 The first item of business this afternoon is portfolio questions. In order to get as many people in as possible, short and succinct questions and answers would be appreciated. Question 1. Maureen Watt. To ask the Scottish Government what progress has been made in reducing the number of senior managers in the NHS. NHS Scotland has set a demanding target to reducing senior management posts by 25 25 per cent oesrwyd 2020 a 25 oesrwyd 2015. That target was exceeded 1 year early. By 31 March 2014, senior management posts had been reduced by 29.3 per cent. The savings from the reduction will continue to be reinvested into services in the National Health Service in Scotland. Furthermore, unlike trusts in England, the savings of more than £1 billion that ydy'r skydeddau o'ch bod oedd wedi'i gyrraethaheidi adeth yn lleidio rhiynau i'r llaw oedd yn yr edithaf Australia yn cyfathoddydiad i'r ynfiadniolol, a bach wedi'r defnyddio, ac yn du panaf i'n gweld'r gwaith yng Nghymru. Mor rai yn fawr. I have a thank the cabinet secretary for that answer. Does he believe that NHS Scotland would have made such substantial progress in reducing bureaucracy if we had indeed followed the example of the Tories at Westminster with their disastrous reorganisation and privatisation? No, I don't. The role of non-NHS providers in delivering NHS-funded care in England has increased markedly from 2006 onwards. In Scotland, we ensure high-quality health provision by other means, including efficiency and productivity initiatives. Many thanks. Question number two is Kevin Stewart. Thank you, Presiding Officer. To ask the Scottish Government how many consultants work in NHS Scotland. There is currently a record number of consultants working in Scotland's national health service with NHS boards looking to recruit even more staff to further increase capacity. There is 5,037 whole-time equivalent consultants working within the national health service in Scotland as at June 2014, an increase of 1,140 full-time equivalent or 29.3 per cent within the lifetime of this Government. Kevin Stewart. Thank you, Presiding Officer. I thank the cabinet secretary for his answer. The rise in the number of consultants under this SNP Government is a welcome one, although I do have some concerns about recruitment of consultants at Aberdeen's A&E, which I hope can be resolved. Can the cabinet secretary also offer any specific information about the number of junior doctors in the health service? Doctors in training within NHS Scotland have increased by 254.8 full-time equivalent from 5,361 to 5,591 during the lifetime of this Government, which equates to an increase of 4.8 per cent. It should be noted that the funded establishment of emergency medicine consultants within NHS Grampian has risen by 125.4 per cent during this period, with 80.3 per cent more consultants working in this speciality in NHS Grampian. The late minute of the meeting of NHS chief executives held in 6 August highlighted a number of issues that require immediate and transformational change, including consultant and other recruitment challenges. Can I ask the cabinet secretary how he is going to close the additional 450 million gap in his budget, much if it is apparently caused by pursuing initiatives that run contrary to his own 2020 policy? The member looks at the published information of the NHS territorial boards in Scotland in particular. He will see that the targets for savings for this year have already been exceeded. There is not a reduction of £450 million in the NHS budget in Scotland. However, I take the point that we need additional resources. Had we been able to remove Trident from the Clyde, we would have had substantial additional resources available for the health service, and I note that the member voted to keep Trident on the Clyde. Nanette Milling. Given the national and international shortage of consultants and certain specialties, can the cabinet secretary outline what research has been undertaken to assess how many potential future consultants are currently in training, particularly within those specialties, and when they may enter the workforce? We are in constant contact with the academic board under Sir David Calder, with the education secretary, with the universities and the medical schools, as well as with the academy of royal colleges and the individual royal colleges themselves. We are continually looking at those vacancies over a three-month period, which have not been filled. There are certain specialities. Pediatrics is an example, GPs is an example where there is a UK, and in some cases worldwide shortage, of available qualified staff. However, as the member knows, in some cases, we are advertising overseas to recruit staff where we find it impossible to recruit staff in the UK. However, for some specialities, it is very, very challenging. To ask the Scottish Government how it is addressing medical staffing issues in the NHS Lanarkshire. Presiding Officer, the Scottish Government is supporting NHS Lanarkshire in aligning its staff to meet patient demand and the implementation of a number of site-specific actions. The number of consultants and posts in NHS Lanarkshire has increased by 59.8 per cent, or 159 whole-time equivalent, between September 2006 and June 2014. Qualified nurses and midwives have also seen their numbers rise by 9.8 per cent or 329 whole-time equivalent during the same period. A recent international recruitment