26/10/2017: First Minister's Questions Politics Scotland

Good morning. Here at the Scottish

Parliament it is questions to the

First Minister as ever. SNPs can ask

everything and anything. I suspect

some may want to ask about today's

Audit Scotland report on the NHS.

The opposition SNPs will want to

talk about report findings on missed

targets, on improvement stalled, on

the improvements for the health

service. The First Minister will

want to reply by talking about

patient satisfaction. That may come

up. Other things may come up. Only

one way to find out. Let's cross to

the chamber.

Ministers will wish to join me in

thanking coming to the gallery the

High Commissioner.

Question number one.

This morning's

Audit Scotland report said reform of

the NHS is progressing, but major

challenges still lie ahead. Nobody

underestimates the work needed to

see services improve year on year

within our health service. The

bottom line is seven out of eight

key performance standards have been

missed this year. Can I ask the

First Minister to confirm how many

of these performance standards have

seen any improvements over the last

five years?

Of course, in England,

under the Conservatives, it is eight

out of eight.

Let me address... Let me address

directly the Audit Scotland report.

Firstly, for completeness, let me

point out some of the audit Scotland

findings, I suspect we will not hear

from the opposition today. Firstly,

NHS staff are maintaining and

improving the quality of care.

Secondly, there is a strong culture

of continuous improvement in the

NHS. There is a continued focus on

safety and improvement. It levels

the patient satisfaction at an all

time high in the NHS and there are

signs that reforms are having a

positive impact. The report points

out that since 2008 there has been

an 8.2% above inflation increase in

spending in the National Health

Service and that health today

accounts for a higher proportion of

the Scottish Government budget than

in 2008. As we know, in every health

service across the developed world,

changing population patterns means

there are rises demands on our

health service. However, in meeting

these challenges in Scotland and

they are big challenges, I think

against many measures, we are seeing

the NHS in Scotland perform better

than the NHS in any other part of

the UK. That is because of the

actions we are taking. Increased

investment, reform, integration of

health and social care. The focus on

realistic medicine and the work we

have done in A&E are doing in

elective care more generally. This

is tough stuff. Nobody denies that.

We will continue to focus on

delivering the investment and reform

the NHS needs and patients across

the country deserve.

The answer according to Audit

Scotland was one. There has been any

improvement at all in the last five

years. The reason they say is

because this Scottish Government is

still struggling to do the basics.

One of the big thuns is staffing.

Audit Scotland warned two years ago

that we needed a new national

approach to workforce planning. The

Scottish Government promised to

deliver by 2017. That grew to three,

two of which we are waiting on. And

the only one published according to

Audit Scotland isn't a plan at all.

And what's more, the auditor makes

clear there's no likelihood of the

Government being able to produce a

proper plan because it still doesn't

have the data to do so. Audit

Scotland has been warning about this

for years. Why is there no proper

plan in place and why isn't there

the data to allow one to be written?

Actually, one of the things the

Audit Scotland report points to is

the improving data we have, not just

in the acute service but across

primary care that allows us not just

to monitor trends in the NHS but

drive improvement. Specifically one

of the things the Audit Scotland

report points to as a sign of

positive improvement. I make this

point seriously because I accept the

challenges in the health Serhal vis

and I accept the responsibility of

this Government, the Government that

I lead to face up to and address

these challenges in Scotland. Ruth

difs son seems to want to say the

challenges in Scotland's NHS are you

-- Davis son seems to want to

suggest it is down to Scotland's

NHS. She has to explain why under

the Conservatives in England why no

NHS targets are being met. It is a

serious question for the

Conservatives. Now on the specific

issue of staffing, as Ruth Davidson

is aware there has been a plan

looking at NHS staff, one of the

pieces of legislation we will take

forward in the coming Parliament is

built enshrined safe staffing levels

in law. But increasingly and anybody

who knows anything about how health

services are delivered these days

knows you cannot look at the NHS in

isolation. So the second and third

part of the NHS and health more

generally workforce plan will look

at social care and local authority

staffing as well. So that we bring

together an integrated plan, mapping

out the staffing needs for the NHS,

not just now, but in the years to

come. That's the right way to do

this. And that is what we will

continue to take forward. The final

point on staffing, it is a point I

have made before, Presiding Officer,

and will continue to make it. One of

the biggest risks we face in

Scotland, generally, and in the NHS

in particular, is a growing

inability to recruit people into our

public services. And why is that?

Because the Conservatives want to

stop or restrict our ability to

recruit the best and brightest from

other countries. That's one of the

biggest risks we face to

recruitment. Ruth Davidson should be

ashamed of herself for supporting

that.

