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Chamber and committees

Meeting date: Thursday, October 25, 2018

Meeting of the Parliament 25 October 2018

Agenda: General Question Time, First Minister’s Question Time, Electricians (Regulation), Education (Primary 1 National Standardised Assessments), Home Detention Curfew, Scotland’s Place in Europe: Our Way Forward, Scotland’s Contribution to International Development, Decision Time


Contents


First Minister’s Question Time


Transvaginal Mesh Implants

1. Jackson Carlaw (Eastwood) (Con)

I thank colleagues from across the chamber for their well-intentioned advice, freely given, on what I should do now, and for the anecdotes that many have offered—with the caveat that they were never quite brave enough to speak them themselves but thought that I might like to have a try. I think that I will probably pass on that.

I begin by stating what a privilege and a delight it is to stand here as the first man in 13 years to face the First Minister at First Minister’s question time on behalf of the Scottish Conservatives. I hope that in communities all across Scotland everybody will see that there is indeed no glass ceiling for ambition in the Scottish Conservatives and that they, too, can aspire to lead—if only temporarily.

I say to the First Minister that I look forward to our weekly exchange of pleasantries over the next few months. I do so because—and this is a failure of character on my part, which my party can scarcely forgive let alone understand—as well as fully respecting the office of First Minister, I actually quite like the First Minister. However, I am sure that neither of us will allow that weakness on my part to stand in the way of robust exchange.

And so to business. Just how badly let down have the thousands of Scottish women fitted with a mesh device been?

The First Minister (Nicola Sturgeon)

I welcome Jackson Carlaw to his temporary place asking these questions. Let me say at the outset that I am very proud to be the last woman standing at First Minister’s questions. I am not sure whether I am expected to reciprocate all the nice things that Jackson Carlaw said to me at this stage, so I will just gloss over that for the moment.

I turn to the substance of Jackson Carlaw’s question, because it is an important one. I know that he has taken a close interest in the subject over a period of time. I have deep and profound sympathy for what the women affected have gone through and the position that they have found themselves in. I cannot begin to imagine the pain and suffering that many of them have experienced.

That is why the Scottish Government has acted, through the review that we set up and the further work that has flowed from it. In her first few weeks as health secretary, Jeane Freeman announced what is effectively a ban—a temporary halt for all mesh procedures—which will be lifted only when a new restricted use protocol is put in place. That will ensure that procedures are carried out in future only in the most exceptional of circumstances and, of course, subject to a very robust process of approval and fully informed consent. I was not in the chamber for the health secretary’s statement on that, but I heard some of it and, on that occasion, I think that I heard Jackson Carlaw welcome the action that the health secretary had taken and I hope that he will do so again today.

Jackson Carlaw

This has surely been the greatest self-inflicted health scandal since the thalidomide scandal in the 1960s. Across this chamber sit MSPs who have led with determination to expose it as such, particularly Alex Neil, Neil Findlay, Rona Mackay, Angus MacDonald and Johann Lamont. In the gallery today are women who many regard as outstanding examples of leadership and courage: Elaine Holmes, who led the public petitions process on mesh, and Marion Scott, the journalist who led and campaigned so successfully on the issue—and many other mesh survivors are watching today’s exchanges at home. To me, they are heroes and are recognised as such across Scotland, the United Kingdom and internationally, given all that they have achieved. They deserve the congratulations and appreciation of every one of us for everything that they have done.

During our October recess, the Australian Government issued a full and formal apology to all those whose lives have been compromised by mesh. Here is part of what that apology said:

“On behalf of the Australian government, I say sorry to all of those women with the historic agony and pain that has come from mesh implantation which have led to horrific outcomes.”

Will the First Minister now follow suit and, on behalf of the Scottish Government, today match that and give an apology to all the women in Scotland who have suffered?

The First Minister

First, I have previously expressed an apology to the women who have suffered, and I know that Shona Robison, the previous health secretary, and Jeane Freeman have done so, too. However, for the avoidance of any doubt and without any equivocation, I say today on behalf of the Scottish Government that I apologise unreservedly to any woman who has suffered because of mesh procedures.

The Scottish Government has acted here. I know that, because of his interest, Jackson Carlaw will be aware of this, but medical devices across the UK are regulated by the Medicines and Healthcare products Regulatory Agency, which is a reserved body. As a result, the Scottish Government cannot totally ban mesh, but we have taken action. For example, suspending the use of mesh in 2014 led to a significant reduction in the use of mesh implants, and the further action that Jeane Freeman announced some weeks ago to temporarily halt procedures until we put in place a new restricted use protocol was the right one to take. Again, I hope that members who have campaigned on this across the chamber will welcome that today.