exercise for A and E and Acute Medicine trainee doctors has led to NHS Lanarkshire successfully recruiting to an ST4 emergency medicine post. NHS Lanarkshire board papers from last month say that medical staffing across all front door emergency services is fragile, and models of care will require further review if vacant posts are not filled. What does the health board mean by further review, and what contingencies are in place to maintain patient safety if the staffing situation deteriorates further? First of all, unlike Labour, we will not be planning to close any accident and emergency departments. What we are doing is recruiting people. If you look at the Lanarkshire situation, when we took over, there was a total of eight whole-time equivalent A and E consultants in Lanarkshire. There are now 32 full-time equivalent A and E consultants in Lanarkshire. Because of the complexity, particularly the number of people who are very elderly with very complex conditions, you cannot just look at the number of patients, you have to look at the complexity and increasing complexity and comorbidities of the patients presenting. I do not want to underestimate the challenge that we face throughout every modern health service and every modern society in rising to the challenge of an ageing population, but, certainly, we have multiplied by a huge factor the number of A and E consultants in Lanarkshire compared with the pathetic record of the Labour administration. At last met NHS Lanarkshire. Cabinet Secretary, Alex Neil. He is presenting office of ministers and Government officials a regularly meet with representatives of NHS Lanarkshire. I thank the cabinet secretary for his response. I know that the cabinet secretary is aware of the situation currently existing at Belshill clinic, where a local GP practice has had to co-locate because its facility burnt down some years ago. It is now over five years since that co-location took place. I know that the cabinet secretary is not responsible for the reason behind that, and there has to be questions asked around why that situation occurred. However, the fact is that services that should have been delivered from Belshill clinic are not being able to be carried out because the GP practice is co-locating in that facility. I am told by staff that that is creating a pressure on services at Monklands hospital in particular, because those services have to be delivered from there. Can the cabinet secretary tell us that he has any contingency plans in place to address that problem, because it cannot be allowed to continue for much longer? The member makes a very valid constituency point, and I fully understand the concerns in Belshill clinic. I am aware of the concerns. I am happy to meet the member to look at the current situation and the plans to deal with it. I accept that speedier action is required to deal with the situation, and I am happy to convene a tripartite meeting between NHS Lancashire and Michael McMahon as a local member, and I am happy to see whether we can agree a way forward. Thank you. I supplement you from Linda Fabiani. Thank you, Presiding Officer. The cabinet secretary is very aware that we have issues in Hermeyr's hospital in East Kilbride, with beds being occupied for longer than necessary, because the local authority hasn't put home care packages in place timidly. I know that action has been taken in that regard, and I wonder if the cabinet secretary can update me on progress. Cabinet secretary? Yes. Delayed discharges have become more of an issue in recent months. Nothing like the scale that there used to be in terms of delayed discharges in Scotland, but in particular areas such as Fife and Glasgow and in South Lanarkshire, in recent months, delayed discharges have not been dealt with by the local authority as quickly as they should have been. As a result of that, we have put £5 million additional money into dealing with the issue of delayed discharges, and some of that money has gone to NHS Lanarkshire and very specifically to help to deal with the situation in Hermeyr's, which on the latest management information figures that I have available to me has shown a degree of improvement, but there is still obviously a major challenge because of the local authority's failure to deal with the level of care that is required either in terms of residential care or assessments for care at home. Briefly Neil Findlay. The cabinet secretary is living in cloud cuckoo land, if he thinks that this is not the biggest issue in health and social care at the moment. It really does him no service to just lay the blame at local authorities when the Scottish Government is slashing local authority budgets every year, so can we start to get some reality into this proceedings? I would happily meet the cabinet secretary to discuss how we deal with delayed discharges because it is the biggest issue in health and social care at the moment. I presume that that was the question, cabinet secretary. I am always happy to meet members, particularly if they have any solutions to offer to any problems. I have never found that in Mr Findlay's case whatsoever. The fact of life is that delayed discharges are nothing like the scale that they were five, six, seven years ago when his party was in power. There has been a very substantial reduction in delayed discharges. However, we have not in certain areas achieved the final reduction that I wanted to see in