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The timing for restarting the over-70’s self-referral scheme is regularly reviewed. The Breast Screening Programme Board (BSPB) agreed criteria to resume the option for women over 70 to self-refer in line with the programme’s recovery route map. The option for women over 70 to self-refer into the breast screening programme will resume once all screening centres are able to offer those aged 53-70 their breast screening appointments within 39 months of their previous screening. Progress towards this criteria is being closely monitored, and the National Screening Oversight, National Screening Committee and BSPB continue to work with Health boards to increase the number of available appointments within the programme.

Regardless of their age, women should remain symptom aware and report any symptoms to their GP immediately for these to be investigated.

The Scottish Government Do Not Attempt Cardiovascular Resuscitation (DNACPR) guidance makes clear that the overall responsibility for making an advance decision about CPR rests with the senior clinician who has clinical responsibility for the patient during that episode of care.

This guidance also makes clear that we expect healthcare professionals to discuss treatment options openly and honestly with patients, their families and guardians - where appropriate, to help ensure that they get the care that is right for them given their specific medical circumstances.

For convenience the guidance can be accessed at: https://www.gov.scot/publications/decisions-cardiopulmonary-resuscitation-integrated-adult-policy/.

Transport Scotland recognise the importance of tourism to the Scottish economy and the role that Dumfries and Galloway and the Scottish Borders serve within this sector as popular tourist destinations. As the current signs on the M74 are in a good state of repair no reviews are currently planned. For new tourist signs to be considered on the Scottish Trunk Road that highlight visitor attractions, applications from the tourist attraction must meet the criteria set out in Transport Scotland’s Trunk Road and Motorway Tourist Signposting Guidance document.

By the end of July, all Health Boards had completed the audit of cases where individuals have been excluded from the cervical screening programme despite their records indicating they may have had subtotal hysterectomies before 1997. Further work was then carried out to collate and analyse the findings. By Wednesday 18 August, around 174 letters were issued by Boards to all those who have been identified as requiring to be re-instated in the programme, or to be offered a gynaecological appointment either because it is not clear from their records if the exclusion is appropriate, or because their age means they are no longer eligible for cervical screening.

In total, 484 records were reviewed. Of these:

• 204 individuals were found to have been correctly excluded and no further action is necessary.
• 39 individuals have been wrongly excluded and are still in the eligible age range for screening. These patients will be re-instated to the programme and asked to contact their GP practice to make an appointment for screening.
• 46 individuals have been wrongly excluded but are now no longer eligible for screening due to their age. These patients will be offered an appointment at a gynaecology clinic.
• 89 individuals’ records did not allow a determination to be made on the appropriateness of their exclusion. These patients will also be offered an appointment at a gynaecology clinic.
• A small number of individuals are no longer resident in Scotland. Efforts will be made to trace them, and they will be re-instated in the screening programme so that they will be invited again for screening should they return to Scotland.
• 100 individuals are now deceased. As noted in the statement given to Parliament on 24 June, a review is being carried out into the deaths of anyone who may have been excluded in error from the programme to verify whether cervical cancer was a main or contributory cause of death.

The care pathways in place for anyone written to in August are the same as for all those written to at the end of June. Jo’s Cervical Cancer Trust also continue to offer support through their helpline services. The helpline can be reached by calling 0808 802 8000 or emailing helpline@jostrust.org. If anyone believes they have had a subtotal hysterectomy and therefore thinks they should have received a letter, Jo’s Trust will also be able to redirect them to a Health Board contact.

We recognise the anxiety anyone receiving a letter will almost certainly feel, and we are sorry for that. It is important to stress that the risk of developing cervical cancer is extremely low – less than 1 in 100 women will develop it in their lifetimes.

As we have stressed throughout this incident, anyone who is experiencing symptoms of cervical cancer – that is anyone experiencing unusual discharge, or bleeding after sex, between periods or after the menopause – should make an appointment with their GP practice. More information on symptoms is available on NHS Inform.

I will provide a more detailed update to Parliament on this issue after recess.

The Scottish Government has committed to the removal of all NHS dental charges in the lifetime of this Parliament.

All dental charges were suspended in the initial period of lockdown through to 31 October 2020. Pregnant women and nursing mothers who required urgent or emergency dental care would still be seen during this period.

Transport Scotland does not hold data on the percentage of passengers wearing face coverings while using public transport. However, ScotRail advise that the most recent observed levels indicate between an average of 80% and 90% of passengers wearing face coverings. The Confederation for Passenger Transport (CPT), who represent bus operators, advise recent observed levels indicate an average of around 80% of passengers wearing face coverings. In relation to ferries, operators have advised that they estimate that observed levels indicate around 85-95% of passengers wearing face coverings whilst using their services.

The recently observed levels do not include those who may be exempt from wearing face coverings on account of age and health conditions and so the levels of compliance with the regulations will be higher than the observed average percentages of passengers wearing face coverings.

The Scottish Government currently only allows travellers returning from green and amber list countries to use NHS Covid-19 tests.

These home PCR kits are sold at a fixed price and can be booked through CTM, the UK Government’s booking portal for international travel.

Wales currently also only allow use of NHS Covid-19 tests, booked through CTM and have the same fixed pricing structure as offered in Scotland.

The Scottish Government does not centrally collect information or data relating to the use of Do Not Attempt Cardiovascular Resuscitation (DNACPR) forms.

As with all other clinical treatments, decisions about CPR should be based on the individual clinical circumstances and wishes of the patient, recorded appropriately and updated when medical circumstances change. This recording is done in hard copy on a DNACPR form, the existence of which is then recorded on an individual’s Key Information Summary. Such information is only shared for the purposes of direct care and is therefore not centrally collected.

Information relating to complaints associated with specific medical treatments such as CPR is not collected centrally.

If an individual wishes to raise a complaint about NHS treatment or care this should be addressed at a local level through the NHS Complaints Handling Procedure (CHP). The Patient Rights (Scotland) Act 2011 and supporting legislation, provides a specific right for people to make complaints, raise concerns, make comments and give feedback to NHS Boards. The Act also places a duty on NHS Boards to thoroughly investigate and respond to any concerns raised, to take improvement actions where appropriate and to share learning from the views they receive. Where an individual remains dissatisfied with the outcome of the CHP investigation, the Scottish Public Services Ombudsman (SPSO) is the second and final stage in the complaints process.

The Scottish Government held a meeting with key stakeholders, including Scottish Swimming, on 11 August to discuss water safety.

Discussions included the provision of lessons and also water safety education.

More discussions on how to move forward are scheduled for the coming weeks.