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Chamber and committees

Meeting of the Parliament

Meeting date: Wednesday, December 12, 2018

Agenda: Portfolio Question Time, Brexit Update, Scottish Government Draft Spending and Tax Plans 2019-20, Business Motions, Parliamentary Bureau Motion, Decision Time, Remembering the Korean War


Portfolio Question Time

Health and Sport

The first item of business today is portfolio questions on health and sport. I will try to get as many members in as possible, so I ask for short and succinct questions and answers, please.

Scope Capacity

1. Stewart Stevenson (Banffshire and Buchan Coast) (SNP)

To ask the Scottish Government what progress it is making in meeting the target in its cancer strategy to increase national health service scope capacity by an additional 2,000 per annum on a sustainable basis. (S5O-02669)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

Since 2016, £6 million of funding has been released directly to NHS boards, including £1 million annually since 2016-17, for scope capacity. In 2018-19 alone, that will support an additional projected 2,250 scopes through 560 endoscopy sessions.

Stewart Stevenson

I was the grateful recipient of a negative diagnosis after a scope a couple of years ago and, like others, I very much welcomed that. Will the Scottish Government indicate how it is monitoring the spend by individual health boards and the outcomes that the 2,250 additional scopes in the current year will deliver?

Jeane Freeman

I am sure that Mr Stevenson will recall our waiting times improvement plan, which I published in October. That plan includes an operational board that has senior health board and other expertise on it, and it will monitor for me both the delivery of the plan against the trajectories that are in it and the individual actions of specific boards against the funding that we release. We release the funding in response to specific requests to increase diagnostic, elective or other capacity in a particular board in order to deliver specific results. The money is allocated and the monitoring is done on that basis.

Miles Briggs (Lothian) (Con)

I refer to the announcement of the endoscopy action plan. What progress has been made in reducing the number of people who are waiting for an endoscopy—I think that the target that was set for December was a reduction of 5,000—and how much of that work has involved using the public sector?

Jeane Freeman

I do not have the exact number to hand, but I am happy to send it to Mr Briggs following today’s meeting. Use is made of the private sector by some of our boards, but he will recall that we have a specific action under the waiting times improvement plan. In effect, that plan is in two parts, one part of which is on immediate action to reduce the longest waits and the most clinically serious waits, which will include, for example, using mobile facilities and so on. That will include agreement on a national contract with the private sector for specific, time-limited use in specific procedures. I will be happy to ensure that, once that contract has been concluded, Mr Briggs is made aware of its contents and what it requires.

Maternity and Paediatric Services (Dr Gray’s Hospital, Elgin)

2. Jamie Halcro Johnston (Highlands and Islands) (Con)

To ask the Scottish Government what progress it has made in implementing the recommendations of the chief medical officer’s advisory group on maternity and paediatric services at Dr Gray’s hospital in Elgin. (S5O-02670)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

NHS Grampian’s phase 1 plan for the reinstatement of maternity services at Dr Gray’s hospital includes a summary of actions that it will take against all the recommendations from the CMO’s advisory group. It is making progress against implementation of the actions in that plan, which resulted in 38 per cent of local births being in Dr Gray’s in November.

In addition to those actions flowing from the CMO’s group’s report, the Scottish Ambulance Service has implemented a test of change to improve local ambulance cover in Moray and has recruited additional staff to cover the service.

Jamie Halcro Johnston

The cabinet secretary will be aware that the advisory group’s report pointed out that communication with the women affected had been poor. Almost a month later, there are still regular complaints from patients, with cases arising of women being left not knowing who to contact if problems arise during their pregnancies, not knowing—even weeks away—where they will give birth and without information about how to get the support that they need. How can she have confidence that communication from NHS Grampian is working effectively? Will she encourage the chief executive of NHS Grampian to attend the keep MUM—the maternity unit for Moray—campaign’s proposed public meeting in January, and will she consider attending it?

Jeane Freeman

I accept Jamie Halcro Johnston’s point about communication with regard to this matter. From the earliest days, it has been poor. I think that NHS Grampian recognises that now, and I certainly do. The Government has worked closely with the board to improve its communication, particularly with the keep MUM campaign and with residents in and around the Dr Gray’s hospital area as well as more widely. I think that improvement is there to be seen, although I accept that there are still areas where more can be done. Earlier today, I read an email exchange about a forthcoming meeting between the keep MUM campaign and the executive manager of the board, who is currently taking a lead role in and around Dr Gray’s, and the delivery of the plan.