terms of this year and projecting into next year. I merely stated that that is because of the time it is taking local authorities either to place people in residential care or to arrange home care or indeed to undertake assessments. It is not a question of blame, it is a question of fact, but I know that Mr Findlay always gets confused with the facts. Question 5, Sarah Boyack. To ask the Scottish Government what additional resources it is providing to address delayed discharges. Cabinet secretary, Alex Neil. Presiding Officer, I will just answer this in the previous question. On 7 August 2014, I announced an additional £5 million for financial year 2014-15 to help health boards to improve the flow of patients through health and social care services. The funding has been carefully targeted to seven health board areas that have faced the most significant pressures from delayed discharge. That investment will enable them to accelerate progress towards sustainable change, drive down delays and release hospital capacity over the long term. Our legislation to integrate health and social care will also ensure that health and social care is provided in the right place at the right time, making the best use of available money facilities and people. I thank the cabinet secretary for his response. He will know that his written response to me during the recent period suggested that he is developing a methodology by next year to assess the cost to individual health boards of delayed discharge. We know that we currently have an upward trend in delayed discharge in the Lothians, and it is a problem for us now. We have heard that tackling delayed discharge could release between £125 million for reinvestment elsewhere. Can the cabinet secretary clarify whether that resource will go to local authorities to address the issues that he has just identified in terms of the lack of care packages and the lack of home care support that councils can offer? Can he clarify what impact the £450 to £450 million funding gap that was identified by Neil Findlay just a few minutes ago will have on his efforts to tackle transferring that resource from NHS to our local authorities? That is a good question until the myth of the £450 million funding that was mentioned. Edinburgh City has got over £1 million of the £5 million, so Edinburgh has actually got more than 20 per cent of that £5 million. As she knows, there is a strategic challenge in Edinburgh, which mainly arises because of the lack of social care capacity, residential care, as well as care at home. Some of that is due to the fact that, of course, 25 per cent of residential care residents in Edinburgh are self-funders, and the private and independent sector tends, obviously, to take them in, sometimes rather than people referred by the local authority. She will also be aware that there is now a very regular meeting between the senior leadership both in terms of councillors and the chief executive in her team in Edinburgh City and the senior team in the health board, both in terms of the chair and the chief executive, and they have now got together a plan to deal with the particular challenges in Edinburgh in relating to delayed discharges and associated issues. I believe that the plan that they have put in place is the right plan, and we need to look at how we can fund that going forward, because I recognise that Edinburgh is one of those areas with very special challenges that have been building up for a number of years, but require to be tackled at the earliest possible opportunity. I am afraid that I must ask for more succinct questions and answers if we will not make much progress. Claudia Beamish To ask the Scottish Government if it can provide an update on NHS homeopathic and complementary medicine arrangements in South Scotland. The Scottish Government's position is set out to my answer to the oral question that was asked by the member on 12 March. The Scottish Government recognises that complementary and alternative medicines may offer relief to some people living with a wide variety of conditions. It is for individual NHS boards to decide what therapies they may make available based on the needs of the resident populations in line with national guidance. Claudia Beamish I thank the cabinet secretary for this answer and wanted to just progress things further beyond the question in March. In NHS Lanarkshire, there has been a significant number that has responded to the consultation and a report as imminent about those services, just highlighting the interest of my constituents in that particular area. More specifically, in NHS Lothian, of which part of my region falls in, I have also heard constituents' concerns about conflicting advice from healthcare professionals and barriers against access to homeopathic care, often in contradiction, as I understand, with NHS Lothian statements. Can I ask the cabinet secretary what guidance is available to practitioners in making these decisions? If she has evidence of contradictory and wrong advice, please let me know, because we will take that up with the health board, and I am happy to send her details of the guidance that we offer in those matters. 7. Graham Pearson To ask the Scottish Government what additional support it is providing to the Scottish Ambulance Service in light of it not meeting a range of targets. 