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The Scottish Government had expected to receive £120 million of additional Health consequential funding in respect of additional allocations to the UK Department of Health and Social Care for testing and vaccination costs.

Whilst we have yet to see the final consequential breakdown for UK Supplementary Estimates, indications were in December that this figure was revised down to £75m.

Rather than a reallocation of £45 million within Scottish Budgets to support business, this figure actually represents the shortfall in Health funding against previous expectations – a reduction of £45 million.

However the financial position has moved considerably since then and full details of all budget transfers supporting the recently announced measures will be set out in the forthcoming Spring Budget Revision.

COBR is shorthand for the UK Government Civil Contingencies Committee that is convened to handle matters of UK national emergency or major disruption. COBR ministerial meetings are described as COBR (M).

The Scottish Government can only report on COBR meetings we are invited to attend by the UK Government. The following table sets out the COBR meetings that the Scottish Government was invited to and which Scottish Ministers attended during 2021.

The Chief Nursing Officer (CNO) has a range of clinical nurse advisors who offer advice and support to both the CNO and Scottish Ministers on a range of issues, including the care of individuals with a stoma. As part of the CNO’s Transforming Nursing, Midwifery and Health Professionals programme, a review of the role definition and education of clinical nurse specialists was taken forward. The review didn’t look at (and has no plans to consider) specific specialties such as stoma nursing and we have no plans to appoint a lead for stoma clinical nurse specialists.

The Framework for supporting people through Recovery and Rehabilitation during and after the COVID-19 was published in August 2020. We then undertook a significant scoping exercise to understand the current status of rehabilitation services in Scotland, from the perspective of the staff working in them. This was done using a self-assessment tool and the report on the findings ( Rehabilitation Framework Self-Assessment Tool: Analysis of Survey Responses ) was published on 9th December 2021.

The findings from the self-assessment tool, along with demand and capacity data, will inform the development of a national programme of improvement work which we will work with NHS Boards, Health and Social Care Partnerships and the third sector to implement. This will deliver a ‘Once for Scotland’ rehabilitation pathway that will ensure everyone who requires rehabilitation will be able to access it.

The National Advisory Board for Rehabilitation last met in October 2021, and it is expected it will meet again in early 2022 now that the report on the self-assessment tool had been published.

The National Stoma Quality Improvement Group’s Short Life Working Group’s final report of November 2019 recommended that NHS Boards review their future Stoma Nurse workforce. I expect NHS Boards to plan their workforce, including stoma clinical nurse specialists, to meet the needs of their population. At this present time, the recommendations from the National Stoma Quality Improvement Group Short Life Working Group and the Scottish Government are not considering the appointment of an implementation lead.

On 3 November 2020 the Scottish Government published a rapid review of outbreaks to learn lessons for practices within care homes Coronavirus (COVID-19): care home outbreaks - root cause analysis - gov.scot (www.gov.scot)

In doing so, the report collated and evaluated local level experiences and responses to COVID-19 outbreaks within care homes. It identified a number of recommendations to support working practices to prevent transmission of COVID. We continue to work to ensure the recommendations are implemented and have recently set up a working group to examine whether further work is required given where we now are in the pandemic.

Providing consistent high quality, safe and effective personalised care for people is our top priority for our health and care services. We continue to take a public health and a clinical evidence based response to the pandemic. In doing so, this continually ensures working practices are fit for purpose, for example Infection Prevention and Control, Personal Protective Equipment and Testing to Protect which continue to be of paramount importance as we come to deal with the impact of the pandemic and apply lessons learned.

In addition, to support the needs and wellbeing of the social care workforce and unpaid carers, we have put in place a combination of measures including working practices which were outlined in the Adult Social Care Winter Plan available at the following link: Adult social care - winter preparedness plan: 2021-22 - gov.scot (www.gov.scot)

As we look to the future and rebuild and remobilise our social care sector in Scotland, we have a significant opportunity to ensure that staff and users of social care people are placed at the centre of the recovery. We are proactively developing an Older People’s Strategy and a Healthcare Framework for adults and older people living in care homes. These principles will also be critical as we establish a National Care Service in Scotland.

Scottish participation in the UK National Cardiac Audit Programme (NCAP), managed by the National Institute for Cardiovascular Outcomes Research (NICOR), was previously enabled through the Healthcare Quality Improvement Partnership (HQIP).

