Nicola Sturgeon has been a close friend of Shona Robison ever since the pair were students at Glasgow University around two and a half decades ago.
Together they have risen through the ranks of the SNP. Side-by-side, they have been on a journey that has taken the SNP from pre-devolution days of relative obscurity to its position now as the pre-eminent party in Scottish politics.
When they started out as student activists, few would have predicted that they would end up sitting round the same Cabinet table in Bute House in a Scottish Government.
Given their shared background and close bond, it must be difficult for Ms Sturgeon to listen to almost daily cries for one of her key allies to quit as Health Secretary.
But with a series of controversies and challenges facing the NHS, Ms Robison’s grip on the health brief is looking more and more shaky.
As a former Health Secretary in Alex Salmond’s administration, Ms Sturgeon knows more than most just how important the health brief is for patients and how important it is for government to be seen to be looking after it properly.
Unfortunately for Ms Sturgeon, Ms Robison and NHS patients, the clear perception is that the Scottish Government is failing on both of those counts.
This week saw yet another slew of damaging statistics that adds to the picture of a health service in crisis.
According to data released by the NHS Information Services Divison, cancelled operations are on the up, bed-blocking is increasing and A&E waiting targets are being missed.
Then there are the concerns about NHS finances – most notably the mismanagement at NHS Tayside and the financial challenges faced by NHS Lothian. Revelations that more than £2 million of NHS Tayside’s endowment fund has been used for routine NHS spending on items like computer systems are severely embarrassing for Ms Robison given that she is a Dundee MSP.
On this issue Ms Robison has acted by changing the management of the health board, but she was slow to respond to the long-standing financial problems faced in Tayside.
Further financial concerns have been raised with the disclosure that NHS Lothian requires £31 million to take spending up to last year’s level.
This comes at a time when the NHS is facing a recruitment crisis when it comes to nurses, midwives and doctors. Meanwhile, short-staffed GP practices are relying on locums and, in the more extreme cases, are closing or handing their contracts back to their health boards.
Throw into this unhappy mix the appalling personal experience of Margaret Goodman – the terminally ill grandmother whose unacceptable wait for an ambulance was highlighted in parliament last week – and Ms Robison does not have her troubles to seek.
For some time now, Labour’s health spokesman Anas Sarwar has been calling for Ms Robison’s resignation. More recently the Lib Dems have joined in the clamour.
Anxious not to cry wolf on the Health Secretary’s future, the Scottish Conservatives are hanging fire when it comes to calls to quit. Therefore, much to Mr Sarwar’s frustration, there is not enough parliamentary support to ensure that a motion of no confidence would succeed in ousting Ms Robison.
Yesterday afternoon, however, the Tories ramped up the pressure by hosting a debate that made a series of demands, including the immediate publication of NHS boards’ financial positions.
The Tory motion added that “failing sustained and immediate action, the Cabinet Secretary for Health and Sport should be held accountable for the on-going problems”.
Shadow health secretary Miles Briggs declared that the Conservatives were putting Ms Robison and the government “on notice” over NHS funding.
Weekend reports suggesting that SNP insiders believe that Ms Robison should no longer be Health Secretary simply add to the impression that she has become a lame duck minister.
So what can Ms Sturgeon do about her old student friend? Given their close relationship, the First Minister will be reluctant to do anything that smacks of bowing to political pressure.
Giving the opposition parties their first major scalp is not something that she would want to contemplate. Another option is managing her departure in a gentler fashion with a reshuffle.
Speculation is mounting that Jeane Freeman, the social security minister, could be in line to inherit Ms Robison’s job should Ms Sturgeon reshuffle her Cabinet.
Ms Freeman, a former Labour special adviser, has a reputation as one of the more able junior ministers.
The problem for Ms Sturgeon is that her current job of overseeing a large transfer of welfare powers from Westminster to Holyrood is a hugely demanding one. Finding someone to step into Ms Freeman’s shoes could be challenging given that there is less than a year before Holyrood takes charge of its first tranche of benefits.
When it comes to considering who else might be capable of looking after what is arguably the challenging health brief, the talent pool looks a little shallow. The bring back Alex Neil campaign is unlikely to have much support in Bute House. John Swinney has his hands full at Education. Michael Matheson has his own battles to fight in the Justice portfolio. The First Minister’s options look a little limited.