With regard to the issue of the meeting in January, it is a matter for the chief executive of NHS Grampian to determine what her diary priorities are, but I hope that she would consider the matter to be a priority.

Addiction Support Services (Highlands)

To ask the Scottish Government what steps it is taking to improve addiction support services in the Highlands. (S5O-02671)

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

NHS Highland recently redesigned parts of its drug and alcohol services. An NHS service improvement group is leading on-going work to reduce the time that individuals wait to access drug and alcohol treatment services, with a specific focus on reducing waits for those requiring opioid substitution therapy. Further, our new alcohol and drug strategy, as set out in the document “Rights, Respect and Recovery”, outlines how £20 million of additional investment a year will be available to support the quality and provision of local services in order to better meet the needs of those who are at risk.

Gail Ross

Having been contacted by a number of my constituents on the issue recently, and given the online petition about increasing addiction services in Caithness, can the minister tell me how the additional funding that was recently announced to accompany the new alcohol and drugs strategy will be distributed to rural areas, where the problem is sometimes not as visible as it is elsewhere?

Joe FitzPatrick

The additional funding that was recently announced as part of the strategy is being allocated across three funds. A total of £20 million is being made available to support service redesign and system change in this financial year. Those three funds are: the local improvement fund, with £17 million being made directly available to our drug partnerships; the challenge fund; and the national development project fund. More than £1 million of that additional investment will go directly to the Highlands to support efforts to make services more accessible and attractive to people who are seeking help.

John Finnie (Highlands and Islands) (Green)

The minister will be aware that there were 19 drug-related deaths in the Highlands in 2016, which was an increase of five on the previous year. The minister will also note that police officers are often the first on the scene of such incidents. Can the minister engage the Cabinet Secretary for Justice regarding police officers routinely carrying naloxone?

Joe FitzPatrick

I thank the member for that question, which is an important one. He is absolutely right to say that, across Scotland, and probably particularly in rural areas, police will be the first people to come across someone who is experiencing an overdose. I know that discussions about the suggestion that Mr Finnie makes are on-going and that positive noises have been made in that regard. I hope that there will be a positive announcement on that issue soon.

Scotland was ahead of the curve in making naloxone routinely available. I have personally undergone the training that is required to administer naloxone, as have two members of my office staff. We have a naloxone kit in the office, which is in the town centre in Dundee. I encourage anyone else who thinks that their office is in a location where such a kit might be useful to consider speaking to service managers to see whether that training could be extended to them as well. However, the point that the member makes about the police is a good one.

David Stewart (Highlands and Islands) (Lab)

Does the minister share the view of Alcohol Focus Scotland that a new public health supplement would provide substantial additional funding for addiction support services in the Highlands and the rest of Scotland? The Parliament has already approved that proposal in passing the Alcohol etc (Scotland) Act 2010. Surely, the time is right to provide additional funds to offset the significant cost to the public sector of dealing with the consequences of alcohol harm.

Joe FitzPatrick

The member makes that point almost weekly in the chamber, and he is right. The Government is sympathetic to the proposal, as I am. The argument is that, with the introduction of minimum unit pricing, there may be a potential windfall. The point that I have made previously to the member is that we need to see what that windfall is. I hope that there is not a windfall, because I hope that alcohol consumption goes down. However, when we have the assessment, if we find that there is a windfall, that will be the point at which to consider any further action.

Oral Health (Adults)

To ask the Scottish Government what steps it is taking to improve adult oral health. (S5O-02672)

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

In January this year, we published the oral health improvement plan, which sets out the strategic direction for national health service dentistry, building on the considerable achievements that we have made on child oral health and access to NHS dentistry. We will be introducing a new programme of preventive care and, over time, we will introduce an oral health risk assessment for adults. We also have a programme for government commitment to provide new oral health domiciliary care services, which will be rolled out next year.

Mark McDonald

In 2017, the number of mouth cancer deaths in NHS Grampian rose from 21 to 28. Late presentation is often a factor. My father ignored an ulcer in his mouth as something that could be dealt with later, but later turned out to be too late. What steps can the Scottish Government take to encourage people to check their mouth regularly and to seek medical advice at the earliest possible opportunity if they notice anything at all unusual?

