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The aim of Minimum Unit Pricing (MUP) of alcohol is to reduce health harms caused by alcohol consumption by setting a floor price below which alcohol cannot be sold. In particular, it targets a reduction in consumption of alcohol that is considered cheap, relative to its strength. It aims to reduce both the consumption of alcohol at population level and, in particular, those who drink at hazardous and harmful levels. In doing so, it aims to reduce alcohol related health harms among hazardous and harmful drinkers, and contribute to reducing harm at a whole population level.

The aim of MUP remains the same as stated at the Bill's introduction in 2011.

The Scottish Government is aware of the concerns raised by the Coroner in respect of this unfortunate case. We will await the responses of the recipients named in the report to help inform any future actions that may be applicable to Scotland, and will continue to work with stakeholders across the UK on matters of national scale.

The Anaesthesia Associates and Physician Associates Order 2024 was passed by the Scottish Parliament on 31 January 2024. It will bring the roles into statutory regulation for the first time when it comes into force on 13 December of this year, addressing one of the key concerns of the Coroner.

In the meantime, extant Scottish Government guidance to NHS Scotland Boards makes clear that all Physician Associates must be registered on the appropriate managed voluntary register. That guidance also recognises the importance of ensuring that patients are properly advised that they are being treated by a Physician Associate and not a doctor.

Building on the above, the Scottish Government will continue to work with partners through its Medical Associate Professionals (MAPs) Programme Board to consider appropriate utilisation of the role within NHS Scotland, taking into account developments over the coming months.

The latest release by Public Health Scotland (PHS), providing information on Hospital Standardised Mortality Ratios (HSMRs), for the period April 2019 to March 2024 is available via the PHS website. (Hospital Standardised Mortality Ratios - April 2023 to March 2024 - Hospital Standardised Mortality Ratios - Publications - Public Health Scotland).

These statistics are updated on a quarterly basis and reflect the HSMR for the latest 12-month reporting period, whilst crude mortality data is presented by quarter and month to show trends. For the period April 2023 to March 2024, the Royal Infirmary of Edinburgh (RIE) is within two standard deviations of the Scotland-wide average for their HSMR, and no hospital in Scotland had a significantly higher standardised mortality ratio than the national average.

NHS Lothian’s January 2024 HSMR report explored the reasons behind the higher ratio of the standardised mortality measure at RIE and specifically to understand if there is any evidence of avoidable mortality.

The report identified 4 cases where a different plan and/or delivery of care may have resulted in a different outcome for patients, but the use of ‘may’ identifies this classification as hypothetical in nature, it is impossible to know if a different care plan would have resulted in a different outcome. Furthermore, the report specifically advised the Healthcare Governance Committee that there is no clear current evidence of avoidable mortality in any of the cases considered.

The practice level workforce survey was administered on behalf of The Scottish Government by NHS Education for Scotland (NES). A closing date of 31 July was set for responses. Analysis of the data is ongoing and while no specific date has been set NES are working towards a publication date towards the end of October.

Every life lost to alcohol is a tragedy and the recent alcohol specific deaths statistics published by the National Records of Scotland is a stark reminder of the challenge we continue to face in tackling alcohol harm across Scotland. There is currently no specific information available on the effect of licensed hours for the off-sale of alcohol being 10:00 to 22:00 on alcohol deaths and alcohol-related illness in Scotland though a number of studies have concluded that reducing the times of availability of alcohol are effective at reducing alcohol harms.

The Scottish Government takes a whole population approach to tackling alcohol-related harms, in line with the World Health Organization’s focus on affordability, availability and attractiveness of alcohol. Reducing availability of alcohol through limiting hours of sale continues to be recommended by the World Health Organization as one of the ‘best buys’ for reducing alcohol related harm.

