 Good afternoon. The first item of business this afternoon is portfolio questions on health, wellbeing and support. As ever, in order to get as many people in as possible, short, and succinct questions and answers to matching would be appreciated. Question 1. Lewis MacDonald. To ask the Scottish Government what progress has been made in filling consultant vacancies at Aberdeenroylan for summary in the last 12 months. Cabinet Secretary, Shona Robison. Consultant vacancies in NHS Grampian have decreased by 27.9 whole time equivalent, or 41.5 per cent between December 2014 and December 2015. The Scottish Government increased NHS Grampians resource budget by 6.7 per cent to 830.1 million for 2015-16. That is above inflation and the largest increase of any mainland board having previously increased by 4.6 per cent in 2014-15. The Scottish Government works closely with all boards to support their staff recruitment efforts. The progress that has been made in filling consultant vacancies, does the cabinet secretary recognise that her Government's apparent decision to back away from its commitment to a major trauma centre at Aberdeen royal and family is causing great concern among clinicians there? Will she undertake to consult and listen to the views of clinicians in Aberdeen about the potential impact of this decision on their ability to recruit and, indeed, to maintain existing services? There is no backing away from anything, and clinicians from all four proposed major trauma sites have been involved in the work of the national planning forum from the outset and continue to be involved. It is important, however, that we try to reach a consensus among the clinical community. I am optimistic that that will happen, but we need to allow them to get on with the good work that they are undertaking. I will keep a very close eye on those matters as they go forward. 2. Richard Simpson I ask the Scottish Government what average number and percentage of hospital beds was unavailable to new patients in 2015. How is that compared with the average number of bed-occupied days occurring because of delayed discharges? The official statistics show that just over 18,100 hospital beds in all specialties were occupied on average in the quarter ending of September 2015. In that quarter, the average number of beds occupied because of delayed discharge was 1,570. The average number of beds occupied because of delayed discharge has reduced by over 100 beds on the same time in 2014. Of course, tackling delayed discharge is one of the key priorities of this Government. Our latest figures published last week show significant progress has been achieved with an 18 per cent reduction in delayed discharge in December 2015, compared to the year before. That reflects the significant investment that we have made into tackling delayed discharge and improving the availability of social care, not least with the £250 million that is announced by the Deputy First Minister as part of next year's budget. Dr Simpson I thank the cabinet secretary for that response and for the welcome of the fact that the trend is once again downward. In July 2011, at the beginning of this Parliament, the monthly figure of bed-occupied days was 20,000. The last available figures were 46,000—they are below last year—but they are still 46,000. Moreover, the total of bed-occupied days in England is 160,000. In other words, our bed-occupied days are three times as much as they are in England. Since we are celebrating the anniversary of the cabinet secretary's promise to end delayed discharges, how does she feel that progress is going to be made over the next period? Dr Simpson We absolutely remain committed to eradicating delayed discharge. I am glad that Richard Simpson recognised that progress is being made. In January this year, 606 patients were delayed over three days. That is a reduction of 19 per cent from 752 at December 2015 and a reduction of 21 per cent from 766 in January 2014. Standard delays over three days were never lower under the previous Labour administration. That is a tough issue to tackle, but the integrated joint boards and the lead agency in Highland are committed to doing. We have seen progress already, for example in Glasgow and the progress that they have made there. We want to see everywhere. That is why the investment in social care of £250 million is so important. Richard Simpson mentioned the issue in England. I do not know whether he has seen the College of Emergency Medicine material that has recently been produced, but it has been monitoring on a week-by-week basis some of the challenges in English hospitals. One of the big challenges is the availability of care. Of course, it has not invested the resources in social care that we have invested here. I would not use England as a model to emulate. I think that they have huge problems and will continue to have huge problems with the availability of social care. 3. Mark MacDonald To ask the Scottish Government what training is available for health professionals to provide healthcare to people on the autistic spectrum. A priority of the Scottish strategy for autism is to improve the understanding of autism, focusing on effective education and training for all healthcare professionals in partnership with NHS education for Scotland. The Scottish Government has published an autism training framework. The framework enables all professionals working in the national health service to identify the level of autism expertise that is required for their role and their after-access appropriate training to meet that need. 4. Scottish Government funding for training in diagnostic tools has increased. The number of practitioners involved in autism diagnosis to over 200 in Scotland. NHS education for Scotland is soon to publish a good practice guide for supporting intervention autism. The good practice guide will assist those who are working across health and social care to plan, adjust and adapt their services for people with autism. 