Joe FitzPatrick

I recognise the member’s personal interest in the subject.

The early detection of oral cancer lies at the centre of our proposals. The focus of the oral health improvement plan for adult patients is to introduce a more preventive system for NHS dental care. Over time, we will introduce the oral health risk assessment, which I mentioned in my first answer. In the improvement plan, we envisage a new system of preventive care, at the centre of which is that assessment of adults. That will be a considerable enhancement of the current check-up regime. Patients will receive tailored services on how to manage and look after their oral health, including advice on lifestyle factors such as smoking and drinking, which are clear risk factors associated with oral cancer.

As well as maintaining free NHS dental checks for patients, we have taken the lead on public health measures. For example, we are the first country in the United Kingdom to announce our intention to implement, as soon as practically possible, a human papillomavirus vaccination programme for adolescent boys.

NHS Greater Glasgow and Clyde (Meetings)

To ask the Scottish Government when it last met NHS Greater Glasgow and Clyde, and what issues were discussed. (S5O-02673)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

Ministers and Scottish Government officials regularly meet representatives of all health boards, including NHS Greater Glasgow and Clyde, to discuss matters of importance to local people. On Monday, I met with the chair of that board.

Neil Bibby

A young constituent of mine in Paisley who is suffering from a severe ear infection has had their operation, which was planned for later this month, cancelled due to the closure of the central decontamination unit in Glasgow. She now faces an extra month of agony when she should be studying for her prelims. Another Renfrewshire woman has been told that she will have to wait for an ear, nose and throat appointment as an out-patient for 52 weeks, when the target is 12 weeks. The response to a freedom of information request that has been passed to me shows that NHS Greater Glasgow and Clyde has only once managed to see more than 70 per cent of patients within 12 weeks. In August, the target was met in only 41 per cent of cases.

Does the health secretary believe that any of that is acceptable? What will she do to ensure that patients in Renfrewshire and the west of Scotland get the treatment that they are entitled to for ear, nose and throat conditions?

Jeane Freeman

As Mr Bibby will know, and as I have put on record many times in the chamber and elsewhere, I find such long waits completely unacceptable and I am very sorry personally for the distress that they cause his constituents and any other patient who is waiting longer than they should for the treatment that they require. The waiting times improvement plan, which is backed by significant additional resources, is designed to reduce, with effective targeted action, as we touched on earlier, those long waits and to tackle the areas in which we have a particular challenge in terms of physical capacity or workforce capacity, where we may need to do additional work to secure the specialisms that we need.

When I introduced the plan, I undertook to report to Parliament the progress on the trajectories that the plan sets out, and I will continue to do so. I am very happy to keep individual members up to date on the relevant propositions that come from boards in their area and which are approved by the operating board that I mentioned. I approve specific actions that are designed to produce specific results, that are backed by a particular amount of money and which are monitored as I have described.

If supplementaries are fairly short, we will get through more of them.

Annie Wells (Glasgow) (Con)

Last week, I was contacted by Anne Hughes, a 75-year-old lady who was unable to visit the out-of-hours general practice service at Glasgow’s Queen Elizabeth hospital due to staff shortages on 1 December. [Interruption.] I am trying to rush now.

Instead of being able to access the accident and emergency services at the hospital, Anne was told that she had to go to the Royal Alexandra hospital in Paisley or to the new Victoria hospital, so she did not arrive home until 10 hours after first seeking medical assistance. Can the cabinet secretary confirm that action is being taken to guarantee that out-of-hours care is available at all times to patients in our country’s largest health board?

Jeane Freeman

I am grateful to Annie Wells for her question. As it happens, before this session I had a longer discussion with Professor Lewis Ritchie, who has undertaken work on out-of-hours services. He updated me on where we are. Our out-of-hours services are undoubtedly displaying some degree of fragility, so the action that we are taking, and planning to take, is needed in order to strengthen the services. That action is part of the whole-system approach and will link strongly to accident and emergency departments and to the integration of health and social care. We are trying to drive forward that whole-system approach very quickly.

There has been a significant increase—more than what is expected at this time of year—in the number of people who are attending A and E departments across the country. That might be related to the availability of out-of-hours services, or it might simply be because of the nature of the weather. We are working to investigate and understand who the additional attendees are and what can be done.