Jackson Carlaw

I thank the First Minister for that. On the MHRA, I have indicated that the Scottish Conservatives will support a representation to the UK Government on the issue. After all, it is not really a question about whether a process is devolved or reserved; it is about a process that has failed, and we have to ensure that such an incident does not happen again.

Exposing mesh has not been a party-political initiative but, that said, the singular serious misstep in the Scottish Government’s record on this issue was its response to the now widely discredited review on mesh, which was regarded by women affected and key clinicians such as Wael Agur as a whitewash. Indeed, nearly 100 MSPs signed a charter to that effect in Parliament. At the time, the First Minister and the health secretary invited Professor Alison Britton to report on the process but not the findings of that review, which they said would stand; however, in the event, the new health secretary has, as the First Minister has indicated, abandoned that position with last month’s robust and welcome intervention.

Professor Britton’s report is now complete. There is no first or second draft amended by any self-interested third party; there is just her unvarnished report, which is or will imminently be in the hands of ministers. Will the First Minister agree to publish Professor Britton’s report without delay, and will she say now that she at least expects to accept its findings and implement its recommendations in full?

The First Minister

Those comments are in order, and I will come to all of them.

I welcome Jackson Carlaw’s offer to help put pressure on the MHRA. The Scottish Government has, of course, already raised these concerns, and I certainly look forward to hearing what the Scottish Conservatives will do to add their voice to the calls that we have already made.

I agree with Jackson Carlaw that the most important issue here is that this is a procedure that has failed, but the question whether it is a devolved or reserved matter is relevant with regard to what the Scottish Government is able to do. That is why it is legitimate to point to the fact that the MHRA is a reserved body.

With regard to the review, it is important to say that its findings were similar to those of recent reviews carried out in Northern Ireland, Wales, England and some countries across the European Union. However, Professor Alison Britton was asked to review the process of the independent review. I understand that ministers have only just received the report. It is our intention to publish it and, of course, to accept and implement the recommendations—or, where we think that they are not appropriate, to set out very clearly to Parliament why that is the case and allow Parliament to form its own conclusions on that.

We are determined to do everything that we can to recognise the suffering that has been experienced by women but, more important, to ensure that that suffering is not repeated for other women in the future. This has been a cross-party campaign, and I hope that it will continue in that vein.

Jackson Carlaw

I thank the First Minister for everything that she has said.

For the women concerned, an apology such as the one offered by the First Minister is a necessary cathartic act, but small and practical actions can make a significant change to their lives, too. For example, responsibility for the blue badge scheme rests with the Scottish Government, but many of the women whose mobility has been impaired by mesh are simply not eligible at the moment. To them, access to the blue badge scheme for those in wheelchairs and on crutches would be a hugely welcome and practical advantage.

This might not be the biggest political ask of the day, but it is an important issue to the women involved, and we could resolve to do something about it now. Will the First Minister agree today to instruct ministers and officials to review access to the blue badge scheme and offer those who have had their mobility severely impaired by mesh this singular and practical improvement to their future lives and wellbeing?

The First Minister

I have a lot of sympathy with the points that Jackson Carlaw has made. I will ask the Cabinet Secretary for Social Security and Older People to work with her officials to look at what action can be taken. I do not want at this stage to give Parliament assurances that I do not know we can deliver on quickly, but I think that it is not necessarily a particularly complicated issue. When it comes to blue badges, local authorities will be relevant in the discussions as well, but I am sure that the cabinet secretary will be happy to talk to Jackson Carlaw about how we can take this forward, once officials have had an opportunity to look at it in more detail.


“NHS in Scotland 2018”

2. Richard Leonard (Central Scotland) (Lab)

Today’s Audit Scotland report is a damning indictment of this Government’s mismanagement of our national health service. It says that

“the NHS is not in a financially sustainable position and performance against national targets is declining”.

It is not the only report that has raised alarming concerns about Scottish Government health spending. A paper by Professor John McLaren of the University of Glasgow points to a future £400 million gap between what the Scottish Government plans to spend on the NHS each year and what it needs to spend. Are the Auditor General for Scotland and Professor John McLaren wrong?

The First Minister (Nicola Sturgeon)

I will respond on John McLaren later. First, I will deal with Audit Scotland and take each of Richard Leonard’s points in turn.

The Audit Scotland report published this morning is, rightly, blunt. It sets out the challenges that the NHS is facing. In that sense, of course, it does not tell us what we do not already know or are not already working to address.

The challenges that our national health service is facing are the same challenges that the national health service is facing in England, Wales and Northern Ireland and, indeed, that health services are facing across much of the world. The Auditor General recognises that those challenges come from demands on the service from the increase in the ageing population. The task for us is not just to describe the challenge; it is to come up with the solutions, and that is exactly what the Scottish Government is doing. We have plans in place, both for the investment that the health service needs and for the reform that it needs.