4. Mark MacDonald Many individuals on the autistic spectrum can struggle with certain healthcare interventions as the intrusive nature of examination can trigger a sensory meltdown. In light of what the minister has just said about the various packages and support measures that are available, can he advise what steps are taken to ensure that health boards promote those appropriately to those individuals working in their area? I thank Mark MacDonald for his question. I acknowledge his interest in those matters and his assidious campaigning to raise awareness of autism inside the Parliament in order for people with autism to be met with understanding that all healthcare professionals need a knowledge of autism appropriate to their role. The NHS education for Scotland has a learning space on autism in a range of resources that help to support our workforce development. There is the training framework that I referred to in my initial answer, which outlines the knowledge and skills that are required of healthcare professionals from generic services through those working in specialist autism services. It is my clear expectation that all NHS territorial boards should ensure that the staff who need to have that training should be made aware of that opportunity. I hope that my initial answer reassured Mr MacDonald and all members of the chamber that there is plenty of work under way, but I am always happy to hear from Mr MacDonald or any other member about suggestions on how we can make further improvements as well. I ask what proportion of the 6,000 rejected referrals to CAME services were from where of young people suffering from autism? I cannot give that specific figure to Rhoda Grant just now. What I can undertake to do is look at that further and get back to writing. I shall do that. My clear expectation is that where any individual has been referred to CAME and has had their referral rejected, that some form of support should be put in place and that I recognise that there is more for us to be doing in that regard. That is why, as part of the £150 million additional investment over the next five years that we have announced into mental health services, that is going to be one of the key focuses for us through that investment. Many thanks minister. Question number four, Leslie Brennan. Can I ask the minister, the cabinet secretary, to ask the Scottish Government when ministers last met representatives from the Dundee integration joint board? On 28 January this year, the Dundee integration joint board was represented at a development and networking session that took place for all integration joint board chairs and vice chairs at which I participated. Last Thursday, the Scottish National Party Administration at Dundee City Council cut £3.5 million from the health and social care integration joint board budget. Dundee City Council is expecting to receive £7 million from the additional £250 million funding for social care. The chief executive has noted that £4 million of that is already earmarked to cover planned staff costs, such as the living wage. Can I ask what reassurances has the cabinet secretary sought regarding care packages, especially given the £0.5 million cut to care packages for people with learning disabilities? Dundee IJB's share of the £250 million will be £7.65 million. After allowing for living wage and existing local authority social care costs—for example, the NI and pay increase costs of their own social care workforce—the IJB will have an additional £3.8 million to fund its investment in additional social care capacity and in the reduction in the charging thresholds. Of course, the important thing about the living wage element will be the number, the thousands of social care workers in the city of Dundee who will receive the living wage. The living wage will apply to around 40,000 care workers across Scotland and many thousands of those will live in the city of Dundee and will benefit from that. I would have thought that the member would welcome that. To ask the Scottish Government what action it is taking to alleviate pressure on the Queen Elizabeth university hospital. There have been some challenges at the new Queen Elizabeth university hospital. We should remember that this was an unprecedented migration of four hospitals to one campus. It took place on time and on budget. I want to pay tribute to local staff, some 10,000 of whom are working at the new facility for that achievement. Clearly, unscheduled care performance at the new hospital has not always been at the level that either the health board or I would have wished. Nonetheless, local staff have been working extremely hard with the full co-operation and support of the national