Tory MSP Miles Briggs says senior management within the health board have raised concerns with MSPs about the timescale for the opening of the new Sick Kids hospital.

Ms Freeman says the timescale was reached following consultation with the health board, including senior management.

She is not sure about the nature of concerns raised with MSPs.

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Mr Cole-Hamilton says in resigning Brian Houston said there was a blame culture in NHS Lothian.

He says there has been a breakdown in communications between the government and the health board.

"Does any of the blame lie at your door, cabinet secretary?"

The health secretary refutes this.

Health Secretary Jeane Freeman says arrangements for an interim chair are underway and will be announced shortly.

The aim is to have a new chief executive in place before the current chief executive retires.

Mr Cole-Hamilton says NHS Lothian is in "crisis", pointing to issues with the new Sick Kids Hospital and mental health waits.

He warns of a "leadership vacuum".

Ms Freeman highlights NHS Lothian is at level four in the escalation ladder but she refutes Mr Cole-Hamilton's claim the health board is in crisis.

We will ensure NHS Lothian is able to meet challenges and make improvements where we require it, she adds.

Lib Dem MSP Alex Cole-Hamilton asks about plans for the leadership of NHS Lothian in light of the recent resignation of its chairman and forthcoming retirement of its chief executive.

Image source, Getty Images/NHS Lothian

The chairman of NHS Lothian has quit after the board was placed in special measures by the Scottish government.

Brian Houston had come under pressure over problems with the new Royal Hospital for Children and Young People in Edinburgh.

Mr Houston's resignation comes two weeks after the chief executive of NHS Lothian announced his retirement.

Read more.

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Rev. Fraser Donaldson from Hope Community Church in Greenock is delivering time for reflection.

Image source, PA Media

Topical questions starts at 13:30, with MSPs asking about NHS Lothian leadership and GDP figures.

Then there will be a debate on the Non-Domestic Rates (Scotland) Bill, external. MSPs will consider several amendments before voting on the final bill at 19:00.

Asked about online pharmacy services, Jonathan Burton says there is a need to step back and think about what communities pharmacies are for because they do more than simply prescribe medicines.

Communities pharmacies are in remote and rural areas, and in places where other business are not, such as deprived areas he says.

We are part of the social fabric of communities and this should be cherished, he argues.

When looking at online pharmacies this aspect is often lost and some are simply selling medicines for profit rather than to benefit communities, he adds.

The committee draws to a close.

Image source, Getty Images

The Pharmacy First rollout does not mean pharmacy is always first, Jonathan Burton tells MSPs.

There is a risk we will be swamped with work and we do not have capacity to see all patients, he adds.

We need to ensure there is adequate signposting for patients and we must be properly plugged into GP and out of hours services, Mr Burton says.

The Pharmacy First, external initiative is designed to encourage more patients to get help from pharmacists instead of GPs for minor ailments. It was first rolled out to treat patients with urinary tract infections (UTIs) and Impetigo, but from April 2020 it will cover more conditions.

Labour MSP David Stewart asks about the effectiveness of the minor ailment scheme.

Mr Shimmins replies the outcomes have been overwhelmingly positive and it is loved by patients.

He confirms eligibility has now been extended to every patient, but he adds it could be better understood.

Gail Caldwell calls for better promotion and signposting for patients.

Tory MSP Brian Whittle says chronic medication services have come under criticism for unnecessary repeat prescriptions.

Campbell Shimmins says this should not happen which is why it is important to keep speaking to patients.

Chronic medications should not increase medication use and should actually stabilise it, he adds.

Are we in a situation where the default system is to medicate but other options are unavailable to medical professions, asks Mr Whittle.

Gail Caldwell says this can be an issue. She highlights the benefits of pulmonary rehabilitation services for conditions like COPD, adding patients are often prescribed drugs instead because rehab is not available locally.

Mr Cole-Hamilton says older people can be harmed by the range of medicines they are on due to a lack of review.

The Lib Dem MSP asks about the benefits incentivisation of de-prescribing.

Prof Tomoney tells the committee we should be moving away from incentivising and moving towards rewarding high quality care.

Lib Dem MSP Alex Cole-Hamilton wonders if the current pharmacy contract has a perverse incentive for community pharmacies to dispense medicines.

Campbell Shimmins says this was the case a decade ago as pharmacies were only reimbursed for dispensing.

We now have services around acute medication, chronic medication, public health and minor ailments, he adds.

Outcomes have started to improve as a result and the changes also recognise the skills pharmacists have, Mr Shimmins says.

The NHS Minor Ailment Service, external is available at pharmacies across Scotland and can help patients access free medication for a minor illness or complaint.

Jonathan Burton cites the importance of medicines reconciliation and of good communication, reiterating that HEPMA will help with this.

We're all under pressure and there is a certain amount of workload that wouldn't be there with better communication, he adds.

Ms Harper asks if HEPMA is moving forward fast enough.

Ms Caldwell replies the Scottish government has provided funding for this. She reveals she is co-chair of the HEPMA implementation board and an update will be provided on rolling it out to all hospitals.

SNP MSP Emma Harper pivots to patients bringing their medicines into hospital and potential duplication.

Ms Harper asks what needs to be done to avoid unnecessary prescribing of medicines and this kind of duplication.

Gail Caldwell says patient's own medicines are a really important source of information and patients are encouraged to bring in their own medicines, particularly for elective procedures.

The NHS Greater Glasgow and Clyde representative points out this helps with continuity for the patient and provides for a safer strategy.

Mr Stewart asks why the costs have been less for community pharmacies than for hospitals.

Campbell Shimmins explains the majority of medicines dealt with in pharmacies are generic, which have already been tested and are well understood.

Hospitals are dealing with branded pharma and they are innovating, which leads to development costs he says.

We are not doing things particularly differently in terms of governance and robustness, he says, but "we're dealing with a different animal than the specialist centres are".

Image source, Getty Images

According to ISD, over the last ten years, the volume and cost of dispensed medicines and provision of pharmacy services within the community in Scotland has increased.

The total number ofitems dispensed, externalincreased by 20.5% from 85.8 million to 103.4 million items.

There was little change between 2016/17 and 2017/18 at an overall net cost of £1.3 billion, an increase of 25.7% over the last 10 years.

A blog by SPICe has lots of useful info on this topic., external

More details on the inquiry can be found here., external

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Labour MSP David Stewart says there has been massive growth in drugs costs in hospitals, making it almost unmanageable.

Frankly some of our health boards in Scotland are financially unsustainable, he adds.

Prof Timoney says there is an increasing throughput in hospitals, with more frail and elderly people.

She explains at NHS Lothian there is an acute prescribing forum that meets once a month to address this issue and adds there has been a £24m saving of the drugs bill in the last seven years.

In hospitals we tend to be using newer drugs which are more expensive, the professor adds.

Through effective procurement strategies we have been able to treat more patients for the same costs, Gail Caldwell explains.

Mr Burton points out there 1,250 community pharmacies in Scotland and they provide a robust and versatile service.

He says: "When the chips are down and there is three feet of snow, we get our skis on and get medicines to rural communities."