In terms of the comment about financial sustainability, the Audit Scotland report recognises—and this is not a criticism of Audit Scotland, because the medium-term financial—[Interruption.] Perhaps the Labour members would like to listen to this; it is important. The medium-term financial plan that the health secretary published in this chamber, just before the October recess, is not taken account of in the Audit Scotland report. That plan sets out a proposal to see the health budget increase by £3.3 billion over the period until 2023. That would be annual growth of 2.9 per cent in real terms and, as Audit Scotland’s report says, the Fraser of Allander institute predicts that the health resource budget is likely to have to increase by around 2 per cent per year to stand still, so we are providing resources over and above that and I think that significantly changes the comment about financial sustainability. My last point on that is that the Auditor General is clear in the report that it is current models of delivery that are not sustainable. That is why the reforms that we are carrying out are so important, as well.

Finally, and briefly, I will turn to John McLaren’s comments last week. There are two criticisms and we dispute the basis on which they are made. The first is that our estimate of the increased demand for health services is too low. Actually, our estimate is in line with many of the independent estimates. We estimate a total rise in demand of 4 per cent. That is in line with Fraser of Allander—in fact, it is slightly higher than what the Fraser of Allander institute has recommended. It is also in line with the Institute for Fiscal Studies, and with the King’s Fund, the Nuffield Trust and the Health Foundation letter to the Prime Minister, so I take issue with that claim.

Secondly, John McLaren suggests that our estimate for the savings that the health service can make is too high, but it is consistent with past performance and lower than the savings requirements that are being expected in England. Those are my views on the John McLaren report. In summary, our health service does face challenges, but we are the only Administration anywhere in the UK that has clear and robust plans in place to address and overcome those challenges.

Richard Leonard

 

“The NHS in Scotland is not in a financially sustainable position.”

That is in today’s Audit Scotland report. The First Minister can talk about her Government’s budget choices, but her budget choices forced health boards across Scotland to make £449 million-worth of cuts in the last financial year alone. The Government calls those efficiency savings, but let us be clear, those are cuts, and those cuts have increased year on year since Nicola Sturgeon became First Minister. Can the First Minister tell the Parliament how much local health boards have had to cut since she took office?

The First Minister

Health boards are not facing cuts. Health spending has increased year on year. If Richard Leonard wants to talk, as he is right to do, about the Audit Scotland report, he has to recognise that the Audit Scotland report today says that over the past 10 years, the health budget has increased in real terms over and above inflation by 7.7 per cent. That is not cuts—that is rising health budgets.

On the point about financial sustainability, I know that Audit Scotland corrected its online version of the report this morning. However, more substantively—this is just a statement of fact—because of the recent publication of the medium-term financial plan, it was not taken into account in the report. That plan sets out increases to health spending by £3.3 billion between now and 2023. That is over and above what the Fraser of Allander institute says is needed to deal with the inflationary pressures that Audit Scotland commented on.

We have put in place plans to build on the current record funding in the health service to ensure that it is financially sustainable in the future. If we had followed Labour’s spending plans from the previous Scottish election and what it said in its manifesto, our NHS today would be—Labour should listen to this—£360 million worse off than it is. That is the equivalent of the NHS losing 9,000 nurses.

We have the plans to ensure that our NHS is fit for the future, and we will get on with delivering them.

Richard Leonard

The answer to the question that I put to the First Minister—which she refused to give because she either did not know it or she did not want to admit it—is £1.1 billion. That is £1.1 billion-worth of cuts that health boards have had to make since Nicola Sturgeon became First Minister.

Today’s Audit Scotland report exposes the mismanagement of the NHS under the Scottish National Party. Too many staff are under too much pressure, too many patients are waiting far too long, and too many health boards are having to make swingeing cuts. The SNP has been in office for 11 years, and the Auditor General for Scotland has concluded today that the NHS in Scotland is not financially sustainable. That represents nothing less than an abject failure of Government, does it not?

The First Minister

In his first question, Richard Leonard asked whether I thought that Audit Scotland was wrong. I do not think that Audit Scotland is wrong. I have made the point that it has not taken full account of our latest financial plan, which was published just before the October recess. However, I could equally posit that question to Richard Leonard. Page 10 of the Audit Scotland report says that there has been a 7.7 per cent real-terms increase in total health spending in the past decade. If Richard Leonard is saying that that is not true and that there have been cuts to the health budget, is he saying that Audit Scotland is wrong? Frankly, he must be. He should try to have a bit of consistency in his questioning.