unscheduled care team. As a result, the latest published weekly four-hour A&E performance was 91.9 per cent for the week ending on 21 February, up over 11 percentage points from the previous week. In comparing the 12-week period to the 21 February with the equivalent period last year, the new hospital has performed nearly 14 percentage points better than the previous sites. The health board remains committed to meeting and maintaining the national four-hour standard, and we continue to provide all the support that we can to that end. I thank the cabinet secretary for that answer. Could she confirm whether the establishment of the new hospital has led to an increase or a decrease in emergency and assessment capacity in Glasgow? There has been an increase in capacity. Of course, the new hospital has developed as it has gone on for the first few months of its existence. For example, one of the innovations that they have developed is the ambulatory care unit, which adds capacity to the assessment unit at the front door of the hospital. Winter period has been a testing time for all the hospitals across the whole of Scotland, and it is a testing time for those in Glasgow as well. However, as the figures that I gave to James Dornan in my original answer show, they are performing at a much more sustainable and improved position than they did this time last year. Jackson Carlaw Thank you, Presiding Officer. I ask the cabinet secretary to pursue two relatively trivial matters, which I believe would improve both the patient experience and that of my constituents visiting the campus. First, there is rather poor signage on exiting the hospital. Lots of signage telling you where to go when you arrive, but not telling you how best to leave with the result that many people are actually not necessarily departing from an exit, which would afford them the sweetest route home. I think that that could be improved. Secondly, there is a rather swanky discharge lounge that has been prepared, but unless you are being uplifted by an ambulance, there is no provision for a patient to be uplifted outside the discharge lounge, with the consequence that many patients are having to be wheeled some distance in all weathers to the multi-storey carpark or to a taxi rank. I think that, with some subtle alteration, the patient experience could be significantly improved if that could be attended to. Cabinet Secretary, I will certainly look into both of those suggestions and get back to the member. Briefly again, Stuart McMillan. I am seeking some clarification from the cabinet secretary that there could be an opportunity for other hospitals in the NHS greater Glasgow and Clyde area to help to deliver services in conjunction with what CUNAL is with hospital. Well, Stuart McMillan raises a good point. Of course, the new national clinical strategy really points towards that of hospitals working together on the basis of a network. That is something that we want to take forward through the strategy. Many thanks, question number six, John Scott. To ask the Scottish Government what measures it is taking to reduce waiting times in the NHS Ayrshire and Arran. The Scottish Government is taking a number of actions to support NHS Ayrshire and Arran to deliver waiting times such as providing £2.6 million in 1516 to deliver outpatient and diagnostic test standards as well as the legal treatment guarantee. Of course, the board has also received £1.3 million from the national unscheduled care fund and over £433,000 to help to deal with winter pressures under the current financial year. John Scott. I thank the cabinet secretary for her answer and the cabinet secretary will be aware that exactly 10 years ago I organised and led the march of 5,000 people in Ayr to keep the A&E unit open at Ayr hospital and so I welcomed the new facility opened last week at Ayr hospital. However, the cabinet secretary will also be aware of occasional but regular spikes in numbers presenting at A&E at Ayr and Crosshouse as well as the 35 consultant vacancies in NHS Ayrshire and Arran as well as recent difficulties in meeting government for our waiting time targets. Is she confident that, even with the new facility but given the lack of staff and the lack of available beds, that NHS Ayrshire and Arran will be able to meet its waiting time targets in future in A&E and other areas such as orthopedics? Can I also join with John Scott in recognising that the A&E unit at Ayr hospital was saved by the efforts of those locally but also by the efforts of this Government and has led to a £27.6 million building for better care project that has led to the new combined medical and surgical assessment units at both of the district general hospitals and the new emergency department at university hospital Ayr. John Scott raised issues around spikes at A&E and he is correct to point to that. Some A&E departments have more of a challenge with that than others. Ayr hospital has a particular challenge and he outlines some of the reasons for that. However, it is operating still, having said that, at a better position this year than it had last year but there is more work to be done and what we want to do once we are through the winter period is to look at what more can we do to further improve the performance, particularly of those units which do spike and have more challenge in delivering