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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.

A report recently published by Public Health Scotland provides details of the most recent statistics for the bowel screening programme, which includes the uptake differences between areas of different socioeconomic status. The overall uptake continues to exceed the HIS standard of 60% of the eligible population, but there continue to be inequalities in the return rates for bowel screening kits, including between the least and most deprived communities in Scotland.

Since 2017, the Scottish Government has provided £1 million funding annually to address screening inequalities, part of which has been distributed to NHS Boards to fund initiatives catering to their specific populations.

The funding is also used for national initiatives, such as the development of the Screening Intelligence Platform (ScIP), which aims to simplify the process of gathering and analysing all screening data. This will allow greater insight into screening inequalities across a range of characteristics, including socioeconomic status, and supporting efforts to increase screening uptake across all groups.

In addition, the Equity in Screening Strategy was published last year. This set out a vision for equitable access across the full screening pathway, including in the bowel screening programme. It is accompanied by the implementation of an Equity in Screening Network that allows those who work across screening to share evidence, best practice and learning around screening inequalities. This will enable NHS Boards to consider proven interventions to address inequalities in uptake, and therefore increase participation in the bowel screening programme.

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.

The Scottish Government works closely with NHS Education for Scotland who are the national body that are responsible for advanced practice across the Allied Health Professions (AHPs) including physiotherapy.

The NHS Education for Scotland Multiprofessional Advanced Practice Toolkit aims to facilitate the professional development of advanced practitioners and provides easy to navigate links to useful information across four pillars of practice.

Although not profession specific, advancing practice and the promotion of AHP career pathways is a key focus of the AHP Education and Workforce Policy Review intended outcomes. The review’s work is being taken forward through an ongoing delivery plan that aims to adopt a comprehensive approach to fostering the growth and advancement of the AHP workforce.

The Scottish Government and COSLA committed to the provision of suicide bereavement support across Scotland in their Creating Hope Together action plan ( 2022-25). The bereavement support service is a core element of our approach to ensuring everyone affected by suicide is able to access high quality, compassionate, appropriate and timely support.

Since August 2021 we have funded bereavement support service pilots in NHS Ayrshire and Arran and NHS Highland. Over 2023-24 we have worked with partners to design and plan the roll-out of the service, drawing on the positive evaluation of the pilots. Expansion of the bereavement support service will begin from 2024-25, working closely with local partners. Further details will be confirmed as soon as possible.

We remain committed to eradicating long waits to ensure all people receive the treatment they need as soon as possible.

We opened two new National Treatment Centres in Fife and Highland in Spring 2023, and NTC-Forth Valley and the second phase expansion of NTC-Golden Jubilee will open in 2024. These centres will deliver eight orthopaedic theatres and will provide additional and protected capacity for hip and knee replacements.

This year NTC Highland is providing 1,500 orthopaedic procedures and NTC-Fife plans to deliver more than 700 orthopaedic procedures by 2025/2026.

Significant progress is also being made in the delivery of same-day discharge arthroplasty, allowing patients to be safely discharged home on the same day as their procedure, increasing capacity within Orthopaedics.

The Scottish Government continues to protect investment in digital within health services, as shown in the published budget. Planning remains underway to fully assess the impact on planned activity for 2024-25 that takes into account the considerable financial challenges facing the Scottish Government in the forthcoming financial year, and we will publish our Delivery Plan for Digital Health & Care in April 2024. This will confirm delivery priorities for the year ahead using the investment available.

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.