Let me set out the Government’s record. Yes, the NHS is under pressure. Rising demand is putting pressure on waiting times, but the vast majority of people are seen within the waiting times targets. Just earlier this week, the Cabinet Secretary for Health and Sport set out a plan that showed how we will deliver significant improvements to performance on waiting times.

Interestingly, if we look at the number of people waiting more than 12 weeks for treatment in the last full year for which we have figures—it is too high, I hasten to add; it is just over 80,000—and we go back to the last year before we came into power and Labour was in office, 104,867 people were waiting more than 12 weeks for treatment.

We have the plans in place to protect our health service, record numbers of staff, record funding and even more funding planned. We have the solutions while Richard Leonard only wants to talk about the problems.

The Presiding Officer (Ken Macintosh)

There is a lot of interest in asking supplementaries. The first is from Gillian Martin.


Immigration Policy (Deportation)

Gillian Martin (Aberdeenshire East) (SNP)

The First Minister is aware of the horrific situation in which my constituents David and Carin Connolly find themselves, with Mrs Connolly’s application to become a British citizen rejected by the Home Office, despite her husband of 32 years being a British citizen. The couple moved from Zimbabwe via Botswana to be with their son Marcus, who is also a British citizen, and they have lived for 10 years in Inverurie. Mrs Connolly is also the carer of her engineer husband, who is quadriplegic and requires 24-hour care. I have written in support of their case ahead of their appeal tribunal and to the First Minister. What more can we do to support the family and make the case for Mrs Connolly being allowed to remain in Scotland with her family?

The First Minister (Nicola Sturgeon)

I thank Gillian Martin for raising the case. I read the details of Mr and Mrs Connolly’s case in the Daily Record this morning, and I commend Gillian Martin for taking up the case and for arguing it so strongly.

My heart goes out to Mr and Mrs Connolly, and I hope that they get the opportunity to stay as a family in Scotland. I have complete sympathy for anybody attempting to navigate the increasingly complex and restrictive United Kingdom immigration system. The one-size-fits-all approach imposed by Westminster is arbitrary, and it is very often inhuman, particularly in cases that threaten to rip apart families.

Every day, we literally hear more and more stories of lives across the country being disrupted by those disastrous policies. We want to welcome people to come and live here and contribute to our communities, not to threaten to force them to leave once they settle.

If there is more that the Scottish Government can do to help Gillian Martin argue the case, I am more than happy to look at that and see that we do that. I take the opportunity to wish Mr and Mrs Connolly well, and give them the message that the vast majority of people in Scotland welcome them here and want them to stay in our country.


National Health Service (Discharge and Care Plans)

Peter Chapman (North East Scotland) (Con)

How many patients does NHS Grampian discharge before a necessary care plan is put in place?

The First Minister (Nicola Sturgeon)

I am happy to have the health secretary write to the member with the detail that he is looking for, as I do not have that detail to hand.

Nobody should be discharged before it is safe for them to be discharged and before the necessary care plans are in place. I know that all health boards and increasingly, of course, integration joint boards work very hard to make sure that that is the case. As we have seen over the past few years, the number of delayed discharges is coming down overall and we have health and social care services working more closely together to make sure that people have the clear plans that they need.

I will make sure that the specific detail is provided to the member.


Recreational Use of Firearms (Regulation)

Daniel Johnson (Edinburgh Southern) (Lab)

In recent days, the recreational use of firearms has been in the press, from the shooting of goats to an issue of concern in my constituency about the opening of a gun shop mere yards from South Morningside primary school. The school has been in touch with the police, but it can take no action because the police’s locus is over who can be a firearms dealer and not where those businesses locate. The council has no locus, because the police regulate firearms. Indeed, on that basis, the council would have more interest if someone was seeking to open a fast-food joint rather than a gun shop. Does the First Minister believe that a gun shop is just another shop? Does she believe, as I do, that this apparent loophole should be closed, and that we should regulate not just who can operate firearms businesses but where such businesses operate? Does she believe that it is right to have a gun shop next to a primary school? I know that I do not.

The First Minister (Nicola Sturgeon)

I thank the member for raising the issue. I do not know the details about the shop that he has raised but, in general terms, I agree that that issue is not something that I feel instinctively comfortable with, so I understand his concerns. I also agree that we should not see gun shops as just the same as all other shops, for very obvious reasons.

As Daniel Johnson will be aware, the power to make most firearms legislation is reserved to Westminster, with the exception of that on air weapons—we are the only part of Great Britain to license those—and firearms licences are issued by Police Scotland. I am more than happy to look into the particular case that he raises, and to come back to him if I think that there is more action that the Scottish Government ,or any of our agencies, should be taking. If he has not already done so, I also encourage him to raise his concerns with Police Scotland. I understand the reasons for what he has described today causing deep disquiet, and I am sure that many other people will, too.