Presiding Officer, if I can talk a

little bit at length to what the

auditor general says on this matter

the First Minister has tried to

sweep under the carpet." It is not a

plan to address mediate issues. The

Scottish Government is likely to

find it challenging to find any more

detail in the next two plans, due to

a lack of national data on the

primary care and social care

workforces." The data isn't there

and the plan isn't there. Let's talk

about one area where that lack of

planning is having a real and

immediate effect. That is in primary

care. GPs are central to the changes

we all agree, all of us agree are

needed to improve health care. This

has been hindered by the continuing

difficulties in recruiting and

retaining family doctors. And the

Royal College of GPs make it clear,

they have said the SNP has cut the

share of spending going to GPs over

the last decade and they ask, how

can hospital targets possibly be met

when people feel they have to attend

A&E because they cannot secure an

pointment closer to home? Does the

First Minister have an answer for

the Royal College of GPs?

Firstly,

in terms of staffing, it is

precisely because we need to make

sure that there is an integrated

plan across not just the acute

health service but primary and

social care, that we are developing

the workforce plan in the way we are

doing it in the way that I think

Audit Scotland would advice us to

do. That is why we will continue to

take forward that work. Now, in

terms of GPs, again, we Scotland is

not the only country that is

experienced in challenges in

recruiting GPs. That is why we have

taken forward a range of different

actions from increasing the number

of medical training places in our

universities to establishing a new

graduate entry programme, which will

focus specifically on general

practise and of course rural and

remote working. We've seen this year

an increase of year one trainees,

compared to last year, at the same

toint point last year, it was 65%.

It is up to 74% this year. And we

have of course have a commitment to

increase the proportion of the total

health budget going to primary care

by 500 million over this Parliament,

taking it to 11% of the total NHS

budget, with which I think is a

greater commitment made by any

Government anywhere else across

these islands. So these are big

challenges. Anybody can stand up

here, Ruth Davidson can point to the

challenges. I accept the challenges.

This Government is putting in place

the actions to address those

challenges and that is what we will

continue to do.

I am standing up

here calling on the First Minister

to honour the promise that she made

to GPs a year ago. I am standing up

for GPs for saying she's gone back

on her words. And it's not being

delivered. Now, today, we've had a

report from the nation's auditor

saying that health in Scotland is

not improving and huge inequalities

remain. There's been a 99% rise in

the number of patients we think more

than 12 weeks in the last year

alone. The SNP set their own target,

but they have improved only one in

the last five years. We know there's

no long-term plan, even though one

was promised for the start of this

year, that GPs are being underfunded

and that we spent £171 million

hiring in agency staff to plug the

gaps. Yesterday I met a group of

fantastic trainees at the Edinburgh

medical school. What assurances can

the First Minister give to them that

after ten years of Audit Scotland

reporting the same failings over r

over health she'll actually take

some action to turn it around?

Actually, a number of points to take

on there. The agency spend in the

first year is down. Something which

is recognised in the Audit Scotland

report. We are taking the range of

actions to make sure we've got the

right people coming into medical

training and making sure we can get

them into the NHS, delivering the

excellent care that the NHS delivers

for patients across the country.

Again a reminder that the Audit

Scotland report points to the fact

that NHS staff are not just

maintaining, but improving the

quality of care across our NHS. Ruth

Davidson I don't know if she

understands the commitment we have

made to primary care. She says we

have not kept the commitment we made

last year. . Over the life of this

Parliament we will increase spending

on primary care by £500 million.

£250 million of that will be

specifically in general practise.

The reason not all of it is in

general practise is that in order to

take pressure off our GPs we need to

build wider primary care teams.

That's the commitment. That will

take the proportion of NHS spending

in primary care to 11%. That is the

commitment we will deliver over the

life of this Parliament. And I would

say again, that is not a commitment

that's repeated by any other

Government across these islands. You

know, we come back to the point

here, the central point that we so

often come back to, when we are

discussing public services in this

Parliament. This Government, the

Government that I lead since we came

to office have increased the health

service budget by £3 billion. Again

recognised in the Audit Scotland

report. Ruth Davidson stands up week

after week calling for action in

health, for education, in a range of

public services, but this is the

same person who would reduce the

amounted of money we have available

for public services by giving tax

cuts to the richest people in our

society.

Presiding Officer, it doesn't add

up. Ruth Davidson cannot offer tax

cuts to the richest whilst calling

for more investment in our public

services. The Tory policies and the

Tory approach has no credibility at

all. So we will continue to deliver

the investment. We will continue to

deliver the reform. Actually the

most important finding in this Audit

Scotland report today is the one

that says these reforms that this

Government is introducing are

starting to show the positive

effects they are designed to do. We

will continue with that focus,

delivering for people across the

country.

Presiding Officer, it is worth

remembering that there was the

report published a few weeks ago

that showed that spending per head

of population in Scotland compared

to England had fallen as a result of

the, direct result of decisions made

by this Government.

But I would say Presiding Officer

that anyone reading this report from

the auditor general this morning on

the NHS in Scotland cannot be

anything but concerned. Concerned

about the budgets and the financial

management of the health and social

care in Scotland.