I appreciate the point that Annie Wells makes. The individual who contacted her is absolutely right that the length of time that it took to be treated and the additional travel are completely unacceptable. I assure her that we are looking in detail at what we can do, and I would be happy to discuss with Annie Wells the specific actions that we are taking on out-of-hours services.

Shorter answers would be helpful, too.

Cardiopulmonary Resuscitation Skills

To ask the Scottish Government what progress it is making with its plan to equip an additional 500,000 people with CPR skills by 2020. (S5O-02674)

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

The Scottish Government is working in partnership with Save a Life for Scotland, which has provided CPR learning for almost 300,000 people since the launch of the out of hospital cardiac arrest strategy in 2015. It is on track to reach the 500,000 target by the end of 2020.

Rona Mackay

Last week, East Dunbartonshire Council committed to training all secondary pupils in lifesaving CPR; it is the 14th local authority in Scotland to do so. In addition, the British Heart Foundation Scotland is offering to equip every local authority school with a free CPR training kit. Will the minister join me in encouraging all remaining councils to offer such training?

Joe FitzPatrick

Yes, I will. It is really encouraging that local authorities have committed to CPR training for their secondary school pupils. I appreciate the contribution that communities and schools are making by purchasing defibrillators. They are taking a huge step towards creating a country of lifesavers, and they are contributing to Scotland’s out of hospital cardiac arrest strategy. We welcome the efforts of all our partners in helping to introduce CPR to everyone, particularly our young people. The British Heart Foundation is doing a great job in supporting schools by providing its call push rescue kits and heartstart training programme.

What is the Scottish Government doing to increase the number of defibrillators across the country? What is it doing to highlight the need to register defibrillators with the Scottish Ambulance Service?

Joe FitzPatrick

We encourage the roll-out of public access defibrillators across Scotland. The point that the member makes about the need to know where they are is important.

Prompt access to defibrillators is vital, so part of our strategy involves the Scottish Ambulance Service public access defibrillators register. The register allows defibrillators to be mapped, maintained and kept accessible to the public, and it enables ambulance service call handlers to direct a caller at the location of a cardiac arrest to any public access defibrillators that might be near. However, it is critical that members of the public, communities, businesses and other partners who are responsible for public access defibrillators register those details, and I encourage people to do so.

Sexual Health and Blood Borne Virus Framework

7. Patrick Harvie (Glasgow) (Green)

To ask the Scottish Government, in light of the development of new tools for HIV prevention and treatment, what action it is taking to update its 2015 to 2020 sexual health and blood borne virus framework. (S5O-02675)

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

I am delighted at the developments that we have seen since the publication of the update in 2015, including Scotland becoming the first part of the United Kingdom to make HIV pre-exposure prophylaxis available through the national health service. Work on developing a further update to the framework will begin next year, and officials will engage with a wide range of stakeholders to identify areas for further action with a view to publishing an update in 2020. We will adopt the co-production approach that has been taken in the past and which has supported the progress that has been made across Scotland, such as our recently exceeding the United Nations AIDS 90-90-90 target for HIV. I am happy to engage with the member and others across the chamber who have a particular interest in taking the issue forward.

Patrick Harvie

I am aware that I am asking this question well in advance of the development of a successor to the framework that runs to 2020, but that is deliberate, because we now have not only PrEP but effective post-exposure prophylaxis and levels of treatment that lead not only to HIV-positive people living long and healthy lives but to the level of viral load being undetectable and the virus being untransmittable. Given such developments, many in the field feel that it would be appropriate and possible to set a target of zero new HIV transmissions in Scotland. Will the Government seriously consider putting such a target into the next framework update?

Joe FitzPatrick

First, it is important to re-emphasise the undetectable equals untransmittable—or U=U—message; indeed, we as politicians must spread that important message as widely as possible, because it tells anyone afraid of having the test because they think that it is a life sentence that treatment is available that will make their viral load undetectable and therefore untransmittable.

It is correct for us to be ambitious in this area, and the Scottish Government supports the ambition of there being zero new HIV infections. I am happy to work with the HIV community, the member and other stakeholders to look at what would be required to get us to the point where we would be confident to put such a target into our new strategy, but I think that all of us across the chamber will share that ambition.

I must ask for short supplementaries and answers, please.