Air Services (Western Isles)

Dr Alasdair Allan (Na h-Eileanan an Iar) (SNP)

The First Minister will be aware that Eastern Airways recently cancelled its Stornoway to Aberdeen service, with effect from tomorrow. What more can the Scottish Government and its agencies do to ensure the economic viability of air services to and from the Western Isles, particularly for those of my constituents who work in the oil and gas sectors?

The First Minister (Nicola Sturgeon)

I can understand Alasdair Allan’s concerns about that. We have to ensure that connectivity between all our islands—including those in Alasdair Allan’s constituency—and the mainland encourages sustainability, both economically and in a range of other ways. I am happy to ask the Cabinet Secretary for Transport, Infrastructure and Connectivity to engage with him and with the airline to see whether there is more that the Scottish Government can and should do to address his concerns.


Teachers’ Pay

3. Patrick Harvie (Glasgow) (Green)

Next Saturday, thousands of teachers will take to the streets of Glasgow to make clear their demand for a fair pay settlement. They have already told the Government that they will not have their members divided against one another, with some being given a decent rise and others being left behind. The loss of 3,500 teachers since 2007 and the reliance on temporary contracts for so many newly recruited teachers are having a direct impact on the quality of education. It means more stress in classrooms and staff rooms, more teachers who do not have the permanence that lets them build strong relationships with their pupils, music lessons being axed, and children going without their additional needs being identified or met. Will the First Minister promise the teachers who will be marching on Saturday that the Government will give them the fair pay rise that is due, so that we can attract and retain the teachers our children need?

The First Minister (Nicola Sturgeon)

First, we are committed to fair pay rises for all our public sector workers. Where we have already agreed deals, we have demonstrated that—both for agenda for change workers in our national health service, for whom we have awarded the best pay rise of any country in the United Kingdom, as far as I am aware, and for our police officers, for whom the pay rise goes beyond that which is being offered south of the border.

The teaching unions have formally rejected the latest offer from the Convention of Scottish Local Authorities, but we are all committed to continuing discussions. Of course, the Scottish Government is actively involved in the negotiations, and urges everyone around the table to take a constructive approach. We had worked with COSLA to put in place a fair pay offer for 2018-19, which would see the Scottish Government contributing an additional £35 million of funding for teachers’ pay. That would result in all teachers on the main grade scale receiving at least a 5 per cent increase, with some receiving up to 11 per cent in one year. I believe that that is a generous and fair offer, and I hope that it will be considered as such. However, we are committed to continuing negotiations in good faith.

Lastly, I absolutely understand and sympathise with Patrick Harvie’s point about parity. We value the whole education workforce and recognise the aspiration for parity between teachers and non-teachers. I simply point out that two different negotiating arrangements are involved: the Scottish Government is party to the teachers’ pay negotiating mechanism, whereas pay for non-teachers is negotiated between COSLA and the trade unions, and we are not part of that process. However, that should not take away from the fact that we have sympathy with the overall point that has been made. We want to have in place pay and other arrangements that attract people into teaching and give them rewarding careers once they are in it.

Patrick Harvie

Parity—even within the teaching workforce—does not seem to have been acknowledged yet. The teachers who will be marching on Saturday say that all teachers deserve a 10 per cent rise: it is necessary in order to make up for the years of below-inflation, real-terms pay cuts. The consequence of getting this wrong will not be just unhappy teachers, who will perhaps even feel forced to take industrial action: holding back teachers’ pay and squeezing the budgets of our local councils will prevent the educational improvements that I believe the First Minister wants to see. The issue is not only about our teachers and schools: the councils that fund them need the resources to do the job properly and to do everything else that we expect of them, from social care to environmental services.

If we want the excellent public services that this country deserves, we need to make the resources available. When will the Government finally give councils both the funding and the powers that they need and deserve?

The First Minister

In our last budget we agreed with the Green Party a deal for councils that delivered real-terms increases in the budget that they have to spend. Of course, we were also the first Government anywhere in the United Kingdom to lift the 1 per cent public sector pay cap.

On the point about parity within the teaching profession, I am not going to comment specifically on teachers as the negotiations are on-going, but generally, within our public sector pay policy—I think that this has been backed by the Greens and others—we have recognised the need to give bigger pay increases to those at the lower end of the scale than to those at the higher end of the scale. I believe in that progressive principle and I thought that Patrick Harvie agreed with it, too.