Concerned about the shortages of

staff at every level and concerned

for the impact of all of this on

patients. The report clearly states

that the patient experience will get

poorer, unless the pace and scale of

necessary change is actioned and

actioned now. When are we going to

see that level of change being

actioned?

As any reading of the Audit Scotland

report would tell you, we are seeing

that change happen in the NHS. It is

one of the key findings of the Audit

Scotland report. One of the key

points that is made in the Audit

Scotland report that we are now

starting to see, the reforms

introduced, it looks specifically

integration authorities and says

these reforms are now starting to

deliver the change that we need to

see. In terms of spending, of

course, spending per head of

population on the health service in

Scotland is 6.5% higher than it is

in the UK as a whole. £143 higher

for every person in Scotland,

compared to the rest of the UK. And

again, this is a point I make

frequently. All parties have to be

accountable for what they put

forward. Labour went into the last

Scottish election promising less

money for the health service than

any other party, even the Tories,

for goodness' sake represented in

this Parliament. The fact of the

matter is, there is record funding

going into our health service, there

are record numbers of people working

in our health service. But as Audit

Scotland expressly says in this

report, it is no longer enough just

to put extra money into the health

service because of the rising

demand. We need to deliver reforms

and those are the reforms that we

are delivering, the reforms,

according to Audit Scotland are

starting to show real benefits to

patients across the country.

If we stick to the facts, we have

health boards, across Scotland, not

able to make the cuts to balance

their budgets. Those same boards

borrow money from the Government to

balance the books, store and got

debt for the future. Prescribing

costs are increasing at a level that

is not sustainable. Indeed, we now

have council tax funding being used

to be able to pay for prescriptions

through the integrated joint boards.

The lack of workforce planning is

driving up costs and we are having

to use more and more agency staff

and locums. The entire thing is

spiralling out of control. The Royal

College of Nursing, Presiding

Officer, are today calling for

clarity on how more care will be

delivered in the community, and they

want to know how staff and the

public will be engaged in the

development of services, community

services, moving forward. Can the

First Minister answer that question?

I am not quite sure which question

he wants me to answer first. Alex

says prescribing costs are rising.

Prescribing costs are rising in

every health service across the

developed world, probably across the

entire world. It is a feature of the

ageing population and it is exactly

the challenge health services here

and elsewhere are dealing with, that

is why we have got to reform how

care is delivered. He asked about

how we deliver more care in the

community. As I am sure Alec Rowl

knows, for the less two budgets, and

again it is narrated in the Audit

Scotland report, we have taken the

very difficult step of transferring

money from the NHS in the

integration authorities, so that we

bring together Health and Social

Care Act not just in theory, but in

practice, because we know, and Audit

Scotland talks about the reduction

in delayed discharges this

integrated approach is now

delivering. If we do that to build

social care, we take the pressure

off the acute services. To all the

parties in Parliament, this is not

easy stuff it is not easy in

Scotland, England, Wales, Northern

Ireland, any part of the world. But

in Scotland, we are doing some of

the necessary stuff still being

dodged in most other parts of the

UK. We are doing the reforms,

integrating Health and Social Care

Act, transferring the budgets,

taking the steps around workforce to

insure the NHS can deliver in the

face of the rising demand basis, and

that is why well everything the

Audit Scotland report says is

important and has to be addressed,

the key finding of the Audit

Scotland report in my view as First

Minister with risk once ability but

these reforms, the key finding is

these reforms are starting to show

positive signs. That says to me we

stick with what we are doing because

we are on the right track and that

is why we keep that focus.

Alec Rowley.

I accept totally that this is not

easy. And I think what the Audit

Scotland report says today is we are

not doing enough and not moving fast

enough. As, however, important for

us to remember that behind all the

statistics is real people. So today,

we should remember it is about

people trapped in hospital because

they cannot get the care packages

that they need in the community. It

is also about those people in

communities across Scotland who

cannot get the support from Health

and Social Care Act that they need.

And it is for all those people on

the waiting list. And it is the

dedicated staff in our hospitals and

health centres and community care

centres that are run off their feet,

that is why we need action. Labour

will use the debate in this

Parliament next week to discuss this

report further. I believe we do need

a more detailed discussion on the

findings of this report. After ten

years in government, the First

Minister has a choice, she can

continue to do more of the same or

will she publish a response to this

report that will tell the people of

Scotland how her government intends

to tackle these big issues facing

health and social care services in

Scotland?

Well, firstly, I welcome the fact we

will debate the report, I warmly

welcome that and maybe in that

debate if Labour's position as the

Government is not doing enough,

maybe Labour will bring forward

ideas as well, rather than simply

talk about the problems. The second

point is this, the point here which

any Reading of the Audit Scotland

report will tell you, is that we are

not just doing more of the same, we

are doing things differently and it

is those reforms that are starting

to have a positive impact the Audit

Scotland report talks about. Alec

Rowley says we should do it faster,

well, I am absolutely open to doing

this faster, but often when we bring

forward proposals for change, what

we find the impediments to those

change sitting on the opposition

benches. Because they never want to

do... Then never want to do that

stuff, they just want to get up

here. It is the easiest thing in the

world to diagnose the problems. Our

job and what we are doing is coming

up with solutions. And we will not

do daft and wrong-headed things that

we are seeing South of the border.