a consistent service. I am very happy to keep John Scott informed of that. To ask the Scottish Government what support it provides to community services in the Clydebank and will guide constituency. We are planning a single and new-built facility in Clydebank, delivered through the HUB programme with an overall funding envelope of £19 million. A new integrated facility for Clydebank already has widespread stakeholder support, including from local politicians and the local community planning partnership. Such a replacement health and care centre build would enable the co-location of multidisciplinary services, including integrated health and social care teams, in a new facility, giving one-stop access and improved accessibility for patients to an increased range of improved quality services. I thank the minister for that answer and say that I very much appreciate the fact that £19 million has been provided for the new health centre in my constituency at Clydebank. It is extremely well welcomed by the community in general. Can the minister outline to the Parliament what next steps will be or an update to bringing this much-needed facility into fruition for my constituents in Clydebank? The initial agreement has recently been submitted to the NHS capital investment group for review, and that will be considered later this month. Subject to approval being received, it is anticipated that financial close will occur in late 2017 and construction will begin in 2018. To ask the Scottish Government what its position is on the recent child and adolescent mental health waiting time stats, showing that around half of patients in NHS Grampian waited over 18 weeks before being seen. Minister Jamie Hepburn. There has been a significant improvement in the waiting times over the past few years, despite a significant increase in the number of people being seen. However, the Scottish Government is determined to continue to see improvements with all health boards, including NHS Grampian, to meet our targets. The Scottish Government has invested significantly to develop mental health services with increased staffing numbers and training and in post, and long waits are being addressed. We have announced that the additional £150 million for mental health service over the next five years to help bring down waiting times and deliver sustainable improvement to services. Through the substantial funding award, we will be able to extend capacity and improve access to services and promote innovation and new ways of treating children and young people with mental health conditions, as well as psychological therapies for all ages. I thank the minister for his response, but it will be of little comfort to the young people facing and agonising weight for treatment in my region. Over the last year, the minister has responded to my concerns by first telling me he had a new improvement programme, and then, six months ago, a detailed recovery plan for NHS Grampian. Perversally, those have both resulted in a continued decrease in performance. Given that, perhaps I should be reluctant to ask the minister what he plans to do next, but I will give it a go. Just what is the minister planning to do to drive down those waiting times? I am bringing about the drastic change that is needed in waiting times in Grampian itself. First of all, let me focus on what has happened in the most recent quarter. Focusing on the figures that were just referred to, the total number of people starting treatment in the quarter ending in December 31, 2015, has increased by 7 per cent in the same period last year. That means that more children and young people in NHS Grampian are being seen. I would accept that the figures that had previously been published were not good enough. I am determined that we see improvements. There have been improvements in the most recent figures. It is very encouraging to note that performance against the 18-week target improved month-in-month during the final quarter of 2015, with 76 per cent of people being seen within 18 weeks during December. There has been significant work to try and tackle the longest waits. I have set out the range of investments that we have. I know that NHS Grampian takes that responsibility seriously. We have seen the response, we have seen the figures continuing to improve, and it is my clear expectation that that improvement will continue so that the target is met. To ask the Scottish Government how it will ensure that front-line patient and carer support from alternative care providers can be maintained in light of the reduction in local authority budgets. Integration of health and social care is one of Scotland's major programmes of reform at its heart. Health and social care integration is about ensuring that those who use services get the right care and support whatever their needs at any point in their care journey. That is why our 2016-17 budget sets out our plans to transfer £250 million from the NHS to health and social care partnerships to protect and grow our social care services. That is on top of the £500 million that we are already investing over three years to support integration of health and social care. In 2016-17, we are allocating over £8 million for carer support. That includes £3 million for the voluntary sector shop breaks fund and £4.75 million for health boards for carer information