8. Alex Neil The Scottish Government funds the Scottish Ambulance Service to provide a high-quality, safe and sustainable emergency ambulance service to Scotland's population when they need it most. Setting and agreeing performance measures is part of that. It is encouraging to note that, nationally, performance this year continues to show improvement. Despite seeing a 10 per cent rise in the number of calls, the Scottish Ambulance's average response time is just 6.5 minutes across the whole of Scotland. However, we are not complacent and they are not complacent, and we will continue to monitor and support the service to make further improvement. 9. Graham Pearson Thank you, Presiding Officer. I thank the cabinet secretary for the reply. He will be aware of reports of ambulances being sent, significant distances to cover shortages in neighbouring areas, and that there are issues about staff numbers and available funding. There are thousands of cases of ambulance taking more than 20 minutes to reach patients, and it is clear that, despite the efforts of front-line staff, the Ambulance Service is still going to deliver a level of service that the public would expect. In light of that failure to meet a wide range of vital targets, will the minister provide further information on steps being taken to address those issues and the timeframe that is expected for significant improvement? Presiding Officer, I recognise that there are challenges particularly in rural areas, and I know that the area that is represented by the member has very specific challenges, not least because, in some areas, the transport infrastructure is not always the easiest to meet the kind of targets that the Ambulance Service sets itself. However, having said that, the Ambulance Service has achieved the target in 74 per cent of the time that it is set for it, but we recognise the need for further improvement. I am happy to send the member details of the improvements that the Ambulance Service is taking forward to improve performance and the quality of service that it provides. I ask the cabinet secretary to look at areas where improvements might be made and to look at concerns that have been raised with me by some of my constituents about the possible capacity issues of the road ambulance fleet in Aberdeen, which appears to be delaying getting patients who are arriving from Orkney and the other island groups by air ambulance, then transferring on to Aberdeen Royal Infirmary. It is correspondence with the Ambulance Service directly, but I would certainly welcome any intervention that he might be able to make on that issue. Presiding Officer, the member wants to write to me with details of that. I am happy to take up the issue with the Ambulance Service and see if we can make substantial progress. To ask the Scottish Government what steps it will take to improve support for unpaid carers. Minister Michael Matheson We intend to introduce a carers bill that will extend and strengthen the rights of both adult carers and young carers to help to ensure that they are much better supported. We will continue to provide support to carers and young carers investing nearly £114 million between 2007 and 2015 in a range of programmes and initiatives. That includes funding for carers initiatives through the reshaping care for older people change fund, funding NHS boards for their carers information strategies and funding the voluntary sector short breaks fund. Subject to parliamentary approval, we will invest a further £5 million in NHS boards carers information strategies and a further £3 million in the short breaks fund in 2015-16. I welcome the minister's full comprehensive response, but will the minister be aware that the carers allowance is the lowest income replacement benefit in the UK? Does the minister agree with me that the UK Government should increase carers allowance to at least the level of jobseekers allowance as a matter of urgency? Michael Matheson I am aware, as the member highlights, that carers allowance is one of the lowest income-based benefits within the welfare system in the UK. Of course, during the referendum, we set out very clearly the need to tackle this and for an increase in carers allowance, but I would certainly add my voice to call upon the UK Government to look at reviewing the overall level of carers allowance, which at times has felt as though it is the forgotten benefit for carers. We should also recognise the very significant contribution that carers make to our society, which they did not provide. That support would cost the taxpayers significantly more. They deserve not only practical support but also financial support. Briefly pleased, Rosie Grant. Will the minister consider improving support to young carers through the educational maintenance allowance? That depends on excellent attendance, which is very difficult for young carers to do because of their caring responsibilities. Will he consider—I know that the legislation of the moment and the guidance means that there are individual circumstances to be taken into account for young carers, but will he consider putting them on the same footing as care leavers so that their educational maintenance allowance cannot be withdrawn from them? The member will be aware that the Scottish Youth Parliament has made a number of recommendations on support to young carers, in particular on educational support allowance and that my colleague Angela Constance made some changes to the guidance in order to reflect how EMAs should be