Because of the action we are taking

in Scotland, delayed discharges are

coming down because of sensible

change. In England, we see proposals

to use Airbnb to get people out of

hospital. We will continue to do the

sensible evidence-based things that

deliver the improvements in the NHS

that we are determined to continue

to deliver.

A couple of constituency questions.

The a 77 was closed for 24 hours

because of severe flooding. The

Director says, and I quote, it is

quite clear from this and other

incidents at the current A77 and a

75 do not fit the requirements. So

major destruction and loss of trade

could be major disruptions until

they commit the necessary resources

to evict these recurring problems.

Will the Scottish Government make

this long overdue commitment to the

people of the South West of

Scotland, and dual the roads?

We

have a range of improvements for the

roads in the South of Scotland and

all parts of Scotland. I'm sure all

members will appreciate there are

times when issues like putting will

result in a road being closed and

that is deeply regrettable but

sometimes unavoidable. I will ask

the Transport Minister to contact

the member about this issue in more

detail, but anybody looking at the

record of this Government, and the

Greens often criticise us for that,

the investment we have made

improving our roads over the past

ten years is good and we will

continue to do more including in the

south-west and the area in

particular the member talks about.

The First Minister may be aware that

the conclusions of the Government's

review of free ferry fares due out

at the end of the summer have not

been published. In the Northern

Isles, we were told freight fares

would be frozen and we later receive

notice they would rise by 2.9% next

year. How does she just by this

decision and houses square of

government objectives for lowering

the costs for those living on

islands? And does she think it is

right freight fares on West Coast

routes remain largely unchanged

since 2010 but have increasing

evidently for hauliers serving

Orkney and Shetland?

We have

invested over £1 billion in the

ferry services in 2007 and have

talked about a particular Audit

Scotland report this morning and

there was a report last week that's

it investment in very services has

doubled over the last decade. We

have introduced new routes and cut

the costs for Calmac customers and

will do the same for Orkney and

Shetland, so we have tackled

underinvestment that had been the

case for a long time and we will

continue to do so. And the terms of

the ferry fares review will be

published as soon as possible.

The First Minister will be aware of

it gas explosion in a derelict

building in Lanarkshire which

resulted in the right -- tragic

death of a worker from Coatbridge.

How will she be supporting the

investigation and what steps is she

taking to enhance safety and work

regulations in Scotland?

I want to

take this opportunity to express my

condolences for the family of the

man who died. The investigation

under the health and safety division

is ongoing and the family will of

course be updated in relation to any

developments. It would be

inappropriate to comment further

while those investigations are under

way. This issue is reserved to the

UK Government, the Health And Safety

Executive is responsible for drawing

conclusions as to whether the

relevant regulations remain fit for

purpose and I'm sure they will do so

once they have completed their

investigation into this particular

incident. But the thoughts in the

meantime of her body in the chamber

with a family and friends of the

individual who lost their life in

this incident.

Looking at today's report into the

challenges facing the NHS, I don't

think anyone should attend that

there is a simple, quick fix that

would solve every problem, but is it

not clear that challenges like

recruitment, retention and staff

morale will be made worse, not

better, if we fail to provide if

there a settlement for the dedicated

professionals providing these

essential services who have seen a

real pay cut of 14% over the last

five years?

Yes, that is why this Government is

committed to ensuring we do see

their pay settlements for public

sector workers, not just in the NHS,

but right across our public sector.

Again, I would say I think we are

still the only government anywhere

in the UK that is giving the

unequivocal commitment to lift the

1% public sector pay cap.

The commitment has been given to

lift the 1% pay cap, but no

commitment has yet been given to an

inflation -based increase, a real

terms increase, restoring the lost

value in people's pay that they

suffered over recent years. We have

heard yes MP's Kate Forbes, the PLO

to the Finance Secretary who works

with the Finance Secretary closely,

saying on television this week pay

settlement for the public sector

should be at least inflation, if not

above inflation. And we have also

heard a wider range of voices from

multiple political parties accepting

the basic green proposition that

their rates and balance of taxation

can raise adequate revenue to fund

our public services, without

resulting in cuts elsewhere and

without cutting the pay of public

service workers. I don't expect the

First Minister to publish her budget

today, but does she agree with that

basic point of principle that we can

provide an inflation -based increase

without hitting low earners through

Beragh taxation?