Mary Fee (West Scotland) (Lab)

HIV Scotland estimates that 13 per cent of people with the virus are unaware of their status. What action can the Government take within the sexual health framework to raise awareness in that respect and reduce that worrying statistic?

Joe FitzPatrick

The good news is that, because of the progress we have made, the 13 per cent figure that Mary Fee has mentioned is now down to 9 per cent, which puts us ahead of the international targets. However, I absolutely want to get to the point where everyone knows their status. The test is not difficult for people to take, and the U=U message makes it clear to people that there is a really good reason why they should take the test and that the virus is treatable. We need to keep sending that message and keep encouraging people to get tested, but we also need to look at new and innovative ways of going out into communities, identifying people who might be at risk and encouraging them to take the test.

The HIV prevention drug PrEP is accessed almost exclusively by men, but given that a third of all people living with HIV are women, what is being done to redress the imbalance of access to the drug?

Joe FitzPatrick

First, we must make it clear that PrEP is available to women. It is right that women who are at high risk of becoming HIV positive have access to it, but the member is absolutely right about the lack of awareness in that respect, which has resulted in a lack of uptake, and organisations such as Waverley Care and the Scottish Drugs Forum have received funding from the Scottish Government and are working to raise awareness of PrEP for women who might benefit from taking it. It is really important that we recognise the work of those third-party organisations in going out and finding communities who are at risk and ensuring that they are aware of their right to PrEP.

NHS Fife (Meetings)

To ask the Scottish Government when it last met NHS Fife, and what issues were discussed. (S5O-02676)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

I chaired NHS Fife’s annual review on 3 December and discussed a number of matters with the area clinical forum, the partnership group and patients and carers. I also discussed matters concerning the board’s performance and improvement plans with the chair and chief executive. On Monday, I met the chairs of all the health boards, including NHS Fife.

Claire Baker

The cabinet secretary will be aware that 18 general practitioner practices across Fife currently have full patient lists, including all of those in Kirkcaldy and Lochgelly and most of those in Dunfermline. According to NHS Fife, seven surgeries are experiencing recruitment difficulties, with two considered to be at high risk.

I recognise that we have seen a small rise in the number of GPs compared with the position this time last year. However, yesterday it was revealed that, compared with a decade ago—

Can we get to a question, please?

It was revealed that we still have fewer GPs, but far more patients. What guarantees can the cabinet secretary give that the pressure on Fife GP services will ease in the interests of patients—and when?

Jeane Freeman

As Ms Baker recognises, the issue affects GP practices in other areas as well. Since 2017, there has been a 10 per cent increase in GP recruitment fill rate. Across Scotland, 352 doctors are currently in GP training posts. As the member knows, we have also introduced the £20,000 GP training bursary incentive to attract doctors to placements that have previously been hard to fill. Our new Scottish graduate entry medicine programme, ScotGEM, is largely located in Fife; it is co-located across the universities of St Andrews and Dundee. That programme is specifically focused on a GP career.

We are working hard to increase the number of GPs that we have available to us and the number of GP training posts. In addition, the new GP contract looks to introduce a multidisciplinary team to GP practices to ensure that GPs are freed from some of the bureaucratic work that they have had to endure in the past and up to today and have time to deal with the complex issues that we need them to deal with, as the local clinical leaders that they are.

Willie Rennie (North East Fife) (LD)

The health secretary will be aware that I oppose the proposals to close the GP out-of-hours facility in St Andrews. The decision on that will be made by Fife health and social care partnership on 20 December. Does the health secretary agree that it would be sensible to give further time to consider new options for the provision of the service in north-east Fife?

Jeane Freeman

Mr Rennie and I have discussed that issue on previous occasions. Indeed, he has a members’ business debate tomorrow that I am looking forward to taking part in. I absolutely understand the concerns that have been expressed by a significant number of people in north-east Fife. It would be wise to wait for the proposals that are taken to the meeting on 20 December before we jump to conclusions as to what might happen in that area.

Question 9 was not lodged.

Sport and Physical Activity (Availability)

To ask the Scottish Government what it is doing to ensure that sport and physical activity are available to all, irrespective of background or personal circumstances. (S5O-02678)

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

The Scottish Government believes that there should be no barriers to participating in sport—everyone should be able to participate in and enjoy sport, whoever they are and whatever their background. In July, we published the active Scotland delivery plan, which sets out our aims to enable people in Scotland to be more active, with a key objective of decreasing inactivity in adults and teenagers by 15 per cent by 2030.