provided to reflect the views and issues that were raised by the Scottish Youth Parliament. I can also tell the member that my colleague Mike Russell was due to meet those representatives from the Scottish Youth Parliament to discuss those issues in more detail. We are taking forward a range of measures under the carers policy aspect to help to support young people within schools and within further and higher education. My colleagues within the education side are also looking at what measures they can take for, including where there are further actions that they can take under EMAs to see whether there is further support that could be provided to young carers in education. To ask the Scottish Government what research has been undertaken to determine if there is a link between the intake of sugar and an increased risk of type 2 diabetes. The Scientific Advisory Committee on Nutrition published its draft report for consultation on the links between intakes of carbohydrates, including sugar, on health on 26 June this year. The advisory committee report referred to evidence suggesting that sugary drinks are associated with increased risk of type 2 diabetes in adults. The report shows that diets high in sugar can contribute to excess calorie intake, which, if sustained, leads to weight gain and obesity. If an individual is overweight or obese, they are more prone to a range of serious health problems, including type 2 diabetes. The Food Standards Agency in Scotland will review the Scottish dietary advice based on the report's final recommendations early in 2015. Does the minister share my concern that we are facing a ticking time bomb with the explosion of type 2 diabetes in Scotland? The minister will know that diabetes is the main cause of blindness of those of working age and contributes half of the non-traumatic leg abutations. A whole variety of studies such as the Stanford Medical School have linked sugar intake with diabetes. Will the minister agree to meet me and Diabetes Scotland to work up new proposals to tackle and prevent Scotland's silent killer? I am sure that the member will recognise that there is a complex one around tackling obesity. It needs to be taken forward on a number of fronts, one around physical activity and improving individuals in participating in physical activity, but it is also important to change their dietary habits, which is not something that is easily challenged on a short-term basis. That is why we have taken forward a range of measures with the food sector from the reformulation programme right through to the supporting healthy choices framework, which we launched a few months ago, and also the work that we are doing in terms of improving labelling, so that people in purchasing goods have a much greater level of understanding of the content of the products that they are purchasing. I am more than happy to meet the member and his colleagues to discuss whether there are specific measures that they feel that we can take forward together in order to help to tackle. What is, of course, a growing problem within Western society and one that we need to make sure that we tackle head-on? Very briefly, Jackson Carlaw. Does the minister agree that many people who purchase low-fat products, particularly dairy products, are unaware that those products very often contain much higher levels of sugar than they might anticipate and that they are not wittingly exposing themselves to the potential of diabetes? We are doing a range of work just now with the food standards agency in order to drill down into the issue much more clearly so that the public understand the choices that they are making. The member has highlighted what is often an area where individuals can be confused in the products that they are purchasing, which is why we push for front-of-label packaging, which allows people—the traffic-like system allows people to see much more clearly the content of their products. We need to make further progress in the food standards agency and do some very interesting work in the field in order to make sure that we take the area forward further. To ask the Scottish Government what issues it discussed when it last met NHS boards. Presiding Officer, the Scottish Government last met NHS boards on the 22 September 2014, the outcome of the referendum, 70 services and the performance of NHS boards where the matter is discussed. I wonder if you discussed the late discharge, given the many questions on that topic today. 150,000 bed days each quarter are occupied by delayed discharge patients, and one patient in Highland had to wait over a year from the date of medical discharge to going home. So what is the Scottish Government doing to support NHS Highland who do have responsibility for home carers to recruit and retain staff to ensure that patients get the care and support when they need it and where they need it? Can I say that the member will be aware of the report that we published jointly with COSLA earlier this year as a result of a review of residential care services? We are following up that with a joint review of home care services. I believe that the social care sector faces a number of challenges. For example, we are committed in principle on the need to introduce the living wage. We need a proper career structure for people working in the social care sector. We recognise that the funding of independent providers is below what it needs to be to provide the