strategies. Much of the funding to health boards is distributed to the third sector, including carer centres. The Scottish Government funding proposed for the coming financial year to deliver a strong financial settlement for local government. I thank the minister for that response, but is he aware that the SNP Council budget in Clackmannanshire has imposed across-the-board cuts of 7.1 per cent cash or 8.4 per cent in real terms on third sector providers, including SAMH and many children's organisations? That is at a time when organisations have been asked to pay a living wage and to implement the employer's pension contributions at least 2 per cent. Does that not fly in the face of the Government's stated commitment to the health and wellbeing of children and young people? No, I do not think that this Government has a strong record and commitment to children and young people. I note the original question relates to the area of carers that we have just collectively as a Parliament passed. I think that there is excellent legislation in relation to the carers Scotland act, with a strong focus on the position of young carers who have set out the range of direct funding that we have passed on to local government through the health and social care partnerships from the NHS through the £250 million allocation. Again, that is a strong commitment. We remain committed to delivering on the ground for all of Scotland's people, including Scotland's vulnerable. Thank you. Before we move on, I am afraid that we will not make much further progress unless questions and answers are much prefer. To ask the Scottish Government what its position is and whether there is a satisfactory level of support for older people in North Angus with dementia. The new integrated authority is responsible for assessing, planning and commissioning the right level of support for all people with dementia in its four localities, including North Angus, as part of the additional £250 million units for social care. Angus will receive an additional £5.34 million, including resources that support the growth in social care and support implementation of the living wage and other social care cost pressures. Angus is taking a strategic approach to moving resources to its enhanced community sport initiative, which has now been adopted as the new model of care for older people across Tayside. That approach reflects one of the Scottish Government's key themes in the new national clinical strategy in moving resources and services into the community and towards primary care. The minister may be aware that, as a result of local circumstances, elderly, mentally and firm care in the Mentosyn district area is no longer available for those who live in that community. Given the importance of ensuring that such care can be found within individual communities, is there anything that the minister can do to ensure that this situation is rectified as soon as possible? I thank Alex Johnson for raising the issue. I recognise that it is an important one. Local service planners were already aware that increasing rates of dementia were challenging the capacity of services in Angus and that arrangements needed to be reviewed. Consequently, a multi-agency review of residential and nursing care will commence in April and report the Angus integration joint board on completion. There is already a range of activity under way to support the challenge and agenda. There are, for example, three community mental health teams for older people in each locality. There has been support from the change fund enabling Angus to enhance the dementia liaison team. Angus has had a post-diagnostic support service since 2004. There are more than 110 staff in health social care in the voluntary sector as dementia ambassadors, but I recognise the particular issue that Alex Johnson has raised. It is on the radar of the decorated joint board and the work is under way. I will be reported back to him soon. To ask the Scottish Government when the last met representatives of NHS Greater Glasgow and Clyde and what matters were discussed. Ministers and Scottish Government officials regularly meet with representatives from health boards, including NHS Greater Glasgow and Clyde, to discuss matters of importance to local people. I attended a meeting of the SAVE late-burn campaign group on Monday of this week. I also say that the chief executive of NHS Greater Glasgow was also invited into decline to attend the event. Does the minister share my concern that an official paid to the tune of a reported £190,000 per year can take trouble not to attend this event? However, when you look at the hospitality registered by Mr Calderwood, you can see that a round of golf is something that is quite keen to attend, but it cannot take the time to attend an event in the east end to assure local people that their local hospital will not be closing. Well, I am not going to get into issues about individuals, but, as I have said to Paul Martin, before I know local people very much value the local hospital, I also know that from the correspondence that I have had from Parkinson's UK, which I have responded to, assuring them that the contents of the draft discussion paper have not in any way been accepted as concrete proposals by the board and none of which have come to me for approval. I have also made it very