The Scottish Government had been working with HQIP since November 2018 to identify a mutually agreeable legal basis that would support Scotland’s continued participation in a number of UK wide audits, including the NCAP programme. It was not possible to identify one and as a result, throughout 2020/21 there was a phased withdrawal of Scottish Government participation in HQIP associated audits as an appropriate point was reached in each.

As replacement for the NCAP, in April 2021 we commissioned Public Health Scotland (PHS) to develop the Scottish Cardiac Audit Programme. PHS have been actively seeking data submissions from all sites across Scotland which previously contributed to the NCAP.

PHS are currently working with clinicians and patients across Scotland to undertake further development of the audit programme.

a) NHS Staffing

In all areas of NHS Scotland, a great deal of effort is going into ensuring that services have sufficient capacity to deal with COVID-19, manage other risks and resume planned services as safely and effectively as possible. Although NHS Scotland’s staffing levels are at a record high, following nine years of consecutive growth, we are fully aware of the difficult circumstances that Boards and frontline staff are working in. That is why we have announced a record £300 million of new investment in measures to help services deal with system pressures over winter.

Measures we are taking as part of this investment include the recruitment of 1,000 additional healthcare support staff to support patients in hospitals and in community health teams, as well as £4.5 million of funding to attract registered nurses to Scotland. This activity is supplemented by an additional £1 million to enhance Boards’ capacity for recruitment.

Decisions on local staffing requirements and recruitment are the responsibility of individual NHS Boards. However, Scottish Government officials are continually engaging with NHS Boards to identify particular areas of concern.

(b) Social Care Staffing

The Scottish Government launched a national recruitment campaign on 8 November to attract more people to the social care sector. This campaign emphasises the value of a career within social care by showcasing the benefits of the sector beyond pay, and towards the extrinsic and intrinsic rewards of the role.

Officials are working at pace with SSSC and other key sector partners to develop a national induction programme to support new entrants into Adult Social Care; to promote career opportunities and deliver policies on fair work, upskilling and developing the workforce. This commitment is crucial to improving the experience of the social care workforce and addressing long standing recruitment issues in the sector.

As a result of lobbying efforts from the Scottish Government, the Home Office have temporarily extended the Shortage Occupation List for EU workers. Social care workers, care assistants and home care workers are to become eligible for a health and care visa for a 12-month period.

The Scottish Government will continue to push for a migration system tailored to Scotland’s needs, including a Scottish Visa, and work with partners and employers to develop proposals that suit their requirements.

(c) Public Transport Staffing

For bus service staffing, Transport Scotland and Scottish Government Officials are continuing to work closely with bus service sector representatives and other partners to help facilitate solutions to the staffing pressures brought by the COVID-19 pandemic compounded by the consequences of EU Exit. This has included work to help connect local employability partnerships with bus service operators as well as ensuring that the sector is represented in the Labour and Skills Shortages Action Plan process.

For rail service staffing, due to an increase in COVID-related absences and subsequent disruption in December, ScotRail has put a temporary timetable in place to provide a more stable and reliable service. ScotRail staff COVID-related cancellations have now reduced significantly following the successful introduction of a reduced timetable on 4 January. Around 8% of services have been withdrawn in this temporary timetable – largely additional peak services – leaving a more reliable core timetable in place. It is planned to retain the revised timetable until the end of the month, but ScotRail will keep this under review to balance staffing resources and demand from passengers as best as possible.

All 14 NHS Boards have hospitals providing acute stroke care. A map showing all hospitals that contribute data on stroke unit admission to the Scottish Stroke Care Audit can be found in the Scottish Stroke Improvement Programme report at: https://www.strokeaudit.scot.nhs.uk/index.html . Of those sites shown on the map, Stracathro, Stobhill, Vale of Leven, Queen Margaret, Falkirk Community Hospital and Stirling Community Hospital are shown because they contributed data solely on stroke rehabilitation.

The remaining hospitals provide acute beds for stroke patients, either in a unit which has solely acute beds with offsite stroke rehabilitation units for ongoing care, within an integrated stroke unit (combining acute and rehabilitation beds) or in a hyperacute unit. The seven smallest general hospitals define stroke unit admission as gaining access to the appropriate acute medical ward.