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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.

The table below from Public Health Scotland shows the numbers of inpatient and day case hospital admissions with a primary diagnosis of diabetic ketoacidosis and the number of these admissions where the patient died in hospital.

Due to the way that complications of diabetes are coded in the international ICD10 coding system this only includes cases of diabetic ketoacidosis without coma. These figures do not include cases of diabetic ketoacidosis with coma, which cannot be identified separately from instances of diabetic coma without ketoacidosis.

We welcome the publication of the Scottish Diabetes Survey which provides an annual summary of key issues and trends in diabetes care and treatment in Scotland. As in previous years, the number of people living with diabetes in Scotland is increasing. However, we are not seeing a great increase in the number of new cases, but rather people with diabetes are living longer with the condition.

At the end of December 2020 the Scottish Diabetes Survey reported that 317,128 people have been diagnosed with diabetes of all types in Scotland compared to 312,390 people diagnosed in 2019.

We are committed to ensuring that everyone living with diabetes in Scotland can access appropriate, high-quality, person-centred care. In February 2021, we published our Diabetes Improvement Plan refresh, which builds on the progress made since 2014 and sets out our priorities to deliver safe, effective and person-centred healthcare, treatment and support to those living with diabetes.

Our Type 2 Diabetes Early Detection, Intervention and Prevention Framework was published in 2018 and is designed to support those at risk of, or diagnosed with, type 2 diabetes. It provides guidance to NHS boards on the provision of evidence-based, person-centred targeted interventions across diabetes and weight management services.

In July 2019, the Scottish standards for the delivery of tier 2 and tier 3 weight management services to children and young people and to adults were published. These standards provide a detailed framework to drive forward consistent, equitable and evidence-based approaches across Scotland in the treatment of higher body weight and associated health risks.

We are committed to reducing the impact of inequalities on health outcomes for people living with diabetes, and equity of access is highlighted as a key priority in our Diabetes Improvement Plan refresh, published in February 2021.

We are working with key partners including NHS Boards, Health & Social Care Partnerships, Diabetes Scotland and people living with diabetes to ensure that evolving care models address existing health inequalities by integrating pathways with existing services and resources such as social work, mental health services, education and third sector.

As diabetes services evolve and include more virtual offerings, we will work to ensure that those people with diabetes who are unable to access services digitally are not disadvantaged as a result of digital exclusion.

We recognise that the Covid-19 pandemic has had a significant impact on our NHS including diabetes services. We took the opportunity to reflect on these challenges as we determined the priorities for our Diabetes Improvement Plan refresh, which was published in February 2021.

On 25 August 2021 we launched our NHS Recovery Plan which is backed by more than £1bn of investment over the next five years. The plan takes forward our aim of increasing NHS capacity by at least 10% as quickly as possible in order to address the backlog of care and meet the ongoing healthcare needs for people across the country.

The Heart Disease Action Plan 2021, sets out a strategic vision to address the impact of heart disease across Scotland. This means that the plan does not provide detailed information on specific conditions but instead identifies four priority areas. These are 1) tackling risk factors, 2) ensuring timely and equitable access to diagnosis, treatment and care, 3) addressing key issues within the cardiac workforce, and 4) ensuring effective use of data to support improvement.

The actions within these priority areas should impact across a number of cardiac conditions and therefore improve services for everyone with heart disease, including for people living with heart valve disease.

The Scottish Stroke Care Standards can be found here: ( https://www.strokeaudit.scot.nhs.uk/index.html ). The current standard relating to brain imaging already sets out that 90% of patients should receive this within 12 hours of arrival at first hospital, unless there is a documented contraindication.

The Scottish Stroke Care Standards are regularly reviewed in line with current evidence and updated guidelines. We monitor the implementation of these standards through the Scottish Stroke Care Audit to ensure that stroke patients in Scotland are receiving high quality care.

Further to the answer to question S6W-04701 I can confirm that the case review was undertaken by a small number of NHS Lothian clinicians who are all suitably qualified and experienced in their relevant fields. As none of the clinicians who undertook the review had previously looked after Mr Slorance there was no conflict of interest in undertaking the review.