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The Scottish Government expects Health Boards in Scotland to consider all of the recommendations made in the Saving Lives, Improving Mothers’ Care reports. The 2019 report was the 5 th MBRRACE audit report, and the reports have highlighted key actions for Health Boards. The report assists Boards in identifying areas for further action, building on any work undertaken following publication of the 2018 Report.

Following the findings of the 2018 report regarding poorer maternal mortality rates for black and Asian women the National Perinatal Epidemiology Unit in Oxford University, who lead on the MBRRACE-UK reports, commissioned further research to explore in depth the underlying reasons for this inequality. Scottish data is included in this research and we expect that this will give further insight into specific actions that can be taken to reduce this disparity.

Maternity care across Scotland is provided by multi-professional teams with quality and safety for all mothers and babies central to decision making. Clinical teams work in partnership with women to design individualised, person centred care, taking account of all relevant factors, including ethnicity, social complexity, and mental and physical health. The introduction of the continuity of midwifery and obstetric care under our Best Start programme will enable further improvements in person centred care for every pregnant woman, and particularly for those at risk of poorer outcomes.

Estimated numbers of people affected by the pause to breast screening were published when the pause to the programme was announced on 30 March. The figures, which are based on the most recent information available to Information Services Division at the time of the pause, indicate that 46,596 people may have had their breast screening appointment delayed as a result of the pause to the breast screening programme over the past three months.

The resumption of screening services is taking place safely, carefully and in a series of stages, as part of the remobilisation of the NHS in Scotland. The breast screening service is currently assisting acute services to prioritise high-risk familial clinics and post-treatment surveillance screening, while preparing for the resumption of the national programme.

In the meantime, it is absolutely vital for those in between screening appointments or awaiting a rescheduled appointment to be aware of any symptoms or signs of the conditions screened for. Anyone having these symptoms should contact their GP practice.

The Scottish Government were concerned to read the findings of this tragic incident. NHS Lothian have accepted the findings of the Fatal Accident Inquiry and have confirmed that a number of actions have taken place since 2014 to improve the number of staff incorporated within ward establishment figures. Firstly, the Royal Edinburgh Hospital was given an uplift in budget of £3 million which allowed it to review establishment levels. In addition, when the new Royal Edinburgh Building was built, it allowed for an improved number of nursing staff per bed ratio.

NHS Lothian has produced a draft action plan in response to the FAI which includes implementation of the standards within Healthcare Improvement Scotland’s (HIS) "From Observation to Intervention" 2019 guidance. This is being taken to the NHS Lothian Health Care Governance Committee for discussion on 24 th July 2020.

On December 16 2019, the Scottish Government published the first Integrated National Health and Social Care Workforce Plan in the UK. Developed in partnership with COSLA, the Integrated Plan sets out how health and social care services will meet growing demand to ensure the right numbers of staff, with the right skills, across health and social care services. Covid-19 has led to widespread disruption to Health Boards' models of service delivery and we are carefully considering the Integrated Plan to ensure its content and associated guidance are, going forward, reflective of the full range of current and developing planning requirements on Boards and the changing circumstances regarding Covid-19.

In addition, implementation of the Health and Care (Staffing) (Scotland) Act, which is the first multi-disciplinary workload and workforce planning legislation in the UK, will support the wider workforce planning process by enabling a rigorous evidence based approach to staffing decisions. Health Boards have also been supported in planning their nurse staffing in response to the pandemic by the development of a professional judgement decision making template, including for mental health.

The Scottish Government will also shortly reconvene the National Mental Health Quality and Safety Board. This Board will be considering all issues that impact upon the quality and delivery of safe and effective services, including inpatient and community settings.

Test and Protect programme is run by NHS Scotland using NHS staff and resources. Spend on private contractors by Scottish Government to support delivery of the programme is to date limited to support for marketing campaigns, contact centre telephony, data analytics and modelling, and systems development. Detail of spend to date is set out in the following table. A minimum threshold of £10,000 has been applied. Spend on governance support has been excluded as it does not relate to programme delivery. Further expenditure on private contractors may have been incurred by NHS territorial health boards. This information is not held centrally.

I refer the member to the answer to question S5W-27044 on 3 February 2020. This confirmed that routine health data records hernia operations, bladder operations, etc., using prosthetic implants, not those specifically using mesh implants. Furthermore, NHS Information Services Division (ISD) confirmed that reported complications or problems following surgery cannot accurately be established from routine health data because readmissions are recorded according to the symptom reported, not the underlying cause.

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/parliamentarybusiness/28877.aspx .

The Covid-19 Clinical Guidance Cell has been established by the Chief Medical Officer to rapidly develop and revise guidance on clinical management of COVID-19 for the NHS.