The Scottish Government is committed to improving outcomes for babies and children and funds key initiatives, including the established Scottish Patient Safety Programme (SPSP) led by Healthcare Improvement Scotland. SPSP Perinatal currently supports NHS Boards to improve outcomes by reducing stillbirth, neonatal morbidity and mortality. The SPSP Paediatric Collaborative, launched in September 2023, aims to improve the recognition and response to clinical deterioration in children and young people.

The Scottish Government continue to fund and participate in UK-wide audits including Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries – UK (MBRRACE-UK), which undertakes surveillance on Perinatal deaths and makes recommendations for improvement, and are considered carefully with an expectation NHS Boards will review their local data and act on emerging themes. We wrote to NHS Boards on 12 September 2024 to ensure they have taken account of the MBRRACE-UK reports and National Records of Scotland data, and to seek assurances from those with higher-than-average rates that work is underway to understand and learn from the possible factors which may have contributed to these deaths.

Since October 2021 a National Hub has been in place to review and learn from the deaths of all babies, children and young people in Scotland. Commissioned and funded by Scottish Government, the National Hub is jointly hosted by Healthcare Improvement Scotland and the Care Inspectorate. A principal aim of the National Hub is to channel the learning from child death reviews to inform change and improvement and ultimately help reduce future preventable child deaths.

NHS Dumfries and Galloway has confirmed that they are aware of the higher than usual rates within their NHS Board as published by National Records of Scotland, Births, Deaths and Other Vital Events - Quarterly Figures: Second Quarter, and have proactively been interrogating the findings to be assured that the numbers can be explained within the local context and not attributed to any shortcomings in care. It is important to note that quarterly National Records of Scotland publications data contains relatively small numbers, and the rates are subject to large percentage fluctuations.

Public Health Scotland have provided some limited information regarding those who have had an inpatient hospital admission which includes a diagnosis of ‘exposure to excessive natural cold’.

Table 1 below provides information on the number of hospital admissions within NHS Scotland for people aged 65 and over treated for “natural exposure to cold weather” since 2010. The code ‘exposure to excessive natural cold’ is only captured where this has been clearly stated by a clinician and is likely an underestimation of the number of people admitted to hospital who had been exposed to excessive natural cold.

Table 1: Number of people aged 65 and over admitted to hospital and treated for natural exposure to cold weather since 2010

The Scottish Government does not hold information on the people admitted to hospital for cold weather related illnesses in each year since 2010.

Hospital admissions data record the diagnostic conditions patients were admitted for using the International Classification of Disease Codes version 10 (ICD-10). Cold weather related illnesses are not a defined list of conditions that can be identified through ICD-10 codes.

Some ICD-10 codes identify specific conditions which may be associated with cold weather, however these do not represent all conditions that could be considered cold weather related admissions.

Official statistics relating to emergency admissions to acute general hospitals in NHSScotland are published by Public Health Scotland annually: Acute hospital activity and NHS beds information (annual) - year ending 31 March 2024 - Acute hospital activity and NHS beds information (annual) - Publications - Public Health Scotland

These statistics will include detailed diagnosis specific information for emergency admissions, the data collection cannot attribute admissions due to prevailing cold weather per se.

The Scottish Government does not hold information on the people admitted to hospital for cold weather related illnesses in each year since 2010.

Hospital admissions data record the diagnostic conditions patients were admitted for using the International Classification of Disease Codes version 10 (ICD-10). Cold weather related illnesses are not a defined list of conditions that can be identified through ICD-10 codes.

Some ICD-10 codes identify specific conditions which may be associated with cold weather, however these do not represent all conditions that could be considered cold weather related admissions.

Official statistics relating to emergency admissions to acute general hospitals in NHSScotland are published by Public Health Scotland annually: Acute hospital activity and NHS beds information (annual) - year ending 31 March 2024 - Acute hospital activity and NHS beds information (annual) - Publications - Public Health Scotland

These statistics will include detailed diagnosis specific information for emergency admissions, the data collection cannot attribute admissions due to prevailing cold weather per se.