clear to Paul Martin previously that there would have to be some material change to the position when Nicola Sturgeon was the health secretary in 2011, when she rejected what was a formal proposal at the time to close Lightburn hospital because she had heard repeatedly, not least from local patients and clinicians, that the hospital provided a high-quality service that was greatly valued by the local community. I did note that in the Parkinson's UK submission for the debate today that they were stressing very much that they did not want this to become a party political issue and that they wanted support from across the world and did not want it turned in to a party political issue. I think that that is something perhaps we should all take notice of. To ask the Scottish Government what progress it is making in tackling delayed discharge in NHS Grampian. Grampian has seen a 35 per cent reduction in bed days loss to delay in December 2015 compared to December 2014, the lowest level since April 2015 and the 35 per cent the lowest level since April 2015. The partnership has received £2.73 million from the three-year delayed discharge funding and I expect the partnership to utilise this money to develop community services aimed at reducing unnecessary emergency admissions and delayed discharges. What impact have junior doctors had in bringing this welcome reduction and how much the protection of the existing deal for junior doctors we have here is helping NHS Grampian recent success? The reduction in delays in Grampian is the result of the continued hard work and dedication of all health and social care staff across the partnership, including junior doctors, to ensure continued success. It is essential that professionals across health and social care continue to work together as part of a multidisciplinary team to maximise people's wellbeing and ensure that they receive the right care in the right place at the right time. The cabinet secretary will be aware that I introduced an amendment into the Carers Scotland Bill to the effect that discharge planning should start as early as reasonably possible on the patient's hospital journey. Does she know if any hospitals in Scotland are already adopting this approach? I think that if it was successful, that would contribute significantly to the way in which we must do this. As I understand it, Dumfries and Galloway have been looking and trialling this and I think we will hopefully provide some good practice models for boards elsewhere, but I am happy to write to the net mill with a bit more detail on what Dumfries and Galloway have been doing. There is a continuing issue around high levels of cancelled operations in Grampian in which the cabinet secretary will be aware of. How far is that related to continuing levels of delayed discharge? Of course, cancelled operations due to capacity issues remain a very small percentage in the recent statistics. There was around 2.8 per cent, which has remained pretty consistent over the past few months. Of course, any cancelled operation is to be regretted, but there are circumstances when emergencies come in that will need to take precedence over planned procedures. That is why we will be investing £200 million over the next five years to develop further elective centres along the model of the Golden Jubilee hospital. To ask the Scottish Government how it seeks to identify and acknowledge outstanding practice and contribution in the NHS. We are committed to rewarding the outstanding and hard-working contribution of NHS Scotland staff to the delivery of high-quality patient care services for the people of Scotland. Unlike in the other UK countries in 2015, we accepted the recommendation of the pay review bodies of a 1 per cent across the board uplift and pay for all NHS staff from 1 April 2015, thereby ensuring that NHS Scotland staff remain the best rewarded in the UK. That pay increase was supplemented by additional measures for the lower paid. Over the past couple of years, my family has been very grateful for the professional healthcare provided by hospital staff. NHS Lothian organises anual event to recognise outstanding healthcare practice. There is one category that offers patients, carers and relatives the opportunity to nominate a healthcare worker who they believe is a true health hero. Will the cabinet secretary join me in encouraging people in the Lothians to nominate a hard-working healthcare professional who has provided exceptional patient care? We should welcome any opportunity to recognise the hard-working dedication of staff across the NHS. That is why the Scottish Government works in partnership with the daily record every year to deliver the Scottish health awards, which recognise the outstanding achievement of staff across a range of roles and disciplines. To ask the Scottish Government whether the new East Lothian community hospital will be fully operational by 2019 and provide at least all of the services that are currently delivered at Rudlands general hospital. The timeline for completion of the new hospital remains unchanged and we fully expect NHS Lothian to welcome their first patients in 2019. The new hospital will be the home to a range of services, including inpatient continuing care beds, mental health and patient beds, orthopedic and rehabilitation beds, as well as shared therapies, including