In terms of pay deals, we absolutely recognise that public sector workers have taken a lot of pain, through pay restraint, in recent years. We are committed—I have made this very clear, as has the Cabinet Secretary for Finance, Economy and Fair Work—to redressing that as quickly as we can. We have to do that in a way that is fair, but it stands to reason that we also have to do it in a way that is affordable.

We have demonstrated our commitment on the issue. The 9 per cent rise over three years that has been agreed for nurses and other agenda for change workers and the 6.5 per cent over 30 months for our police officers strike a balance between fairness and recognising that we have ground to make up for public sector workers, and recognising that we must have deals that are affordable. I hope that we can reach the same fair outcome for teachers, because we all want them to be properly rewarded for the excellent job that they do, for their sake and so that we can continue to attract new people into the profession in the years to come.


National Health Service (Waiting Times)

4. Willie Rennie (North East Fife) (LD)

I will take the First Minister back to the national health service. Earlier, she talked about her plan to meet the waiting time targets that she has so far failed to meet. Page 4 of that plan shows that performance will continue to decline. The next quarter’s figures will be worse than those for the last quarter, which were worse than the ones before that and the ones before that, too. Why is it that, in year 12 of a Scottish National Party Government, we still have to expect waiting times to get worse before there is any sign of them getting better?

The First Minister (Nicola Sturgeon)

The answer to that is pretty well known to Willie Rennie and others. I repeat what I said to Richard Leonard: the vast majority of patients are seen within our waiting time targets. One observation in the Audit Scotland report on the NHS that was published today is that 90 per cent of patients rate their care as good or excellent. That is a tribute to the NHS and to all of the staff across the country who work in it. However, demand on our NHS is rising, largely because of the ageing profile of our population, and that is putting enormous pressure on waiting times.

This week, the Cabinet Secretary for Health and Sport was utterly transparent about those challenges, the impact that they are having right now and the funded plans that we have in place to address those challenges and substantially and sustainably reduce waiting times. I think that that is the right way to go. Although it gives Willie Rennie the opportunity to come and ask his questions today, it is important and right for us to be fully frank, honest and transparent with Parliament about the nature and scale of the challenge that we face, so that Parliament can hold us to account as we work through the plan in the years ahead. I will continue to work with the health secretary to ensure that we have in place the funding, the staff resources and the reform plans to ensure that our NHS is fit for the future. That is my responsibility, and I will continue to live up to it.

Willie Rennie

But the law states that patients will be guaranteed NHS treatment within 12 weeks—it is the First Minister’s law from when she was health secretary. It was an SNP flagship law, which helped the party to take power in 2007, and it is a law that the SNP Government has broken more than 100,000 times.

On Tuesday, the Government said that it would keep on breaking the law for another three years. If a member of the public were to break the law that many times, they would serve time in Barlinnie, so why is it that when the SNP Government breaks the law, it thinks that it can get away scot-free? Will the First Minister tell the people of Scotland what exactly the penalties are for breaking the law that she has flouted so many times?

The First Minister

Willie Rennie always manages to let himself down on serious issues. I will return to the serious point.

Mike Rumbles (North East Scotland) (LD)

You are not answering the serious point.

The First Minister

I am trying to answer it. It is true that the 12-week treatment time guarantee has not been adhered to more than 100,000 times, but 1.6 million patients have been treated within the time—patients who might have waited more than 12 weeks without that guarantee. As I have just said, there are now fewer people waiting more than 12 weeks for treatment than was the case when the SNP Government came into office.

The sanctions and steps that are taken when health boards do not meet the treatment time guarantee are laid down in the law. Like anyone else, Willie Rennie can go and look at what they are. The health secretary engages with health boards. Health boards have obligations to advise and inform patients of what they will do to deliver the treatment as quickly as possible, and the health secretary monitors health boards on that.

Standing here today, I do not shy away from the challenges that our health service—in common with health services across the United Kingdom and further afield—faces. We have put in place plans around both investment and reform to ensure that we meet the targets and that the quality of care is what patients expect.

Finally, I go back to the Audit Scotland report. On radio this morning, the Auditor General repeated the point that the report is very clear about the high quality of care delivered by staff in our NHS. That is something that we should thank them for.

The Presiding Officer

There is a lot of interest in asking supplementary questions, so I will take several questions.


Climate Change (Targets)

Mark Ruskell (Mid Scotland and Fife) (Green)

The science is clear: we have just 12 years, which is three parliamentary sessions, left to avoid dangerous climate breakdown. This week, the Environment, Climate Change and Land Reform Committee heard directly from the Intergovernmental Panel on Climate Change that all climate change targets need to be reconsidered.

Can the First Minister explain why the Scottish Government, alongside the UK Tory Government, has asked its advisors to consider only whether changes are required to the long-term climate target, and not also to consider the need to increase ambition between now and 2032?