Firstly, we have given the

commitment to lift the public sector

pay cap, we have not made that

dependent on actions being taken by

the UK Government in the budget,

unlike the Welsh Government which

has done exactly that. We have said,

and I have said personally, that we

must look for pay settlements that

of fair and of course they must be

affordable, but they must also

reflect the real-life circumstances

public sector workers are facing and

that includes the rising cost of

living. We will of course, in the

normal course of events, confirmed

the detail of our public sector pay

policy when we publish the budget

because we require to know the

overall budget we have available

before we do that. That is the

normal way we do things and we will

continue to set out policy in that

way. In terms of the part of Patrick

Harvie's question focusing on tax, I

have the game said openly that

notwithstanding the different

manifesto commitments we are

required to come to a consensus

position on tax in order to pass a

budget. I think given the

continuation of austerity and the

implications of Brexit that are

becoming clearer by the day, we need

to ask ourselves as a Parliament how

we use our still limited tax powers

in order to protect our public

services and provide the

infrastructure businesses need to

thrive. Next week, we will publish a

discussion paper setting out some of

the options and the principles to

guide that's decision and that

discussion paper will form the basis

of the discussions across as

Parliament in the lead-up to the

budget. I suppose that is a long way

of saying, I do agree with much of

the sentiment behind Patrick

Harvie's question, but we have to

take proper decisions in line with

the proper process of budgeting

because unlike the opposition

parties, the governing party in any

Parliament has the responsibility of

making sure we campaign for the

commitments that we make. -- we can

pay.

The Government's policy of

prioritising full-time college

courses has result nds a cut of

150,000 part-time places. It has

deprived thousands the education

they want and need, particularly

women and older people. Last week,

the Education Minister sent a

guidance letter to colleges with an

apparent change in policy that had

never been announced publicly

before. Can the First Minister tell

me, has the policy changed? If so,

when did it change?

Of course, I

think most recent figures show the

majority of college courses are

still part-time courses. We and this

was a commitment we set out in a

manifesto. Given the rate of youth

unemployment we faced at the time we

made a deliberate decision and it

was the right decision to try and

increase full-time places at

colleges in order to increase the

likelihood of people going through

our colleges, getting into work at

the end of that and do you know what

- the proof of the pudding is in the

eating because youth unemployment in

Scotland today is half the rate it

was ten years ago when we took

office. We have one of the lowest

rates not just in the UK but

anywhere across the European Union.

The policy we will ask our colleges

to pursue will depend on the needs

of the economy at any given time and

that is the basis for the guidance

that the minister put forward that

Willie Rennie has referred to.

I think we see the evidence of that

in some of the economic data I have

talked about.

So nothing is changed,

but everything's changed? It is a

bizarre answer. Has the policy

changed or hasn't it changed? If

this was such a success story, why

did her minister sneak it out in a

paragraph seven of a letter on a wet

Wednesday afternoon? If it was a

success she'd be parading knit this

Parliament. Everyone knows, everyone

knows if the birth rate at the turn

of the century is more responsible

for the drop in youth unemployment

than any policy of this Government.

The truth is it's taken six years

for this Government to realise the

economic value of part-time learner

over the age of 24.

This is a crashing U-turn and the

First Minister should be big enough

to admit. Six years of narrowing the

focus has left us shot. That is six

years of missed economic

opportunity. Six years of abusing

those in this chamber, who dared to

question the policy. Will the First

Minister now apologise to the

generation of women and older people

who have lost out because of this

Government?

Order please!

Order please!

I'd appreciate if members would list

on the the question and listen to

the answer.

Thank you. First Minister?

Probably the fact his pals on the

opposition benches needed to give

him so much help there, suggest they

know how fundamentally wrong Willie

Rennie is. I will not apologise for

the fact we have youth unemployment

at half the rate today than it was

when this Government took office.

Normally I apollise for the fact

that we fought on a manifesto to

maintain full-time numbers in our

colleges. We exceeded that manifesto

commitment. So these are solid

achievements. But you know, the real

flaw, the real flaw in Willie

Rennie's question here is, in spite

of delivering that commitment to

increase full-time students at

colleges in order to get more young

people into work, the majority at

our colleges tend to be part-time

courses, open to the people that

Willie Rennie is talking about. We

will continue in colleges and every

other aspect of Government policy to

take forward the policies which are

right for this needs oh this

country. That is what we have done

and we will continue to do.

Thank you, Presiding Officer.

Today's record has figures showing a

quarter of Scottish councils are

already spending almost £9 million

mitigating the impact of Universal

Credit. Does the First Minister

agree with me that the impact on

people left in dire financial states

because of Universal Credit is

morally unacceptable? And the idea

that local authorities, or the

Scottish Government should have to

pay the price for failed Westminster

austerity is a disgrace?

Well, the fact that the UK

Government is refusing to pause the

implementation of Universal Credit

knowing that they are pushing people

into debt, into rent arrears, making

it difficult for parents to put food

on the take to feed their children

is not just morally unacceptable, it

is morally repugnant. Every

Conservative should be deeply

ashamed of this. The fact of the

matter is that Universal Credit is

not working. It is demonstrated in

the pilot areas. I went to

Inverness, talking directly to

people who found themselves in these

situations. We need to see a pause

to Universal Credit and now before

any other person has to suffer the

indignities and anxieties so many

have suffered. Again we come back to

this issue about mitigation. As

people across the chamber now we

should mitigate where we can. On

health, colleges, mitigating welfare

cuts, implemented and imposed by a

Conservative Government at

Westminster. The sooner we get all

the welfare powers into the hand of

this Parliament, the better.

