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Obtaining informed consent, which is primarily a matter for clinicians working in NHS Scotland and their patients, can only be achieved through partnership and joint decision making. The General Medical Council (GMC) has produced comprehensive guidance, Good Medical Practice and Consent: patients and doctors making decisions together. This sets out the principles on which good clinical decisions should be based. It also provides a framework for good practice that covers the various situations that doctors may face in the course of their work. The guidance can be found at: http://www.gmcuk.org/guidance/ethical_guidance/consent_guidance_how_guidance_applies_to_you.asp

The Scottish Government expects all NHS boards and their clinicians to adhere to the GMC guidance and to have clinical governance arrangements in place to ensure that the principles and framework contained in the guidance are applied by all doctors when seeking informed consent to treatment from patients.

Patients are not referred under the terms of the European Cross-border Healthcare Directive. They are exercising an EU Treaty right that allows them to travel throughout the European Economic Area (EEA) to receive treatment that is the same as or equivalent to treatment that is provided by the state in their home country, and to be reimbursed on return to that country.

The home healthcare provider has no responsibility for the quality, safety, outcome or governance of the treatment sought in another part of the EEA. In considering reimbursement (which is restricted to the amount the treatment would have cost if it had been provided by the state at home) the home healthcare provider - in Scotland the relevant NHS board - must ensure that the treatment was medically necessary and that prior authorisation has been agreed (if the patient travelled for specialist treatment). The NHS board must also be satisfied with the supporting documentation from the country of treatment, before reimbursement can be paid. Scotland's European Cross-border Healthcare National Contact Point, administered by NHS inform, provides further guidance on the operation of the directive at: http://www.nhsinform.co.uk/rights/europe/.

The directive was transposed in October 2013, although since then Cross-border healthcare activity has been modest. The 14 local NHS boards would be best placed to provide numbers for both outgoing and incoming patients who have used the Directive to travel in the EEA for treatment.

The following tables shows the number of people from Scotland who have received treatment in hospitals in other parts of the UK in each year since 1999. The data across the UK is not directly comparable due to differences in data definitions.

Information is provided in the following table on the number of finished admission episodes for patients resident in Scotland who have received healthcare from the NHS in England since 1999.

Source: Hospital Episode Statistics (HES), NHS Digital (England)

Information is provided in the following table on the number of patients resident in Scotland who have received healthcare from the NHS in Wales since 1999.

Source: Patient Episode Database Wales (PEDW), NHS Wales Informatics Service

Information is provided in the following table on the number of patients resident in Scotland who have received healthcare from the NHS in Northern Ireland since 1999.

Source: Hospital Inpatient System, Northern Ireland Health Department

^P -Provisional

The Scottish Government does not hold this information for independently contracted practices. It does expect patients to be offered an appointment with a member of GP practice staff within two days; the latest figures (Health and Care Experience Survey 2015-16) show that nearly 92% of people were able to get a consultation within that time.

The figures on the percentage of patients able to arrange an appointment with a member of GP practice staff within two days by board are given in the following table:

Figures broken down by GP practice are held at the following website: http://www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey/HACE2015-16/LDP-GP

The Scottish Government has agreed with Scottish General Practitioners Committee to begin extracting data this transitional year (01 April 2016 to 31 March 2017). This has two purposes:

The creation of an anonymised extraction process at a practice cluster level will support quality improvement activities across a group of practices within a cluster.

The creation of an anonymised extraction process will support service planning and delivery in the new integrated partnerships.

This extraction of patient information follows the abolition of the quality of outcomes framework and will begin towards the end of September 2016.

The consultation document makes it very clear that the proposal relates to cleft surgery only. The consultation document can be accessed at: http://www.nsd.scot.nhs.uk/news/index.html

Clear and categoric assurances that, with the exception of surgery, all other cleft services will continue to be delivered locally have been given throughout this process in correspondence with campaigners and MSPs. These assurances have also been given to the National Specialist Services Committee and NHS board Chief Executives, during their consideration of the proposal. The decision whether to accept the proposal rests with Ministers. I will make my decision in due course.

In line with our vision, Scottish Government policies are enabling more people to live longer and more independently in their own homes, which results in fewer people needing residential care. We are providing more than £0.5 billion additional funding over three years to help Health and Social Care Partnerships establish new ways of working, and investing a further £250 million per year to protect and grow social care services.

Each Health and Social Care Partnership is required by the Public Bodies (Joint Working) (Scotland) Act 2014 to put in place a strategic commissioning plan for the integrated functions and budgets that they control.

Before undertaking the strategic commissioning plan, partnerships are required to undertake a strategic needs assessment which considers: needs; population dynamics and projections; service activity; supply and demand; and gaps in provision. This informs their strategic commissioning plan and shapes services and support to deliver better outcomes. It will be for partnerships to determine the need for care home places in their localities and to work collaboratively with others, including providers, to meet that need.

The Scottish Government is committed to improving the quality of care in Scotland and we meet regularly with COSLA, Scottish Care, Coalition of Care and support Providers in Scotland and other key stakeholders in order to do this.

As part of this partnership approach the Scottish Government is a member of the National Contingency Planning Group, which includes providers and is chaired by COSLA. The group works with stakeholders in identifying potential risks which could lead to the disruption of adult social care provision in Scotland.

We are also working with COSLA and care providers to deliver a major programme of reform to adult social care. These reforms will maintain the continuity, stability and sustainability of residential care provision while embedding greater local flexibility, maximising efficiency, improving quality, enhancing personalisation and promoting innovation.

The following table shows the number of laboratory confirmed diagnoses of borrelia infection each year but there will be cases which are not captured by surveillance. This is because current guidance states that if a patient presents to their healthcare professional with a history of a tick bite and erythema migrans (rash), antibiotic treatment should be recommended immediately. This treatment renders subsequent samples non-diagnostic and therefore not recorded by surveillance systems.