level and standard and quality of care required and a whole range of other things as well. We are now looking at the implementation of the recommendations of those reports across the whole of Scotland because the description that Mary Scanlon has outlined in Highland in terms of the social care sector could be applied in many other parts of the country. If you go to Aberdeen, for example, at the moment, people can earn more filling shelves in a supermarket than they can very often than working in the social care sector. We have to tackle the underlying strategic issues so that we get the social care sector in Scotland into far better shape, including in the Highlands, and dealing with the very specific challenges in rural, remote, rural and island communities. I'm afraid I must once again ask for shorter questions and answers or some members will be disappointed. Question number 11, Patricia Ferguson. To ask the Scottish Government what the average waiting time is for children who require an upgraded cochlear implant processor. Michael Matheson. If on clinical assessment by the cochlear implant specialist team at Crosshair's hospital it's considered that a cochlear implant processor needs upgrading, then if there is a suitable processor in stock there is no waiting time and it will be provided to the patient at the time of assessment. If a processor has to be ordered then it normally takes two to three weeks to be delivered. If on clinical assessment a patient is found to have a processor that is faulty but can be repaired then the patient is provided with a like-for-like processor from stock whilst their processor is sent for repair. There is no waiting time for this process. Patricia Ferguson. I thank the minister for that answer. He will be aware that young people who have profound hearing difficulties and who use cochlear implants also face a very challenging environment, for example in the classroom, which can often affect their ability to learn going forward. As new technology becomes available their parents are obviously anxious to secure the best possible opportunity for them. I wonder if he would sympathise with the parents of one of my constituents who has been told there are some 200 young children in the queue ahead of her before she is likely to have an upgraded cochlear implant processor and whether he believes that, in line with the rest of the country, those should automatically be replaced after a handful of five years. Can I comment on a final point about changing the cochlear implant in five years? We are in the process of doing that just now through NHS Scotland. The member will be aware that the national cochlear implant service provided that at Crosshouse hospital in Kilmarne, because it is a nationally delivered service. However, I have outlined to the member that, if there is a need for a processor to be changed or to be repaired, there is a process in place for that to take place with no waiting time if there is one in stock. However, if the member wants to write to me with specific details on a particular type of cochlear implant that she is referring to that presently is not available through her national service, I would be more than happy to get the clinicians who are responsible for deciding on the approach that we take here in Scotland to be able to respond to her specific constituents' issues. To ask the Scottish Government what evaluation is undertaking on the sexual health and blood bone virus framework 2011-15 and when it will publish the framework of work beyond 2015. The sexual health and blood bone virus framework comes to an end in 2015, and we have already commenced work to evaluate the progress that has been made. NHS boards and their partners in local authorities and the third sector are preparing reports on progress. Those will be related to presenting a national report on progress overall. Officials will also be visiting each NHS board before the end of 2015 to hold detailed discussions on achievements, challenges and progress. Our national monitoring and assurance group is also carrying out an analysis of data to establish progress against each of the framework's outcome indicators and a report of the work that will be produced soon. A refreshed framework setting out the future strategic direction in this area will be published in the summer of 2015. Thank you for that response. A study in Glasgow found a prevalence rate of hepatitis C among South Asian communities in Glasgow of up to 3.1 per cent compared to around 0.6 per cent or less in the rest of the population. However, the current strategy makes only a passing mention of awareness rising in ethnic minority communities. Can the minister assure me that the review framework will adopt a more thorough approach in tackling the virus in South Asian communities in Scotland, in particular in Glasgow? What I can say to remember is that our boards are responsible for broadly delivering the framework on the ground already do that work. For example, Greater Glasgow and Clyde take forward a range of work in their minority ethnic groups in Glasgow around blood-borne viruses. However, when we review the progress that has been made, we will consider what further steps need to be taken and that should be reflected in the new framework in 2015. To ask the Scottish Government what the impact on NHS Fife would be of the reported shortfall of up to £450 million in NHS funding. Let me be clear