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As noted in S6W-19908 on 31 July 2023, the age ranges for breast screening are based on recommendations from the UK National Screening Committee (UK NSC), an independent expert advisory group which informs decisions taken across the UK on screening programmes. There is no clear evidence that the benefits of screening this age group outweigh the potential harms.

Since October 2022, women aged 71-74, and those over 75 with a history of breast cancer, have been able to self-refer for a screening appointment. Due to the challenges around programme capacity and wait times as a result of the pandemic, self-referrals for those over 75 without a history of breast cancer remain paused. This ensures those between 50 and 70 and for whom screening has clear benefits are prioritised. The most recent statistics show that breast screening uptake has increased across Scotland which is the most important factor when maximising cancer detection and effectiveness of the screening programme.

Considerable work has been undertaken to improve programme capacity, including extending screening hours, using additional mobile units, and optimising appointment allocation. The scale of the challenge facing the screening programme since the pandemic means it has taken time for this work to have a significant impact. However, considerable progress has been made, and the scope to extend self-referrals to all those over 75 remains under active review. Both Parliament and NHS Inform will be updated when any decision is made to lift the current pause.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers

The Best Start recommendation to move to a model of three intensive care units in Scotland was based on evidence that this will improve outcomes for the smallest and sickest babies.

The Framework for Practice ‘Criteria to Define Levels of Neonatal Care including Repatriation within NHS Scotland’, published on 25 July 2023 describes the care that can be provided at each level of neonatal care. It outlines that Local Neonatal Units can continue to care for babies requiring short periods of intensive care in accordance with agreed pathways.

In addition the British Association of Perinatal Medicine published ‘ Optimal Arrangements for Neonatal Intensive Care Units in the UK’ in 2021, which provides a framework for practice for neonatal care. This sets out the optimal arrangements for neonatal intensive care to provide the lowest mortality and morbidity, and the best baby and parent experience.

The Best Start emphasises parents as key partners in caring for their baby and aims to keep mothers and babies, and families together as much as possible in the crucial early weeks, with services designed around them.

The new model of care aims to minimise the separation of families, and to support parents with babies in neonatal care. We have a number of measures already in place to support families:

• Providing accommodation for parents to stay on or near neonatal units;
• Roll out of the Young Patients Family Fund (formerly the Neonatal Expenses Fund) to support families with the costs of travel, accommodation and food whilst their baby is in neonatal care;
• and
• Repatriating babies to their local neonatal units as soon as clinically possible.

Under the new model of care mothers in suspected extreme pre-term labour are transferred before they give birth (in-utero) to maternity units in the hospitals that have neonatal intensive care units. Experience from the Early Implementer Boards indicates that this will happen in the vast majority of cases. On occasion when it is not possible to transfer mothers before they give birth, the baby will be stabilised and transferred to a NICU by the specialist neonatal transport service ScotSTAR, and the mother will be transferred to the maternity unit in the same hospital as her baby.

The Options Appraisal Report , published on 25 July 2023 describes the process undertaken to determine the three final Neonatal Intensive Care Units, and the feasibility analysis and testing that followed the conclusion of that process. Annex A of the Report includes the criteria and weighting used for the Options Appraisal Process. Annexes C and D of the report outline the data that supported the Options Appraisal process.

Further detail on the methodology and the scoring of individual units can be found as part of the following Freedom of Information request:

Information relating to Options Appraisal Report: FOI release - gov.scot (www.gov.scot)

The 5 reports from the Neonatal Early Implementers have been placed in the Scottish Parliament Information Centre (BIB number 64669).

The Best Start Report, published in 2017 followed a review of maternity and neonatal services in Scotland, and was based on research evidence, the views of clinicians and the views of service users. Based on data on birth data, the report recommended that we move to a model of three intensive care units in Scotland.

The process of determining which units should provide Neonatal Intensive Care followed an Options Appraisal process undertaken by an expert group, including clinical leads and service user representatives. The Royal Hospital for Children in Glasgow, Edinburgh Royal Infirmary and Aberdeen Maternity Hospital scored highest based on an agreed short list criteria, definitions and weighting. The group were asked to recommend three units and there was no consideration given to including a fourth unit.

The locations of the three Neonatal Intensive Care Units was based on clinical evidence that the very smallest and sickest babies, including those born extremely premature (below 27 weeks), do best when they are cared for in larger specialist neonatal units which look after a lot of these babies, and have the right staff and services available on site to give them the very best care. The Best Start report recommended that we move to three of these units in Scotland, to meet the needs of our population.

The Options Appraisal Report , published on 25 July 2023 describes the process undertaken to determine the three final Neonatal Intensive Care Units, and the feasibility analysis and testing that followed the conclusion of that process. Annex A of the Report includes the criteria and weighting used for the Options Appraisal Process. Based on the evidence, the criteria focused on collocated clinical specialist services.

To support all parents who have babies admitted to neonatal care the Young Patients Family Fund provides funds to cover the cost of travel, subsistence and any accommodation required.

The three NICU units; Royal Hospital for Children in Glasgow, the Aberdeen Maternity Hospital and the Edinburgh Royal Infirmary will serve the West, North and East regions of Scotland. Data on births in Scotland is published on the National Records of Scotland website for every year since 1991, broken down by NHS Board or council area of birth.

The membership of the Best Start Review Group and the Best Start Sub-Groups is published in Appendix E and Appendix F of the Best Start Report .

Dr Ian Wallace, at the time Medical Director at NHS Lanarkshire, was a member of the Best Start Review Group and the Neonatal Models of Care sub group.

The statutory responsibility for delivering and commissioning services at a local level lies with local authorities, NHS boards and integrated health and social care partnerships. Publicly funded places in care homes are covered by the National Care Home Contract, which is negotiated annually between COSLA and Scottish Care. The information requested on the number of NHS funded beds that are currently empty is not held by the Scottish Government.