Brian Whittle

Scotland’s cities have some magnificent national stadium venues. However, with so many local venues closing their doors, access is difficult, especially in rural communities. Does the minister agree that the most viable route to ensuring access to sporting activity is to utilise the Scottish schools estate more efficiently?

Joe FitzPatrick

Brian Whittle makes a good point, and he knows that I agree with him on the issue. Community access to sporting facilities is important, which is why there has been significant investment from sportscotland in our community sports hubs up and down the country to ensure that sport is accessible at community level. The resource has been particularly targeted at more deprived communities and people from sections of the community who are less inclined to participate in sport, and at encouraging more women and girls to get involved in sport.

We do not run schools, so the partnership of the Scottish Government, sportscotland, local authorities and community groups needs to work together to get this right. However, if we get it right, we can make a difference to the health of our nation, which is a goal worth aiming for.

Hospital Visiting

To ask the Scottish Government what authority the national health service has to stop family members visiting a patient in hospital. (S5O-02679)

The Minister for Mental Health (Clare Haughey)

People should normally be able to see the friends and family members who are important to them while they are in hospital. The national health service has authority to prevent family members from visiting someone in hospital when that is the expressed wish of the person, when the family member has been abusive or presents a risk to staff or other patients, or for sound clinical reasons.

Richard Lyle

One of my constituents has been trying to see their daughter in hospital for several months but has been stopped at the entrance to the ward and told that there is an on-going police investigation. They spoke to Police Scotland and were told that there was no investigation. I have written to the local health board about the case. I recognise the limitations of the minister’s response, but I ask her to ask health boards to ensure that the families of patients are treated correctly in future and that information is up to date, as what is happening is causing severe distress to my constituents.

Clare Haughey

As Richard Lyle acknowledged in his question, I am limited in what I can say. I cannot comment on an individual case. I normally expect staff to take such a decision at the request of a patient, but there might be a small number of cases in which a family member is prevented from visiting for other reasons. Health boards should always ensure that patients and their families are treated correctly. If Richard Lyle’s constituent feels that that has not been the case, I encourage them to raise the matter directly with the board.

The Patient Rights (Scotland) Act 2011 provides a right for people to make complaints, raise concerns, make comments and give feedback about the care that they or a family member have received from the NHS, and the patient advice and support service exists to help them. The act also places a duty on NHS boards to thoroughly investigate issues and take improvement actions, where appropriate.

General Practitioners (Recruitment)

12. Jeremy Balfour (Lothian) (Con)

To ask the Scottish Government, in light of recent figures reportedly showing that the number of doctors in training in Scotland is at a five-year low, how it plans to address general practitioner recruitment issues. (S5O-02680)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

I think that the figures that Jeremy Balfour refers to are the most recently issued from ISD Scotland. In that set of figures, he needs to look at the two lines on “doctors in training” and “other grades”, where he will see an overall increase between 2013 and September 2018. The reason why I ask him to look at both lines is that under “other grades” are doctors in training who are also clinical fellows or locums. We must take both figures together to understand the real picture.

That said, Jeremy Balfour will know that I am not the least bit complacent about our workforce numbers and the work that we need to do to increase accessibility and capacity across our whole health and social care workforce.

Without repeating myself, as I know that you are keen for us to move on, Presiding Officer, I make the point that Scottish general practitioner recruitment has increased by 10 per cent. We have the measures that I talked about, such as the bursary, the Scottish graduate entry medicine programme and the increase in the number of medical undergraduates, and there is a focus in some of those programmes on GP training, particularly in remote and rural areas. I am very happy to talk to Mr Balfour outside of portfolio question time and take him through further details of the specific measures.

Jeremy Balfour

I remind members that I have a number of close family members who are doctors or training to be doctors.

The cabinet secretary makes some interesting points, but the programmes that were created in 2015, 2017 and summer 2018 are simply not working overall. Does the cabinet secretary agree that a radical new action is needed to get more doctors and GPs working here in Scotland?

Jeane Freeman

It is an interesting proposition, but it falls down by not telling me what that “radical new action” might be, so I am a bit stuck to say whether I agree that it is needed. We are taking a number of steps. I remind Jeremy Balfour that we do not produce GPs quickly—quite rightly, because we want them to undergo extensive training as undergraduates and then as graduate medical doctors in training.