The purpose of the Clinical Guidance Cell is to rapidly prepare guidance for the health and care system in Scotland on the clinical management of COVID-19.

Membership is drawn from key organisations and professional communities across Scotland who have a direct interest. This includes the Scottish Academy of Medical Royal Colleges and Faculties and Health Protection Scotland.

The Scottish Government is also advised by the COVID-19 Advisory Group, which was established to address the need for additional scientific analysis of the impact of COVID-19 in Scotland, based on regularly updated advice and modelling from the UK Scientific Advisory Group for Emergencies (SAGE), and other emerging scientific evidence.

The group is chaired by Professor Andrew Morris, Professor of Medicine at the University of Edinburgh, supported by vice chair, Professor David Crossman, Dean of Medicine at the University of St Andrews and Chief Scientist (Health) at the Scottish Government. Members are public health experts, clinicians and academics spanning the disciplines of epidemiology, virology, public health, behavioural sciences, global health, medicine and statistical modelling. Full details of the group’s membership are available on the Scottish Government’s website at https://www.gov.scot/groups/scottish-government-covid-19-advisory-group/

As part of the Scottish Government response to the COVID-19 pandemic, on 25 th March 2020 the Chief Scientist Office (CSO) launched a call for rapid research in COVID-19. The call attracted 139 individual research project proposals. CSO convened an independent expert panel to review the applications. This panel, which met virtually on 21 April 2020 to consider the applications, comprised 35 expert members from the medical and wider health and social care research sectors and 3 lay members and was co-chaired by Professor Eleanor Davies from the Univeristy of Glasgow and Professor Shaun Treweek from the Univeristy of Aberdeen.

The outcome of the review was that 56 research projects were funded, led by 15 different research institutions from across Scotland. The work funded through this call involves researchers from the medical and wider health and social care research sector. This includes research to:

• Better understand the effects of COVID-19 infection in order to inform treatment and management of disease

• Develop and test new diagnostics and therapeutics

• Investigate novel disease surveillance approaches

• Inform interventions to prevent transmission of infection

• Support the resilience and mental health of frontline health and social care workers

• Understand the physical and mental health implications of social distancing and other restrictions and their impact on the general population and also a number of vulnerable groups

Details of the funded projects are available from the CSO website. https://www.cso.scot.nhs.uk/rapid-research-in-covid-19-programme/

Staff and carer wellbeing was highlighted as one of eight key objectives for safe and effective mobilisation across health and social care in “Re-mobilise, Recover, Re-design: the framework for NHS Scotland”, which was published on 31 May 2020.

The Scottish Government is working closely with partners across the health and social care sector, including NHS Boards, Health and Social Care Partnerships and local employers, to ensure a range of psychological and wellbeing support is in place for the workforce as normal services are remobilised.

A range of support is available at the national level, including through the National Wellbeing Hub (www.promis.scot), which continues to be widely used by the workforce. We are exploring with partners how best to respond to those who may need more specialist support and care over the coming months.

The exact information requested is not available centrally. Public Health Scotland collect social care information directly from Health and Social Care Partnerships; however, it is not possible to identify from this if social care packages have been withdrawn or the reason why a package may have been withdrawn or reduced.

It is possible to estimate the number of people receiving home care services each month and how many hours of home care were received. Table 1 provides this information for January to March 2018. Information for 2018-19 is not yet available.

Table 1. Number of people receiving home care 1 services and total number of hours 2,3,4 of home care by month and Health and Social Care Partnership 2,3,4 , January to March 2018

We have been clear that throughout this pandemic, the NHS is there for those who need it. Our NHS is Open campaign was launched 24 April and we have seen a steady increase in the number of people presenting to their GP practice with symptoms that could be suspicious of cancer – now 86% pre COVID levels.

Our Clinical Director for Scotland, Jason Leitch also made a statement urging patients who have an appointment to attend hospital for these as it will have been deemed clinically safe to do so.

We are working hard to ensure vital and urgent care remains, including the use of private hospitals to treat these NHS patients. By utilising the private sector capacity we are able to provide a COVID free environment for urgent cancer procedures. The Golden Jubilee is also supporting the treatment of urgent cancer patients.

Data on patients recruited from NHS Scotland in each of the last 12 months into non-COVID-19 Trials in Scotland are set out below.

June 2019 1,678

July 2019 1,839

Aug 2019 1,725

Sept 2019 1,358

Oct 2019 1,647

Nov 2019 1,431

Dec 2019 991

Jan 2020 1,500

Feb 2020 1,293

Mar 2020 789

Apr 2020 34

May 2020 19

Notes

1. The data does not take account of patients recruited into other types of research.

2. The number of patients recruited in previous years and still involved in Clinical Trials is not captured by NHS Research Scotland.

3. The data has been provided by research teams working in NHS Scotland and may not be complete.