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Patient care and service delivery are the statutory responsibility of local healthcare providers. NHS Boards are responsible for working with their partners to plan and provide health services which meet the needs of their populations. Use of the independent sector has been an option open to all Health Boards to help address short-term capacity issues.

Within the wider policies set out by the Scottish Government, NHS Scotland is expected to deliver services that provide high-quality care that is safe, effective, accessible and person centred. It is NHS Boards and healthcare professionals locally who have responsibility for service delivery, including antenatal classes, to meet the needs of their local population and service users.

Our expectation is that NHS antenatal classes will include information for parents on bonding with their baby, which supports the mental health of both parents and babies. The precise content of antenatal classes is likely to vary between NHS Boards and antenatal class groups, to better respond to the particular needs of local service users.

Midwives discuss mental health and general wellbeing with all women during antenatal and postnatal care appointments, ensuring that all women have access to advice and support throughout their pregnancy journey. These discussions may include the management of pre-existing mental health issues; the identification and management of emergent mental health issues during the antenatal and/ or immediate postnatal period, and possible postnatal changes which women may experience, such as “baby blues”. Following birth, these conversations continue with families during each contact with Health Visitors and Family Nurses.

All pregnant women are also provided with a copy of Ready, Steady, Baby! , a guide to pregnancy, birth and early parenthood up to one year, as part of their routine antenatal care. This includes information on mental health and wellbeing to help provide information for families, as well as signposting to further sources of support. The information in Ready, Steady, Baby! is available in translation and alternative formats, including an Easy Read resource, to ensure the information is accessible for women and families across Scotland.

We are clear in our expectations that all women, at all times, receive high-quality and person-centred maternity care tailored to their needs, with quality and safety for mothers and babies central to decision-making. To understand the quality and safety of maternity care and identify where improvement should be made, we are closely following data published by Public Health Scotland (PHS). Occurrences of third- and fourth-degree perineal tears (also referred to as obstetric anal sphincter injury (OASI)), a leading cause of faecal incontinence following childbirth are recorded by PHS as part of its Maternity Inpatient and Day Case - Scottish Morbidity Record (SMR02) dataset and can be viewed via its Scottish Pregnancy, Births and Neonatal Dashboard .

We are also aware of the research and evidence endorsed by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives on obstetric anal sphincter injury and recognise that further work is required to improve care for women who experience incontinence including follow-up care and specialist care. Obstetric anal sphincter injury is on the agenda at various meetings bringing together senior leaders in Scotland’s maternity care.

The Scottish Government is committed to continuous improvement in maternity safety across Scotland, in partnership with NHS Boards and clinicians and service users, to deliver the best and safest person-centred care for mothers and babies. We are aware of the evidence around implementing care which aims to reduce risk of developing stress incontinence. We regularly facilitate meetings and events bringing together senior leaders in maternity services to discuss evidence aimed at improving services and provide learning opportunities.

All pregnant women are also provided with a copy of Ready, Steady, Baby! , a guide to pregnancy, birth and early parenthood up to one year, by their midwife as part of their routine antenatal care. Ready, Steady, Baby! includes information on and signposting to additional materials regarding stress incontinence and pelvic floor muscle exercise for women, both during pregnancy and following birth, which can help to reduce the risk of stress incontinence following childbirth.

Information on pelvic health is also available on the Women’s Health Platform on NHS Inform. This includes information on urinary incontinence in women and is publicly available to both service users and healthcare professionals.

Although it is the statutory duty of local authorities to manage their school estate, the Scottish Government will convene a working group - including representatives from COSLA, community organisations and sports organisations - to explore how community access to facilities, such as the school estate, can be enhanced. The first meeting of this group will take place in March.

Schools in Scotland have the flexibility to decide on the content of their physical education lessons. The Scottish Government does not specifically evaluate the extent to which swimming lessons form a part of those decisions.

We know that some local authorities offer swimming lessons as part of their physical education classes. In other cases, schools may take into account a range of factors, including the time that is required to travel to a swimming pool, in deciding against offering swimming lessons as part of PE.

However, the Scottish Government has been working with Scottish Swimming, Education Scotland and other stakeholders to develop interventions and approaches to provide opportunities for children to become confident, competent and safer swimmers.

Community youth work remains an important pillar of local authority provision, including in schools. The Scottish Government utilises a Block Grant system, affording local authorities significant autonomy in allocating financial resources, including those designated for youth work in schools. This approach empowers councils to prioritise local needs and tailor services accordingly, while fulfilling mandatory obligations and adhering to nationally-agreed priorities. Transparency is ensured through annually-published breakdowns of spending on the Scottish Government website, though there is no statutory obligation for youth work activity to be recorded or monitored by local authorities, third sector organisations or voluntary organisations.

An independent review of Community Learning and Development (CLD), encompassing youth work, was launched in December 2023 and is expected to conclude in June 2024. This review aims to assess the impact of CLD on learners across Scotland, providing valuable insights for the future.

Community youth work remains an important pillar of local authority provision. The Scottish Government utilises a Block Grant system, affording local authorities significant autonomy in allocating financial resources, including those designated for youth work. This approach empowers councils to prioritise local needs and tailor services accordingly, while fulfilling mandatory obligations and adhering to nationally-agreed priorities. Transparency is ensured through annually-published breakdowns of spending on the Scottish Government website.

Furthermore, an independent review of Community Learning and Development (CLD), encompassing youth work, was launched in December 2023 and is expected to conclude in June 2024. This review aims to assess the impact of CLD on learners across Scotland, providing valuable insights for the future.

TrakCare is used as the main patient management system by 13 Health Boards:

• NHS Ayrshire and Arran;
• NHS Borders;
• NHS Fife;
• NHS Forth Valley;
• NHS Great Glasgow and Clyde;
• NHS Grampian;
• Golden Jubilee National Hospital;
• NHS Highland;
• NHS Lanarkshire;
• NHS Lothian;
• NHS Orkney;
• NHS Shetland; and
• NHS Tayside.

All 13 Health Boards use TrakCare for waiting lists, Outpatients and inpatients, clinical coding, national Scottish Morbidity Records and new ways returns. Various Boards also use TrakCare for Emergency Departments, maternity services, mental health, community services, radiology, and theatres.

In addition, the system supports order request functionality for the service departments to manage the provision of laboratory, X-ray and diagnostic services; and Allied Health Professionals, observations, and clinical data recoding in clinical forms to varying degrees.

The Scottish Government does not collate or hold information on how many staff the Health Boards employ to maintain TrakCare.

The UK Government did not inflation-proof its capital budget which has resulted in nearly a 10% real-terms cut in the Scottish Government’s capital funding over the medium-term between 2023-24 and 2027-28. The result of this cut is that new health capital projects have currently been paused.

Work is underway to update the pipeline of projects and programmes relating to the 2021 Infrastructure Investment Plan to ensure it is affordable and deliverable and provides best value for money. Our emphasis for the immediate future will be on addressing backlog maintenance and essential equipment replacement.