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In the context of specialist provision of gender identity healthcare to children and young people, since publication of its Strategic Action Framework for Gender Identity Service improvement in December 2021, the Scottish Government has maintained an extensive dialogue with NHS Health Boards in Scotland on how to collectively work to improve healthcare provision in this sphere.

On 18 April, in a joint statement, NHS Greater Glasgow and Clyde and NHS Lothian confirmed that both Boards have paused any new prescription of puberty-supressing hormones and cross-sex hormones for young people as a treatment option for gender dysphoria.

The small number of patients directly impacted by this change, and their families, were notified in advance of this statement. It is right that they were the first to hear about it, sensitively and from the services caring for them, before a public statement was made.

Parliamentary business is a matter for the Scottish Parliament’s Parliamentary Bureau and the Parliament itself.

The Scottish Government considers youth work within the school environment to be incredibly valuable.

An independent review of Community Learning and Development (CLD), 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 which will provide valuable insights for the delivery of CLD in a reformed education system.

As part of our work to develop a sustainable healthcare workforce, we continue to look for opportunities to increase levels of student attraction to healthcare professions. Careers in NHS Scotland are promoted on the NHS Education Scotland (NES) NHS careers website, designed to promote opportunities to school leavers, those in education and those looking to change careers. This site can be accessed at NHSScotland Careers

Additionally, NES are leading on the AHP Careers National Working Group. The group have developed materials for a national career service including a ‘workshop toolkit’ for careers advisors and teachers.

Following the completion of the Allied Health Professions (AHP) Education and Workforce Policy Review, an advisory group has been established. NES are represented on this group and will work in conjunction with the Scottish Government, and wider stakeholders, to oversee the effective implementation of the recommendations.

The group held its second meeting on 4 March 2024 and will consider the timescales required to meet the overarching aims at its future meetings, scheduled in June and October 2024.

The primary funders of locally based advice services are local authorities and it is for them to decide how best to target resources to meet local needs. Scottish Government do not, therefore hold information on the number of money advisers employed within the most deprived communities. The Improvement Service publishes a report annually on local authority spend on money advice services. The latest report can be accessed using the following link: https://www.improvementservice.org.uk/products-and-services/performance-management-and-benchmarking/common-advice-performance-management-framework/2022-23-report

In 2023-24, the Scottish Government invested more than £12.5 million in free welfare, debt and income maximisation services. Our funding approach is intended to maximise household incomes, tackle problem debt and to reduce poverty. Whilst the majority of our funding is allocated to organisations with a national reach, our investment also supports a range of other initiatives such as the Welfare Advice and Health Partnerships, which has enabled welfare rights advisors to be integrated in up to 180 GP practices across Scotland, with 150 of these targeted in the most deprived communities and 30 in remote, rural and island settings, and the Advice in Accessible Settings programme that supports 24 local partnerships to deliver advice in community, education and health settings.

Healthcare Improvement Scotland (HIS) is the health body which undertakes assessments and reviews of the quality of care throughout Scotland, however third sector organisations are not captured by their current inspections of NHS services. Health Boards might arrange for treatment to be provided for patients by non-NHS Scotland providers in exceptional circumstances for clinical reasons however the responsibility for consultation, diagnosis and treatment of patients fully remains with the originating Health Board.

Independent Healthcare is regulated by HIS which consists of independent hospitals, private psychiatric hospitals, independent clinics and also voluntary hospices; some of which are commissioned to provide NHS services.

The Scottish Government takes an evidence-based approach to tackling child poverty by ensuring that plans are underpinned by evidence and that we carefully monitor progress. The evaluation strategy summarises the approach which is split across three key areas:

(1) Careful monitoring of the four child poverty targets(relative poverty, absolute poverty, low income and material deprivation, and persistent poverty).

(2) Examination of the three drivers of poverty via the child poverty measurement framework (income from employment, cost of living, and income from social security and benefits in-kind) and

(3) monitoring impact of key interventions on child poverty.

The hyperlinks to all key documents mentioned above are included in the background note.

The Scottish Government has worked with NHS Education for Scotland (NES) to develop ‘Perinatal mental health curricular framework : a framework for maternal and infant mental health’. This framework sets out the different levels of knowledge and skills required by members of the Scottish workforce who have contact with mothers and their babies, to enable them to support mothers, babies and their families to have positive well-being and good mental health during the perinatal period.

The Scottish Government has also worked with NES to advance training on Perinatal and Infant Mental Health. Training in evidence-based approaches and interventions is delivered to staff across sectors and across practice types including informed, skilled, enhanced and specialist, as appropriate to their role.

This includes education and training within Perinatal and Infant Mental Health through e-learning modules which are available on TURAS, covering seven topic areas of essential knowledge. We have also worked with NES to create a specialist Perinatal and Infant Mental Health Learning Programme which allows NES to track the progress of staff in Specialist Perinatal and Infant Mental Health Services including Mother and Baby Units, Community Perinatal Mental Health Teams and Maternity and Neonatal Psychological Interventions.

During 2024-25, NES will continue to promote training at all levels across the sectors that support the development of positive relationships and attachment in the early years. This will be achieved through increasing workforce capacity to deliver evidence-based parent-child relationships focused interventions and approaches from the antenatal period, through infancy and across childhood.

The Perinatal and Infant Mental Health Managed Clinical Network Scotland (PIMHNS) has developed a workstream ‘Parents as Patients’ to develop guidance around joined-up working (i) between perinatal/infant mental health services and other mental health services (e.g. general adult mental health, unscheduled care, liaison mental health), and (ii) between perinatal/infant mental health services and other relevant medical care services (particularly primary care and acute hospital care). The important role of the third sector will feature in both. Initial meetings of two Short Life Working Groups (SLWG) have taken place to progress these workstreams, along with amending the existing care pathways which were published in 2021 ( https://www.nn.nhs.scot/pmhn/wp-content/uploads/sites/11/2021/06/Care-Pathways-full.pdf ) .

Both SLWGs will focus on the themes of:

• Interfaces – to cover both care between specialist and general or universal services. This would also include principles of joint working and good practice.
• Education and training – to address knowledge of parent infant relationships and infant mental health needs as well as child protection issues and risks in relation to childbearing.

The final guidance and updated care pathways are due to be published in the final quarter of the financial year.

The Scottish Government recognises that social prescribing can be an effective method of improving an individual’s physical, mental and social health. It plays an important role in helping us achieve our commitment to prevention, holistic care and Realistic Medicine. Our Primary Care Community Link Worker programme has been in place since 2014 and a 2017 commitment to create 250 Community Link Worker posts in general practice has been achieved.

Due to the wide range of activity which is described as social prescribing, there are many Scottish Government policies and resources which play a role in supporting its delivery. For example, we recognise the important role played by local organisations in supporting the health and wellbeing of their communities and we are working with the community and voluntary sector to look at how we can enhance the capacity of the sector to help those organisations address the challenges they face. The ongoing development by the ALLIANCE of the ALISS online database helps to provide information on community resources and our Green Health Partnership programme led by NatureScot helps to promote the connection between health and the natural environment.

We recognise that there may be a need for more national guidance to support Community Link Workers. We are currently considering how to take that forward in relation to the Community Link Worker programme in Primary Care. While this work will focus on Link Workers in Primary Care, we hope that there will be wider learning that may be able to be shared with the wider social prescribing community.