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Whilst the need to protect non COVID-19 healthcare activity remains paramount, it will inevitably be affected by the degree to which we can suppress the virus. Consequently, given the differing levels of virus prevalence we are seeing across the country, we need to give our clinicians and NHS Boards flexibility to manage the demands of this continuing emergency situation.

Due to these demands, NHS Boards are stepping back their non-urgent routine procedures consistent with the Framework for Clinical Prioritisation of Elective Care . To support NHS Boards and to ensure that urgent elective and cancer patients continue to receive treatment, and following the arrangements set out in the NHS Scotland - winter preparedness plan: 2020 to 2021 - gov.scot (www.gov.scot) , we have secured further capacity from the private healthcare sector in Scotland. Our strategy for using the private sector is to ensure that there is a green pathway for those patients who require vital planned care. The private sector hospitals will provide support for breast surgery, urology, and gynaecology.

This support comes on top of the additional capacity already being provided by NHS Golden Jubilee and NHS Louisa Jordan for a number of elective treatments and outpatient appointments. This will allow NHS Boards to concentrate on the front line response to the impact COVID19.

The Scottish Government will continue to work closely with NHS Boards to ensure those requiring urgent care can be seen as quickly and safely as possible.

Even as we expand our vaccination and testing programmes, the number of COVID patients within our hospitals remains very high – so it is absolutely vital that people continue to stay home, protect the NHS, and save lives.

While cancer services have remained a priority throughout the pandemic, we recognise there continues to be an impact on cancer services due to the necessary reduction in some areas of clinically determined non-urgent care. Today, we have published and launched our Recovery and Redesign: An Action Plan for Cancer Services which details how we will continue to prioritise cancer services and steps that will be taken in order to ensure resilience in the future, and adopt new innovations. The Plan, which will be live from now until March 2023, is operationally focused with an emphasis placed on diagnosis and treatment. We have outlined 68 actions in total, including 4 flagship innovations. We will establish two Early Cancer Diagnostic Centres within existing NHS infrastructure, a Single Point of Contact Framework to aid patients navigate through cancer services, a programme of Prehabilitation to prepare patients for treatment and achieve optimal outcomes, and a National Dedicated Resource for Cancer. This plan will be backed by up to an additional £17 million, bringing our planned total investment in cancer services up to £114.5 million by March 2023.

Engagement is regular and ongoing between Scottish Government and Dumfries & Galloway Council officials regarding the regeneration of Stranraer town centre and the plans for the waterfront.

The discussions have covered the progress of projects being supported through the Regeneration Capital Grant Fund and Town Centre Fund, and also wider Borderlands Growth Deal plans and projects.

I refer the member to the answer to question S5W-32111 on 26 October 2020, which continues to represent the latest position on this, with the Council’s proposals still awaited.

All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

The role of the clinical nurse specialist was last reviewed in 2019-early 2020 under the Chief Nursing Officer Programme for Transforming Nursing roles, however this work was paused to allow us to focus on our response to the Covid 19 pandemic. We have recently restarted elements of this work and the Transforming Roles Specialist Nursing paper will be published as soon as we are in a position to do so.

Whilst we are working to maintain as much non COVID-19 healthcare activity as we safely can, that will inevitably be affected by the degree to which the virus is suppressed. Consequently, given our Strategic Framework approach and the differing levels of virus prevalence we are seeing across the country, we need to give our clinicians and Board flexibility to manage the demands on activity in this continuing emergency situation.

As outlined in the NHS Winter Preparedness Plan published on 28 October, I am today publishing the Framework for the Clinical Prioritisation of Elective Care: https://www.gov.scot/publications/supporting-elective-care-clinical-prioritisation-framework

The Framework provides NHS Boards with clear guidance for prioritising elective care ensuring appropriate COVID-19 safety and priority measures are in place.

NHS Boards will follow the Framework to categorise patients into four levels of urgency based on their particular clinical condition. This clinically based prioritisation will determine the timeframe within which patients will be seen and treated, ensuring that patients with the greatest clinical need are treated quickest.

The Framework sits alongside section 8(3) and (4) of the Patient Rights (Scotland) Act 2011 which continues to require NHS Boards to take all reasonably available steps to ensure they are compliant with the treatment time guarantee (TTG). These steps include appropriately prioritising the start of the patient's treatment taking account of their clinical needs, and the clinical needs of other eligible patients, in accordance with the treatment time guarantee.

Implementation of the Framework will ensure patients have a clear and realistic expectation of when they will receive their treatment that is clinically appropriate to their individual circumstances. This is especially important at the current time as the NHS manages the demand pressures of winter, responding to COVID-19 and delivering non COVID-19 healthcare. We will also take steps to ensure that patients receive clear and timely communication with respect to their planned procedure.

The Framework has been developed with senior clinical leadership from the Deputy Chief Medical Officer and senior clinical representation from across Scotland.

The Scottish Government is aware that in recent weeks people have experienced a number of problems with the testing system, including being unable to book tests/obtain home testing kits; being offered testing slots far from their homes and/or experiencing delays in receiving the results of tests they have taken.

We are working to increase overall testing capacity in Scotland by:

• Deploying additional mobile testing units.
• Increasing the number of tests that can be carried out at regional testing centres.
• Utilising additional NHS testing capacity, for example by activating additional drive-through facilities.
• Establishing 22 new walk-through centres (Local Test Sites) across Scotland.

We are engaging closely with universities, health boards and local authorities to deliver these local test sites (LTSs), which are designed to meet the needs of people who do not have access to a car. 11 Local Testing Sites (in St Andrews, Glasgow city centre, west Glasgow, Aberdeen, Edinburgh, West Dunbartonshire, Stirling, Dundee, Sighthill in west Edinburgh, Inverness and Inverclyde) are now operational.

We have made testing a priority for care home staff so we are currently migrating the routine testing of care home staff into NHS Scotland labs.

Three new regional hubs will open during November and December and when fully functional will provide at least an additional 22,000 tests per day for NHS Scotland. The hubs will be used in the first instance to process care home staff testing and provide capacity and resilience to health boards throughout the winter and beyond.

At the outset of the pandemic, the four Chief Medical Officers (CMOs) published a list of six groups where people would be considered to be at the highest clinical risk from COVID-19.

The initial approach was based on best evidence at the time. We are committed to following the evidence and we have refined the shielding criteria as new evidence emerges.

For this reason the 4 UK CMOs considered data from a new study recently published (QCOVID model - https://www.bmj.com/content/371/bmj.m3731 ) and based on evidence agreed to include to the shielding list people aged 18 and over with Down’s Syndrome and patients with Chronic Kidney Disease stage 5.

Letters will be issued as soon as possible to those people affected to inform them that they will be added to the shielding list and to explain what it means for them.