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Weekly information on the mode of outpatient clinical interactions by NHS Board is published by Public Health Scotland (PHS) as part of the Wider Impacts Dashboard .

Table one shows new and return outpatient face to face appointments by NHS Board of Treatment between 2 March 2020 to 27 December 2020

The number of staff working in NHS Grampian has increased by 20.7 per cent since Sept 2006, to over 13,520 Whole Time Equivalent (WTE). This includes a 6.9 per cent increase in numbers of Qualified Nurses and Midwives, which have risen to 4,099.1 WTE.

NHSScotland Boards are required to have the correct staff in place to meet the needs of the service and ensure high quality patient care. They have fully delegated powers in relation to employment issues. The Scottish Government works closely with Boards to support their efforts in staff recruitment. The creation of posts and filling of individual vacancies will depend on the service needs of each Board, taking account of national and local priorities.

We are investing £11 million in new recruitment activity and in the creation of a National Centre for Workforce Supply. The Centre will offer NHS Boards expert advice on labour market intelligence and coordinate recruitment campaigns, providing vital additional support to health board recruitment teams.

We are also taking forward a comprehensive programme to support recovery and build further capacity. The programme will include measures to increase international recruitment, retain staff and attract more returners to the service. The Scottish Government will continue to work with partners to explore options and opportunities that allow us to best support our registered staff.

The Scottish Government regularly reviews performance data from the Scottish Ambulance Service which includes data on response times across the country.

This information is normally reviewed weekly, however, given the current pressures being experienced we are receiving twice daily sit reps from the Service on performance.

Like all areas of Scotland, and indeed throughout the UK, we are aware that some patients are experiencing delays in response times from the ambulance service. This is why we have already taken significant action both prior to and since the pandemic to input measures to ensure our Ambulance service has the full resources and range of support in place to deliver services.

We announced an additional package of support for the Service, backed by an additional £20 million of investment, which will help increase capacity and improve response times and staff wellbeing, including assistance from over 100 military personnel.

We have also previously taken action to help with the situation, including an additional investment of £20m as part of the £1bn NHS Recovery Plan. This investment comes from continued involvement with the SAS Demand and Capacity programme which this Government has been involved in since its inception in 2019. It will deliver almost 300 additional Ambulance Service staff by April 2022.

This breaks down as 69 staff in the North of Scotland, 139 in West of Scotland and 88 in the East of Scotland. The additional staff are a mixture of paramedics, newly qualified paramedics (NQPs) and technicians. Extra ambulances and vehicles will also be introduced over the coming months, including two in Edinburgh.

The number of patients who have waited over 12 weeks for Trauma and Orthopaedic surgery in NHS Highland are published by Public Health Scotland (PHS) on a quarterly basis. These details are available on PHS’s website and can be found in table 1.2 through the following link: https://www.publichealthscotland.scot/media/8811/newop_aug21.xlsx

The Scottish Government is committed to the early detection of cancer. We are in currently in the process of establishing Scotland’s first Early Cancer Diagnostic Centres which will see the creation of a person-centred fast-track pathway for patients with non-specific symptoms (i.e. weight loss, nausea, fatigue) suspicious of cancer. These centres have been in operation since June 2021 and are continually taking patients with plans for equitable access across Scotland over the course of this parliament.

An estimate of the number of patients who have missed an early diagnosis of melanoma can be made by using data from the Public Health Scotland (PHS) Covid Wider Impacts Dashboard ( https://scotland.shinyapps.io/phs-covid-wider-impact/ ). The data indicates there were a total of 1,131 individuals with pathologically confirmed specimens for malignant melanoma of the skin between 1 April 2020 and the week ending 21 st February 2021. This was 398 individuals fewer than in the same period one year before.

Therefore, the data suggests there have been around 400 fewer melanoma diagnoses overall during the time of the COVID-19 pandemic.

GP practices have remained open, accessible and at the forefront of our community services to deal with non-COVID-19 medical care throughout the pandemic. As outlined in the NHS Recovery Plan, a key aim is to work with our GPs to continue to restore face-to-face practice consultations as quickly and safely as possible, while ensuring everyone can continue to make use of eHealth services if that is their preference.

