produces financial prudence and good use of resources. That is absolutely my experience in the health service and that is the way we will do it going forward. Lewis Macdonald is followed by Colin Beattie. Thank you very much. The cabinet secretary rightly said that this is an annual report, but she will also know that the Auditor General's warnings of the need for change have grown more urgent year on year. Given the importance of public engagement in meeting those challenges, does she agree with the Auditor General that better information is needed on how the NHS uses funding to support change and that reporting on progress towards vision 2020 needs to be made public? If she does agree with those views in this report, how will she deliver those changes? I am grateful to Mr Macdonald for those important questions. Yes, I agree. I have accepted all the recommendations in the Audit Scotland report. I am hopeful that I will shortly have the opportunity to meet the Auditor General in order to discuss what is in that report and take her mind on some of the other areas where she thinks that we might make improvements over the coming year. We are clearly committed to transparency of information. We make information public, but that does not mean that there is not more that we can do. I would be very happy to hear of any propositions from across this chamber about what more we can do. It is not just about making information public, it is about making information accessible and understood. I think that we have a way to go in that regard in terms of individual health boards and our Government. I am keen to look at how we might do that. Can the cabinet secretary outline what Audit Scotland observed in its report on the long-term increase in health spending in Scotland? In terms of the long-term health spending in Scotland, the Audit Scotland report said that the Fraser Allander Institute estimates that the health resource budget is likely to have to increase by around 2 per cent per year to stand still. What I have said in my statement and otherwise is that the commitment that is made in the financial framework, our medium-term financial framework, sets out additional funding for the health portfolio of £3.3 billion by 2023-24, which represents a 2.9 per cent increase in real terms. That is, as I said at the time, when I made that statement and when I made the waiting times improvement plan, when I published that and made that statement. That is predicated on the UK Government making good its commitment from June for consequentials. They have already failed in the first year of that. I hope that they will not fail in future years, but what we absolutely need from them is how they are going to make good the shortfall in this first year and what they are going to do in future years so that we can have a realistic forward look and understand whether or not we can make our political choices and our political commitment good or whether the UK Government is going to let us down yet again. Weekend, we saw NHS Lothian exposed, taking in private patients for millions of pounds worth of procedures and diagnostic tests, while private procedures and diagnostic tests, while NHS patients wait up to 60 weeks and beyond on waiting lists. Does the cabinet secretary understand just how angry patients are who are waiting with worry and pain? How angry are they at that unacceptable situation and what are you going to do about it? In terms of the situation that Mr Finlay refers to, I am not best pleased myself, I have to say. From my point of view, our NHS boards should deal with private patients only in circumstances in which life is at risk. My understanding is that it is something like £2.2 million, so it is not an enormous amount of money. That does not, however, lessen my concern about what NHS Lothian has done here. What I have already done is asked for detail on the circumstances in which it has dealt with that private sector in terms of treating patients from the private sector and whether they can justify that they were able to do that because they had capacity in terms of their services for NHS patients. Once I have seen what they wished to tell me on that, then I will make a decision about what I do, not only in terms of NHS Lothian but in terms of any other boards, so that there is real clarity that NHS resources are focused on NHS patients and that that is the right direction for us to go on. The treatment of private sector patients should be, of course, possible when there is a matter of life or death at risk, but otherwise I do not expect to see it in our NHS in Scotland. Thank you very much, cabinet secretary and ministers, for their co-operation. That concludes that statement. We are now going to move on to the next item of business, which is a debate on motion 14509, in the name of Kate Forbes, on a digital society for all working together to maximise the benefits of digital inclusion. Again, I would encourage all members who wish to take part in this debate to press their request to speak buttons.