Do you believe that cutting yet more

firefighter posts and closing fire

stations will, a. Make our

communities safer or B, put more

lives at risk? If you don't know the

answer, have a guess.

Firstly, let me... Sometimes you

only have to listen to the tone to

know the dire straits they are in.

It is bad. Firstly, let me take the

opportunity for thanking our firemen

and women across the country for the

vital work they do. It is the

importance of that work that has

meant that the Scottish Government

this year has increased the

operational budget of the Fire

Service. There's been, since reform,

no compulsory redundancies, no fire

station closures. Over the last year

we have seen the recutdment of 100

new -- recruitment of 100 new

firefighters. They cannot standstill

when circumstances are changing.

There are changing risks, changing

patterns of demand, changing

technology. It is right the Fire

Service look closely at how they

deal with that. The priority of them

and this Government is not just

protecting the front line, but

enabling our firefighters to do a

better service for the people of

Scotland in the future.

Could I ask the First Minister what

progress has been made with the

reaching 100 programme, for those

who did not receive support from

previous programmes for access to

super fast broadbands

The digital

programme Scotland programme has

been a huge success so far. It has

enabled fibre broadband to be

delivered to over 800,000 premises

in Scotland and we are on track to

meet 95% of premises with broadband

by the end of this year. However, we

recognise that many areas still

don't have access. That's why the

reaching 100 programme will focus on

extending super fast access to those

premises that will not be reached in

the current programme. We've

completed an open market review and

public consultation to formally

agree an intervention area and

undertaken engagement to maximum

competition. We will set out a

delivery approach in greater detail

shortly ahead of the launch of the

procurement exercise later in the

year.

I congratulate the Scottish

Government on its success on rolling

out super fast broadband. Tens of

thousands of military stations have

benefitted from the programme. I

wonder if the First Minister would

recognise the one side effect of the

success is the gap between the haves

and the have-nots. They have got

bigger and many rural communities

have not benefitted or received any

form of public support. Whilst we

await the next programme, the roll

out of 100, can the ministers

consider any other short-term

measures, perhaps working the

private sector to connect such

communities who in this day and age

see it as a utility, not a luxury.

Can they press UK ministers for

regulation like introducing

universal onably thegations and the

like -- obligations and the likes of

BT who are charging the same amounts

for widening levels of service?

I am

very acutely aware that some

premises, particularly in the rurl

parts of the country don't yet have

fibre broadband access, that is why

the Reaching 100 Programme will seek

this. While it offers residents the

premises with broadband speeds of

less than two megabits a second. The

costs of alternative solutions. I am

sure all members will want to make

their constituents aware of that. As

Richard Lockhead knows it is a

reserved function. There are a range

of issues which need to be

addressed. We are working to ensure

that Scotland's particular

challenges are considered and indeed

will be calling for a more regional

approach. The problem with that of

course is it's not delivering

broadband at super fast speeds. But

we will continue to deliver in our

own programme and continue to press

the UK Government to take action

that they need to take in order to

deliver the same.

Question number six.

Thank you Presiding Officer. To ask

the First Minister what actions the

Scottish Government is taking to

hold to account NHS boards that do

not meet the waiting time targets?

We work with and support NHS boards

to deliver targets. In May we

announced £50 million would be made

available to improve waiting times

between now and the end of March

next year. In August we announced

the setting up of an expert group to

improve the way elected care

services are managed across all

boards. Derek Bell of the academy of

Royal Colleges who will lead that

work was the same person what did

similar work which led to the

improvement of A&E waiting times. We

are investing in the diagnostic

centres over the period of this

Parliament.

I thank the First Minister for that

answer. I'd like to just put out

some things hooer to help the First

Minister so she does vptd to address

them in her answer.

Staff in NHS

Scotland are dedicated and hard

working. We appreciate what they do.

Failing to reach seven out of ten

targets is OK because other places

in the UK are worse, it doesn't help

people who are waiting for

treatment. Making targets easier is

not acceptable table. Just

increasing spending on the NHS won't

solve the problem. Therefore,

turning to the Audit Scotland

report, it says previous approaches,

such as providing more funding to

increase activity, or focussing on

specific parts of the system, is no

longer sufficient. There is no doubt

the situation is getting worse. And

the Health Secretary was unable to

say this morning on Radio Scotland

when it would get better. What is

the First Minister going to do to

ensure our NHS has the leadership

that it desperately needs, but clear

lilacs?

We certainly -- clearly

Lacss. - lacks.