that there are no planned cuts to NHS funding. Read my lips, there are no planned cuts to NHS funding. The Scottish Government is a record of protecting and increasing the NHS budget, and NHS Fife, like all other territorial boards, will receive above inflation resource increases in 2014-15 and 2015-16. Despite that response, what is absolutely clear is that there are at the moment problems that have been facing patients and staff across NHS Fife, with up to 40 vacant consultant posts needing filled and reports of increasing use by the health board of private firms such as MediNet. In August, patients awaiting surgery were sent home at the last minute, as operations were cancelled as wards were full. Therefore, will the cabinet secretary join with me in supporting calls for an independent inquiry into whether the model currently being followed by NHS Fife is fit for purpose in meeting the needs of the people of Fife? I accept that NHS Fife, like every other health board in the civilised world, is facing particular challenges. NHS Fife's performance has improved dramatically in recent years, and the quality of provision across a range of services has also improved dramatically in recent years. If the member, however, has any specific concerns, I am happy to listen to those so that we can address them with NHS Fife. Thank you. To ask the Scottish Government how front-line services would be affected if the reported £400 million reduction in NHS funding gets implemented. Presiding Officer, let me make it absolutely clear. There are no plan cuts to NHS funding. The Scottish Government has a record of protecting and increasing the NHS budget, and its latest £12.1 billion resource budget, the first time it has ever gone over £12 billion, reflects a funding increase in real terms, both this year and next. I thank the cabinet secretary for his response. The leaked memo from NHS health board chiefs previously referred to said that boards would have to consider centralising hospitals and closing services. Can the cabinet secretary give us a cast iron guarantee that, across Fife, Tayside and Forth valley, there will be no such centralising nor closing of services? Specifically, can he give us that guarantee in relation to the services at Perth Royal Infirmary? The memo that was leaked was some thoughts of a number of chief executives, and it does not represent Government policy. The member knows perfectly well that any proposals for service redesign go through a very intense process, including a major process of public engagement. I certainly have no intention of redesigning services in a way that leads to any retrograde steps in terms of the quality of provision, and certainly we will always ensure that any proposals for change will require to go through a very comprehensive exercise in public engagement, as we always do. The biggest threat to the national health service in Scotland are the £25 billion-worth of cuts being promised by George Osborne and Ed Balls. That is a real threat to the national health service. I was going to ask the cabinet secretary if he could confirm indeed how the Scottish budget has, in fact, been impacted since George Osborne has been chansored and how much NHS front-line budget in Fife has changed over that same period of time. We have passed on every penny of the funding allocated to us for health in Scotland, and just for the record, the IFS report that tried to allege otherwise was factually incorrect, and I think that I am right in saying that they have admitted their mistake. They got it wrong. To ask the Scottish Government how it supports the provision of accessible GP services for people in remote and rural areas. In Scotland, we know that some health boards face significant difficulties recruiting in remote and rural areas. In the Highlands and Islands, there are some particular communities that have been without a permanent GP for a while, and I completely understand how frustrating this is for residents. One key element of the recently agreed GP contract agreement are the changes to golden hello payments for remote and rural areas from 1 January 2015. That will mean that health boards will have more flexibility to specifically incentivise GPs to work in those areas that are more difficult to recruit to. That will hopefully make the challenge of recruiting to remote, rural and deprived areas easier for boards and help those communities who have faced a long wait for a permanent GP. Is the minister aware of plans to reduce the number of GP-consulting hours in Dalmali, which geographically is one of the most remote GP practices in the UK? Do you apparently to the fact that there has been a lack of uplift in additional payments from the health board to support Dalmali surgery since 2004? Is he also aware of concerns in Inverary nearby, where they have had to rely on locum GP cover for three years? Will he raise those concerns with NHS Highlands and work to ensure that communities in those rural areas are not receiving a poorer level of GP cover compared to areas on the central belt? Does he agree that defolution was meant to improve living standards for everybody in Scotland? I am already doing everything that the member asks. I am going to Oben even in Nectober and I am glad to meet him there so that we can report in progress. Many thanks. That concludes portfolio questions and I will allow a brief pause before we move to the next item of business.