I also remind Jeremy Balfour that we are talking about a health and social care workforce across a whole system. The GP contract is specifically designed, negotiated and agreed with the British Medical Association general practitioners committee to ensure that our GPs, in particular, can come forward as the local clinical leaders within multidisciplinary teams so that we can focus their highly specialised and important skills on the patients who need them most. In the absence of detail on a “radical new action”, my answer is no, I do not agree with the member.

Fulton MacGregor (Coatbridge and Chryston) (SNP)

Does the cabinet secretary agree that the biggest threat to the NHS workforce is the danger that Brexit poses to the staffing of Scotland’s NHS, as reported in the new survey of European Economic Area doctors by the British Medical Association?

Jeane Freeman

I agree, and I am sorry that the members to my left—purely in the geography of the chamber, clearly—have groaned about that matter, because it is self-evidently the case. What makes it worse is when the United Kingdom Government will not assist the Scottish Government to meet our objective of paying the resettlement fees, which is a ridiculous proposition for people who live and contribute to our country. It will not assist us in meeting those fees in order to demonstrate—in the practical way that we can in the absence of any other half-decent powers—that those individuals who work in our health service are welcomed and valued and that we want them to stay.

Ophthalmology Services (Repatriation to Island NHS Boards)

To ask the Scottish Government what progress has been made in repatriating ophthalmology services from NHS Grampian to island NHS boards. (S5O-02681)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

As Tavish Scott will know, NHS Grampian provides a visiting ophthalmology service to NHS Shetland every two months; a multidisciplinary team provides four clinical sessions over two days. Some treatments, however, require patients to travel to Aberdeen to receive their care. A meeting has been scheduled between NHS Shetland and NHS Grampian for January 2019 to discuss the provision of those services on Shetland. Actions to progress that, including whether services can be sustainably delivered on Shetland in the future and associated timelines, will be agreed at that meeting.

Tavish Scott

Does the cabinet secretary recognise that there are older people in the islands in Shetland who now do not travel to Aberdeen for essential eye injections, simply because of the disruption, the travel and the difficulties for people who undertake those visits? Will she redouble the efforts to make sure that, when the meeting happens, it will make decisions to ensure that these essential services can take place on Shetland for the great benefit of those elderly people in particular?

Jeane Freeman

I recognise the issues that Tavish Scott has raised and I will take a personal interest in how that meeting progresses, the actions that it agrees to and the timelines that it sets. I will ensure that Mr Scott is made aware of those.

Power of Attorney (Effectiveness in Health Cases)

To ask the Scottish Government what assessment it has made of the effectiveness of the power of attorney in health cases. (S5O-02682)

The Minister for Mental Health (Clare Haughey)

We recently undertook a consultation on making changes to the adults with incapacity legislation. We know from that work that using powers of attorney can encourage people to think through how they might want their health, welfare and financial affairs to be managed in the future if they are unable to make decisions themselves on those matters. That means that adults who use powers of attorney are better placed to be as involved as possible in decisions about their lives, even if their circumstances change.

Does the minister believe that there are sufficient checks and balances in place for all parties when a public body seeks to take over a power of attorney?

As I alluded to in my previous answer, there is a review of the Adults with Incapacity (Scotland) Act 2000, and I am sure that the subject will be reviewed during the review.

I will take question 15, because I know that it can receive a short answer.

Cardiopulmonary Resuscitation Skills

To ask the Scottish Government what progress it is making with its plan to equip an additional 500,000 people cardiopulmonary resuscitation skills by 2020. (S5O-02683)

I refer the member to my earlier answer to Rona Mackay.

Bill Bowman

The British Heart Foundation Scotland is offering to equip every local authority school with a free CPR training kit, and training takes less than 30 minutes to complete. The Scottish Government has made lesbian, gay, bisexual, transgender and intersex education compulsory on the curriculum; will it do the same for life-saving CPR, given that there is international evidence that such an approach has the potential to triple survival rates from out-of-hospital cardiac arrest?

Joe FitzPatrick

What the British Heart Foundation is doing is fantastic, and the work that schools up and down the country are doing is great, but, ultimately, it is for schools to decide when it is appropriate for them to provide that support.