There was so much in that, I was

going to say, it wasn't really a

question. There's so much in there

that's making targets easier. One of

the things we've done over the past

ten years is make many of the NHS

targets tougher. That is one of the

challenges we face. While many of

them, and I have not said it is OK

we are not meeting them. We are

performing better against tougher

targets than used to be the case

against targets that were weaker. We

are toughening up many of these

targets. In other words, stretching

our expectations of what the NHS

delivers, at the same time as demand

on the NHS is increasing. We will

continue to take the action I have

set out here several times already

today. Investing record sums. Making

sure record number of peoples are

working in our NHS but also taking

forward the difficult, but necessary

reforms that will equip our NHS to

deal with rising demand now and in

the years to come.

What is this Government -- what is

the Scottish Goodman put that

position on whether public sector

workers should be given a real terms

pay increase in 2018-2019.

As I made

clear today, the 1% public sector

pay cap ends in 2019. Enter stand

the impact cuts are having on

working households and we will set

out our plans on December 14 and

develop a pay policy that is

affordable and that recognises

real-life circumstances like the

cost of living and supporting those

on the lowest incomes. Public sector

workers in Scotland and across the

UK deserve a fair deal and the UK

Government should follow our lead

lifting the pay cap and ensuring

there is proper investment in our

vital public services.

In recent

years, the policy of a public sector

pay cap followed by the Scottish

Government has resulted in 156,000

health service and police staff

being worse off in real terms. This

is unacceptable and the budget is

the opportunity to address that.

This issue was raised previously by

Patrick Harvie and we got two

minutes of offal by the First

Minister, so let me give the First

Minister a chance to answer the

question. Does she support the

position that the pay rate should be

set to at least inflation and will

the Government bring forward the

consequential tax changes required

to give public sector workers the

pay rise they deserve?

We will bring

forward the detail of our spending

plans and our tax plans in the

budget that will be published on

December 14, but the Aprot receipt

of Labour on this issue is quite

frankly staggering because we set --

we said the pay cap will be lifted

and have not made that dependent on

actions taken elsewhere and that is

completely different to the position

taken by Labour. I have a letter

here. I will not want to hear this!

They will not want to hear this! I

have a letter here from the Health

Secretary, the Labour Health

Secretary in Wales, the Jeremy Hunt,

the UK Health Secretary. It says

this, I quote, without a commitment

from the UK Government to give the

Welsh Government more money, the

public sector pay cap will remain.

That is what Labour in Wales say. So

here is what we have got. Labour

called for the cap to be lifted in

Scotland, they called for the cap to

be lifted in Westminster, but in

Wales, the only part of the UK where

they have got the power not just a

call for things to be done, but

actually to do things, Labour

refused to give a commitment to

raising the public sector pay cap.

What does that tell us about labour?

This is what it tells us about

Labour, Labour poll mouth and no

action! -- Labour is all mouth.

There we have it, ending on the

subject of pay linked to taxation.

The primary questions on health and

we will get to that in a moment.

I'm joined now by journalists

Libby Brooks and Robbie Dinwoodie.

The issue of pay Commission was

saying to end the 1% cap and it was

unique in Scotland to offer that.

But not committing to a particular

level of pay for public services.

Patrick Harvie was trying to push

her to give an indication of how

much of 1%.

James Kellie said, no

more waffle.

Which brought the

response in Wales that Labour are in

control and they said there will be

no change in the pay cap. Nicola

Sturgeon's argument is regardless of

what comes in the Westminster

settlement, there will be a lifting

of the pay cap, but how much, she is

not giving away.

It is linked to

this issue of taxation and we learnt

the document to assess what the

opposition parties are proposing on

tax will be published next week as

part of the Scottish budget in

December.

Yes, Nicola Sturgeon is

not going to pre-empt the budget,

but Patrick Harvie was pushing very

hard to get Turk just to commit to

Beragh taxation and she revealed the

discussion paper would be launched

next week to set out the different

positions of the parties on

taxation, with the aim of reaching a

consensus, which means the budget

can be passed.

Is it a U-turn on

colleges or not regarding part-time

payments? A crashing U-turn

according to William Rennie.

We

don't know. The letter suggested it

would focus on part-time courses.

And the argument of the Liberal

Democrats and critics more widely is

the overwhelming focus on full-time

courses has been costed for women

and older students. But as Nicola

Sturgeon pointed out, the majority

of college courses remain and ways

have been part-time. So I am not

that clear.

Almost adapting the

circumstances. Stay with me for a

second. Behind me, this is

health-related and celebrating the

fact there has been an almost

complete eradication of polio. And

we had that Audit Scotland report

which is critical, but it also says

there is satisfaction among patients

with the NHS. I discussed that with

two MSPs, Miles Brick the Tory MP

first, the point about users of the

health service being satisfied.

In

terms of the public and politicians,

there is huge support for the NHS,

of course. But the's Audit Scotland

in what was shocking and this is

even worse and that is a real

wake-up call for the Government.

What the Audit Scotland report

outlines is how is our health

service not working for the public?