The First Minister (Nicola Sturgeon)

We have specifically asked the advisors about the shorter-term targets, too. The Cabinet Secretary for Environment, Climate Change and Land Reform has told me that that is the case, but I will be corrected if I have got that wrong.

The shorter-term targets for 2020 and 2030 that are set out in the Climate Change (Emissions Reduction Targets) (Scotland) Bill that is currently going through Parliament are already the most stretching targets anywhere in the world. We take the IPCC report extremely seriously. The report’s central recommendation is that the world should reach carbon neutrality by 2050. The bill will deliver that for Scotland. We are already well past peak emissions; the other point that the IPCC report makes is that the world needs to get to peak emissions imminently.

Many people have the aspiration, which I share, to go to net zero for all emissions as quickly as possible. We have asked the Committee on Climate Change to give us updated advice on that, because its current advice is that the target in the bill of 90 per cent by 2050 is already at the limit of feasibility. The bill puts obligations on ministers to review the targets to get to net zero as quickly as possible.

We are recognised internationally as a world leader in tackling climate change; I am determined that we should stay at the leading edge of world action to tackle climate change for the benefit of this generation and, more important, future generations.


Social Security (Children)

Tom Arthur (Renfrewshire South) (SNP)

What is the First Minister’s response to comments that were made in Parliament yesterday that people who are reliant on social security, including those receiving in-work benefits, have no right to have more than two children?

The First Minister (Nicola Sturgeon)

The comments that were made by Michelle Ballantyne in the chamber yesterday were both appalling and ignorant of the reality that is faced by many families. [Applause.]

The comments were appalling because the idea that being poor should be a barrier to having a family is Dickensian, and shows the Scottish Conservatives in their true colours. The comments were ignorant because the rape clause will not apply only when children are first born: from next year it will apply to children of any age when a family’s circumstances change such that they need to claim benefits. To defend the rape clause misses the point, which is that any of us can experience a change in circumstances at any time.

Michelle Ballantyne seemed to suggest that if a family who had three children while the parents were in work were suddenly to fall into different circumstances, those children should be penalised as a result, which is absolutely shameful. The social security safety net is there for all of us, should we need it in times of distress or in changed circumstances. Shame on the Conservatives for dismantling that social security safety net.


Migrant Workers’ Pay

Jackie Baillie (Dumbarton) (Lab)

The First Minister will be aware that the workers who have been hired to build the flagship £2.6 billion Beatrice offshore wind farm have included migrants without immigration documents who have been paid a fraction of the minimum wage—some of them have been paid less than £5 an hour.

The Scottish Government believes that green energy is a priority. Will the First Minister act to ensure that green jobs are not exploited jobs, and stop that happening on major infrastructure projects in Scotland?

The First Minister (Nicola Sturgeon)

I unreservedly condemn any employer that exploits workers in that way. I am happy to ask the Cabinet Secretary for Finance, Economy and Fair Work and the Cabinet Secretary for Transport, Infrastructure and Connectivity to look into the specific case to which Jackie Baillie has referred, and to give her their findings once they have had the chance to do so.

It is my expectation as First Minister, and it is the expectation of the Scottish Government, that employers have fair work policies. Over the recess, we announced plans to toughen our approach to fair work as regards our expectations when Government grants are awarded, and in relation to the public procurement system. We will in due course set out more details of those plans to Parliament.


Influenza Vaccine (Over-75s)

Rachael Hamilton (Ettrick, Roxburgh and Berwickshire) (Con)

Despite receiving an influenza vaccine, one of my constituents developed pneumonia and, as a result, required a four-day admission to Borders general hospital. The First Minister will be aware that, in Scotland, the new flu jab is available only to over-75s. Last year, influenza and pneumonia deaths hit an 18-year high. With a cold snap predicted, is the First Minister confident that under-75s are properly protected, and that the NHS has the correct resources that it needs to prevent more deaths?

The First Minister (Nicola Sturgeon)

Yes, I am confident in our vaccination programme. As responsible members of the Scottish Parliament, all of us should encourage the public to be confident in that vaccination programme. Supplies of the vaccine are already available to general practitioners and the programme is under way.

A number of different vaccines are in use for different groups of people. As far as over-75s are concerned, it was the recommendation of the United Kingdom Joint Committee on Vaccination and Immunisation that if use of vaccine had to be prioritised, over-75s should be in the priority group, so the Scottish Government has ensured that.

Supply issues that are beyond our control have meant that, this year, we cannot extend that to over-65s, but we will do so in future years. However, the vaccine that is being used for over-65s is effective. I take this opportunity to encourage all those who have not yet had the vaccine and who are eligible to receive it to do so as quickly as possible, because as well as protecting them, that helps to protect the population as a whole.