Public Health Scotland have published guidance on social distancing and infection control measure in health settings, changing the 2 metre social distancing rule to 1 metre, enabling more patients in waiting rooms, while continuing to ensure that vulnerable patients and staff are kept safe. In addition, specific guidance to general practices has been published making it clear that there is no longer a need to triage every patient, although they should continue to screen patients for Covid before seeing them face-to-face. We will continue to take advice from public health experts and clinicians when reviewing these measures.

With these recently announced changes I would expect the number of face-to-face appointments to increase.

While high quality data from across the health system is collected, we are working with stakeholders to improve the quality of data we can collect from GP practices to ensure it is robust.

We have continued to meet routinely with GPs and their representatives, and hear regularly from patients, to help build intelligence around appointments and pressures in GP practices throughout the pandemic, and are currently working together with NSS and PHS on a more advanced digital solution for capturing this information moving forward.

We are working closely across the four nations and international partners on restarting international travel safely. Our discussions are still ongoing with the UK Government and international partners on exemptions for people who cannot receive COVID-19 vaccinations. In the meantime, people intending to travel should check that vaccination status is a requirement of the country they are visiting on the GOV.UK foreign travel advice pages, as PCR testing is also widely accepted.

The number of people for whom vaccination cannot be safely completed with the right support will be very small. Reasons for exemptions would be medical contraindications that might include severe anaphylactic reaction across the range of vaccines and those receiving end of life care. We would encourage people to take a vaccine where they can do so safely and they can contact our national helpline on 0808 196 8565 for support in arranging this.

Consideration for people who do not have digital access has been built into our vaccination programme from the start. Communication has gone out via non-digital channels and we have also undertaken a door-to-door paper leaflet drop with important information on vaccines. COVID-19 vaccine leaflets are available in audio, BSL, easy read and large print as well as other languages.

Those who do not have online access can call the COVID-19 National Helpline on 0800 030 8013. The helpline allows people to check and, where required, reschedule appointments. All information and services on NHS Inform are available via this phone line. We encourage people to double check their GP holds correct address details, to make sure that any appointment letter reaches them.

For those who are eligible for flu and/or COVID-19 booster vaccines, we have ensured that:

• Those aged 70 and over or those who are clinically extremely vulnerable will receive a vaccine invitation by post or may be contacted by their GP.
• Letters will be sent to those aged 60-69 years of age inviting them for vaccination from late October.
• When the online booking portal becomes available for those in stage 2, people who do not have access to digital booking will also be able to book their vaccinations via the COVID-19 National Helpline.

Our forthcoming national marketing campaigns for both flu and COVID-19 booster will direct people towards both the online booking system as well as the phone line so no one should be left out.

Informed consent is integral to the vaccination programme, and we have developed detailed information for young people and their parents or carers to allow them to make informed decisions on vaccination. Vaccinators are fully trained and have materials to support discussions on informed consent at appointments.

Further information on consent for children and young people can be found on NHS Inform: Vaccinating 12 to 15 year olds | NHS inform .

A new leaflet from Public Health Scotland will be circulated and is available to view online at: COVID-19 vaccine information for young people in English (healthscotland.com) .

Whilst we strongly encourage those eligible to receive coronavirus vaccination to do so, the decision is one of personal choice and the Scottish Government has no plans to introduce mandatory vaccination.

We are working with NHS Scotland Health Boards to put in place delivery models for the 2021-22 seasonal flu vaccination programme to suit local circumstances, whilst maintaining a COVID-19 safe environment and maximising efficiency.

If someone is unable to attend for their flu vaccination, they can rearrange their appointment to a more convenient time or location on line at Rearrange your flu vaccine appointment | The flu vaccine (nhsinform.scot). If invited by their GP practice or local Health Board, they should rearrange their appointment with them directly. If cancelling the appointment, the Flu Vaccination Helpline on 0800 030 8013 can assist with this.