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There has been a significant decrease in the number of children who are exposed to second-hand smoke in their own home. It is very reassuring to see that parents and carers are still protecting children from the harms of smoking in the home.

One of our priorities will be to keep up momentum on protecting them from associated harms.

The Scottish Government recognises the continued importance of awareness-raising campaigns in support of our current strategy. It is clear that our smoke-free homes campaign (Take it right outside) has raised awareness of second-hand smoke in enclosed spaces and has contributed to the keeping second hand smoke exposure levels low.

Current data indicates that the target to reduce the percentage of children exposed to smoke at home to 6% by 2020 was met in 2015 and 2017. Figures will continue to be examined in future years to assess adherence to the target.

The Scottish Government is raising awareness amongst prescribers about the relative effectiveness of varenicline compared to traditional nicotine replacement therapies. The percentage of smoking cessation service users being prescribed varenicline rose to 19% in 2017-18. The Scottish Government expects this percentage to rise further in future years.

NHS Public Health teams are working within Health Boards to improve clinical confidence in varenicline, which has now been cleared for use by the Medicines and Healthcare products Regulatory Agency.

People are offered a wide range of approaches and products for smoking cessation. The level of varenicline use will reflect in part that people are currently preferring other methods, such as nicotine replacement. Public Health teams are working within the Boards to improve clinical confidence in varenicline, which had been associated with potential harm by the Medicines Health Regulatory Association in 2008. Subsequent clinical research has demonstrated that varenicline is safe to use for many people wanting to stop smoking. It is anticipated that the use of varenicline will continue to increase.

Health Environmental Services (HES) provides clinical waste management services to 18 Health Boards that covers collection through to disposal of waste.

We do not hold details of the contracts which individual NHS Boards have with HES, including value of the contract.

A National Once for Scotland tender is currently underway and being managed by NHS National Services Scotland.

The Scottish Government is committed to ensuring consistency in local smoking policies on vaping on hospital grounds. We are currently consulting with NHS Boards in order to reach a consensus on whether vaping should be allowed on hospital grounds through a consistent national approach.

Clinical waste collection continues as normal for NHS Scotland and we are not aware of any issues regarding the disposal of this waste in Scotland.

The Scottish Government is monitoring the situation and receiving regular updates from Health Boards.

In the event of disruption to clinical waste management services at NHS sites across Scotland, all NHS Scotland Boards have contingency plans ready to put into place. The plans ensure that there is sufficient storage capacity for clinical waste to be stored safely on site for a period of 72 hours.

There is a strong existing evidence base around coexisting psychosis and substance misuse. NICE clinical guidance CG120 contains detailed information about assessment and management: https://www.nice.org.uk/guidance/cg120

SIGN 131 guidelines cover the management of schizophrenia, and include a dedicated section on dual diagnosis:  https://www.sign.ac.uk/assets/sign131.pdf

We are not aware of any current plans to update this guidance.

Some local services across NHS Scotland have their own specific policy and guidance to ensure that local service delivery is matched to need.

Additionally, the Scottish Government will publish a new alcohol and drug strategy this autumn. It will challenge alcohol and drug treatment services to adapt the ways in which they work, in order to better meet the wide range of complex health and social care needs.

A range of specialist support is available depending on the type, severity and symptoms of the syndrome.

Most people with Ehlers-Danlos syndrome (EDS) in Scotland are managed by consultant rheumatologist or physiotherapy services in their local hospital. Depending on the type of EDS and the severity of their symptoms, some people are managed by or receive additional input from a range of clinical speciality areas such as dermatology, paediatrics, vascular surgery, gastroenterology and neurology.

People with rarer types of EDS will normally be referred to regional genetics for confirmation of diagnosis. There are also specialist EDS diagnostic services based in Sheffield and London available on referral for people in Scotland with complex symptoms.

People with EDS may also require specialist pain management advice, for which there is a national service for Scotland provided by NHS Greater Glasgow and Clyde. Very complex cases can be referred for a residential programme to the Royal National Hospital for Rheumatic Diseases in Bath.

Haematologists within each NHS board are expected to take account of any relevant guidance, such as the guidelines published by the British Committee for Haematology Standards 2014 and the National Institute for Health and Care Excellence Clinical Knowledge Summary on Anaemia, B12 and foliate deficiency.

Authorities in England alerted Scottish Government to issues regarding the company’s management of clinical waste at its sites in England in August.

Since then Scottish Government have been working with Scottish Environment Protection Agency (SEPA) and NHS National Services Scotland (NSS) to monitor the situation and have sought assurances with NHS Boards that they have contingency plans in place.

NHS Scotland, working with SEPA , have developed contingency plans which firmly maintain environmental protections. SEPA is clear that compliance is non-negotiable and is robustly monitoring sites in Scotland.

Scottish Government continues to monitor the situation in England and any potential impact on services in Scotland.

NHS whistleblowers who have concerns should raise them locally in the first instance. Staff can also contact the Whistleblowing Alert and Advice Line for independent, confidential advice from legally trained staff on whistleblowing matters. This also provides a route, where appropriate, for staff to have their whistleblowing concerns passed to the appropriate regulatory or scrutiny body.

I announced on 8 October that I will personally appoint Health Board`s non-executive Whistleblowing Champions, and that this will now be a dedicated role. If any of the Whistleblowing Champions feel they, or staff within their area are not being heard by their Board, they will be able to contact me directly. More detail on the process for appointments will be provided in due course.