Daylight Saving Time

5. Christine Grahame (Midlothian South, Tweeddale and Lauderdale) (SNP)

To ask the First Minister what the Scottish Government’s position is on the use of daylight saving time. (S5F-02693)

The First Minister (Nicola Sturgeon)

I am aware of the European Commission’s proposal to end the current daylight saving arrangements. The Scottish Government does not believe that there is a substantive economic or social case for any change to the arrangements. This week, the Cabinet Secretary for the Rural Economy has written to the United Kingdom Government to stress that the effect of the proposal, if it is implemented, would be more pronounced on Scotland, given the greater extremes in the extent of our daylight hours. It is likely that the impact would be particularly strongly felt by the farming community and other outdoor workers.

We are engaging with stakeholders to understand better the potential impact of the proposal, and we will ensure that any concerns that are raised are reflected in our on-going discussions with the UK Government.

Christine Grahame

I thank the First Minister for her answer, and the Scottish Government for its support for putting the clocks back by one hour this weekend. I must remember to do that; I did not do it one year.

I welcome the Cabinet Secretary for the Rural Economy’s letter to the UK Government which, being located so far south, sometimes fails to recognise how long our winter mornings can be. Will the Cabinet Secretary for Transport, Infrastructure and Connectivity also contact the UK Government on the issue of road traffic accidents and the effect of the dark mornings on the safety of our schoolchildren who walk to school and, in particular, those who do so in rural areas where there are no pavements and no street lighting, such as in my constituency in the Borders and Midlothian?

The First Minister

I am tempted to say that the fact that Christine Grahame, due to a lapse of memory years ago, is one hour out of sync with the rest of us might explain an awful lot; I am sure that I will pay dearly for that comment in the weeks and months to come.

The issue that Christine Grahame raises is a serious one. We will be happy to make available to Parliament the letter from the Cabinet Secretary for the Rural Economy and, likewise, any response that we receive.

As I said in my answer, we are currently gathering views on the impacts of the proposed change, which will include the impacts on transport and other areas that were highlighted by Christine Grahame. The European Commission has stated in its proposals that the evidence is currently inconclusive in terms of road safety.

This is a reserved matter, so we will continue to liaise with the UK Government, and with the transport sector and rural communities, on this important issue. If there are issues that the Cabinet Secretary for Transport, Infrastructure and Connectivity also needs to raise, he will certainly do so.


Support for Patients

6. Alexander Stewart (Mid Scotland and Fife) (Con)

To ask the First Minister what the Scottish Government’s position is on the report from Chest, Heart & Stroke Scotland, which suggests that one in five patients is not receiving the support that they require. (S5F-02709)

The First Minister (Nicola Sturgeon)

We welcome Chest, Heart & Stroke Scotland’s report and will continue to work alongside the charity to support people living with and affected by those conditions.

Our plans to improve rehabilitation are set out in our stroke and heart disease improvement plans. We are working in partnership with national health service boards, the voluntary sector and a range of providers across health and social care, to ensure that people who have heart disease or who have had a stroke get access to the care and support that they need to help them to return to independent living.

Our strategy for tackling strokes and heart disease is delivering improvements, with mortality rates having reduced by about 40 per cent for both stroke and coronary heart disease over the past 10 years.

Pulmonary rehabilitation is already a key recommendation in our national clinical guidelines.

Alexander Stewart

What assurances can the Scottish Government give that it will do all that it can to end variations in access to NHS rehabilitation services and allied health professionals, given that although pulmonary rehabilitation is in the clinical guidelines, an estimated 60,000 people who should be receiving it are not currently doing so?

The First Minister

As I said, we welcome the report by Chest Heart & Stroke Scotland and I take the opportunity today to commend the charity for the work that it does. The Cabinet Secretary for Health and Sport recently met CHSS to begin discussions on the campaign, and she has given the charity a commitment, which I repeat today, to continue the discussions in order to see how we can move towards a right to rehab, which is the end result that CHSS is looking for.

As I said, we have plans in place to improve rehabilitation: the stroke and heart disease improvement plans, which include priorities on rehab, transition to the community and supported self-management to support people to live longer, healthier lives in their communities. Our stroke improvement team and the cardiac rehabilitation champion are working across health and social care and with the third sector to help us to deliver on those priorities.

We will continue to take forward our existing proposals and any enhanced proposals that are required as a result of our discussions with Chest Heart & Stroke Scotland.

The Presiding Officer

That concludes First Minister’s question time. Before we move to the members’ business debate, we will have a short suspension to allow the gallery to clear and our guests for the next debate to arrive.

12:47 Meeting suspended.  12:50 On resuming—