physiotherapy, occupational therapy, speech and language therapy, dietetics and music therapy. NHS Lothian will have its full business case to the Scottish Government later this year. In the process of doing this, some options and proposals for surgical services are being discussed with staff. That work links directly to the issue of maximising all of NHS Lothian's assets and ensuring the effective use of resources. NHS Lothian's local clinical objectives is to improve services in the local community, and I am confident that the project will deliver on that. I thank the cabinet secretary for that answer. I am afraid that the timeline is not unchanged since this hospital was due to open in 2009, but I am glad to hear that there should be no further delay. However, there are discussions under way to reduce day surgery services, eliminating day surgery under general anesthetic and to cut bed numbers, too. I have talked to staff about those already. They reject those proposals. Will the cabinet secretary tell Lothian NHS that a new hospital should provide more, not less, services? There will be surgical services at the new hospital. No final decisions have been taken on this matter, but a group has been established, which brings together clinical and leadership experts, including surgeons, anesthetists, endoscopists and theatre nurses, as well as union colleagues. As part of the review, they will work together to ensure the best outcome for patients. However, although Lothian NHS's business case is yet to be finalised, we are currently looking at 60 per cent increase in inpatient beds from around 78 to around 132. I hope that that will provide Ian Gray with the assurance that inpatient beds are increasing, not decreasing. 15. NHS boards have made in recruiting extra specialist nurses and whether the resources allocated for that purpose have been fully spent. In 2015-16, the Government invested over £2.4 million of recurring funding to improve specialist nursing and care, including the appointment of additional specialist nurses. NHS boards are responsible for ensuring that those funds deliver maximum benefit for patient care and are submitting regular progress reports on how those funds are being invested. NHS boards are in the process of recruiting additional specialist nurses or increasing the hours of existing nurses and patients are already benefiting from those changes. I welcome the MND nurses that we know about and hope that additional specialist nurses have been recruited for relatively common conditions such as MS and Parkinson. In this week, when we mark rare diseases day, can you say whether any rare diseases have benefited from additional specialist nurses using models such as the single gene complex need specialist nurses that operate in Edinburgh and other cities? The specialist nurses will cover a range of conditions. I am very happy to write to Malcolm Trism with some of the detail, but I can see from the list of different specialist nurses employed by different boards that there is a wide range of specialties that are covered by those nurses. I am very happy to write to Malcolm Trism with the detail, because it runs to quite a lot of detail here, but I am happy to furnish him with that. To ask the Scottish Government what progress there has been on the review of neonatal and maternity services. Since the launch of the review last year, a chair has been appointed and the review group established. The review group has now met on five occasions and is supported by four subgroups, which were established in January this year. The subgroups focus on maternity models of care, neonatal models of care, workforce and evidence and data. In total, around 100 NHS staff, academics and other professionals and service user representatives are involved in the review main group and the subgroups. The review has a strong focus on engagement with events taking place, with service users and with maternity and neonatal care professionals in each of Scotland's 14 territorial NHS boards. In addition, further engagement is planned with other interested stakeholders, including professional bodies, academics and third sector representatives. A communications plan, which includes a regular newsletter, blog, Twitter feed and website, is in place to inform a wide range of interests. I thank the minister for that detailed answer. What recommendations are likely to be made for upskilling nurse practitioners and extra training for local GPs to back up maternity services in rural and remote centres? Our review group has set up a subgroup to specifically consider workforce issues in relation to maternity and neonatal services. The subgroup will provide recommendations to ensure that we have a modern, flexible and efficient workforce that can deliver safe, effective and high-quality maternity and neonatal services that puts mothers and babies and families at the centre of care. That will include consideration of the roles of workforce in remote and rural locations. I ask that, as part of the review, the variation in stillbirth levels, which were highlighted, particularly for Ayrshire and Arran recently, should be looked at very closely to determine why the significant variations occur. That is already under way. Thank you very much. That concludes questions this afternoon. We note on to the next item of business.