That is something we have to find

solutions in this Parliament about.

Waiting times have gone up,

improvements appear to have stalled.

This report is very critical of the

NHS.

There is challenges the NHS in

Scotland face and they are not

unique, they are faced by NHS and

health services across the world as

the population ages.

I take your

point, but your ministers

responsible for the position in

Scotland.

There are lots of

positives in this report about

patient satisfaction, about the

increased investment in the NHS.

Increased staffing levels. Do you

accept that are positives in this

report as well, patient satisfaction

is high and the NHS is making

improvements?

In terms of the health

service, the Government have eight

priority areas and they failed to

meet all but one last year and this

year they have failed to meet all

but one, why is that not being

progressed if these are the

Government's priority areas, which

they consistently failing?

They are

targets you have set yourself and

you have not met them.

We are

looking at improving waiting times

and have recently announced an

expert group to look at waiting

times and how they improved the

patient experience.

I hear what you

say about improvements but the

findings are that things are not

getting better. The report is highly

critical.

We have looked at the

biggest changes in Health and Social

Care Act over the last year's and we

are starting to see improvements in

our health care through the

integrated authorities.

Starting to

see improvements? I support the NHS

staff 100% but meeting them on a

day-to-day basis, they are not

seeing these changes, they are

seeing crisis after crisis and we

launched a save our surgeries

campaign because it is clear general

practices on the edge. Recruitment

is in crisis throughout the service

and people are handing back their

keys. The gateway to our health

service is DUP is and if we cannot

get that right in Scotland, the rest

of the service will continue to

decline -- the gateway to our health

service is GPs.

Millions is being

invested. Increasing GPs and

training. Advanced nurse

practitioners. Investment in

community pharmacy, two EV eight

pressure off GPs.

Scotland's health

is not improving and the NHS is

facing significant challenges. You

say there is progress, not according

to this report which is an

independent study.

This government

is putting lots of money and

investment and programmes into

improving Scotland's health and the

NHS is not the sole arbiter. It is

not working. We are putting money

into baby boxes, free school meals,

increasing exercise and active

travel to improve the nation's help.

They have tried to get a GP

appointment and they have been told

weeks to wait, that is not

acceptable. We need urgent action

and politicians working on this

together.

Politicians across parties

need to work together, absolutely.

We are seeing improvements in our

NHS. That is due to the improvements

this Government is driving.

Thank

you both very much.

Two members of the health committee

discussing that the Audit Scotland

report and two journalists joining

me now. Let's talk about how it went

down in the chamber, Nicola Sturgeon

robust and fighting back criticism

from the Conservatives and Labour.

She has it easier with the

Conservatives on this because she

can simply point the finger back to

Westminster. Later, there was a

question about Universal Credit and

she said, if we did not have the

spend our money mitigating this

failed Westminster Mass, more of

that could go to help on colleges.

So pointing out the failings of the

English system and this daft idea

that people with spare bedrooms

might be encouraged to take on

patients, but at the end of the day,

it goes back to the act that she is

in charge here. This report does not

make British Reading.

In terms of

the politics in the chamber, the

attack was vigorous from Ruth

Davidson and Alex Rowley, but a

vigorous bottle as well.

Nicola

Sturgeon is a former Health

Secretary and it is hard to rattle

her on this territory and she kept

coming back to the fact that Audit

Scotland did say that her reforms

were bearing fruit.

The report does

say that indeed. And yet she was

under the individual items of

workplace learning for example, they

were pursued by her colleagues.

By

the same token, she was pointing to

the very specific nature of

Scotland's needs in terms of an

ageing population and the

difficulties of getting staff in

rural and remote areas. And that the

reforms are specifically tailored to

Scotland and that they are beginning

to come through.

I was struck by

something in the report mentioned by

the First Minister, she said the

report says it is not about money

primarily any more. It is about

money of course, but perhaps

different ways of doing things.

That

is absolutely true. As Ruth Davidson

said, you are not changing fast

enough. There is some evidence for

that. There is evidence that the

changes being made are also

beginning to bear fruit. It is not

easy. The NHS is like a giant

supertanker. It is very slow and

hard to make it turn. I think any

sign they are beginning to get

things on the right track to cope

with increasing demands of the day

quite encouraging, but it is taking

a long time to come through.

Population projections say

Scotland's population will increase

and it will also age is a balance to

add to the pressure on the NHS.

Absolutely. One of the key issues

raised in the chamber was that the

front line pressure on GPs and

recruitment being...

Recruitment

falling on that level. Thank you

both very much indeed. Discussion on

the NHS and the question of tax

which will be a big decision for the

Scottish Government to make in the

aftermath of the UK budget. The UK

budget details first in November and

then the details of the Scottish

budget in December. I am away to

cover more on that health service

issue, and also to find out whether

Dundee United have managed to get a

manager during this programme. You

can see the pain and the anguish!

From me, Brian Taylor, goodbye.