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Scottish Government notes this report with interest and is fully aware that the risk of liver disease is increased by the impact of harmful alcohol use and obesity.

This is why we are determined to do all we can to reduce alcohol-related harm, one of the most pressing public health challenges that we face in Scotland. We take a whole population approach to tackling such harm, in line with the World Health Organisation’s focus on affordability, availability and attractiveness of alcohol.

Our Alcohol Framework 2018 contains 20 actions to tackle alcohol-related harm. One of the key actions was the implementation of Minimum Unit Pricing (MUP) in May 2018. Since then, we have seen a reduction of 3% in total alcohol sales,with a focus on the cheap high-strength alcohol which is often drunk by people drinking at harmful levels. Recent research by Public Health Scotland has found that MUP has been found to save more than 150 lives a year and 411 fewer hospital admissions. It’s also encouraging to see that this research has highlighted that the policy is having an effect in Scotland’s most deprived areas – which experience higher death rates and levels of harms from problem alcohol.

We also want everyone in Scotland to eat well and have a healthy weight to help reduce the impact of a range of diet-related ill health conditions, including liver disease. We continue to implement the wide-ranging actions set out in our 2018 Diet and Healthy Weight Delivery Plan to address this challenge. This includes our commitment to restrict less healthy food promotions and improve the availability of healthier options when eating out, as outlined in our Out Of Home Action Plan.

Scottish Government through its national Centre for Sustainable Delivery (CfSD) has formed a Specialty Delivery Group for Liver Disease with the first meeting on 6th November 2024. Early Detection is one of the pathways being prioritised.

The Early Detection Pathway has already been passed through the first Gateway in the CfSD delivery pathway. The challenges are around how individual boards can implement this before the National Laboratory Information Management System.

There has been progress in developing the Early Detection pathways in individual health boards using the technology as currently available while others are using the Referral Advice to Primary Care with increased use of the FIB-4 and Fibroscan with advice for Lifestyle changes and repeat investigation as required.

The 2025-26 Budget will provide a record £21.7 billion for Health and Social Care, including almost £200 million to reduce waiting lists and improve flow through hospitals. Gynaecology will be targeted as a key priority area for additional funding.

We are committed to ensuring those living with endometriosis are able to access the best possible care and support and that they benefit from healthcare services that are safe, effective and put people at the centre of their care.

Endometriosis is one of the key priorities in the Women’s Health Plan and will continue to be so. Timely access to gynaecology services will also be a priority as we continue to develop the next phase of our Women’s Health Plan, which we aim to publish in 2025.

In recognition of financial pressures, our 2025-26 budget includes record levels of investment - over £21.7 billion for Health and Social Care and over £15 billion for the Local Government Settlement.

While the Scottish Government has overall responsibility for health and social care policy in Scotland, it is for Health and Social Care Partnerships to ensure that support services are in place to provide people with the appropriate support in the right place and at the right time. Decisions on how best to deliver services to local communities, including funding for services like the Notre Dame Centre, are ultimately for local partners to make.

However, these decisions should be made in consultation with people who use those services and in full awareness of the impact on them and on other services who may be asked to provide support in their place.

I would therefore encourage all partners to work together to find solutions that not only address financial pressures but put the needs of local people, particularly those who are most vulnerable, at the centre.

Glasgow City HSCP is refining its reporting systems and cannot yet provide a precise percentage of users referred solely to rehabilitation services. Given the early stage of the facility’s operation, data validation is ongoing.

The service has now recorded over 30 formal referrals to health, care and recovery support. This likely underrepresents engagement with recovery services and is above expectations for so soon after implementation. The Thistle’s primary focus is harm reduction, ensuring vulnerable individuals access a safe environment where recovery support begins. Staff respond to service users’ needs in a person centred manner, supporting them to meet needs they identify.

An independent evaluation is underway, and further data will be shared once reporting systems are improved.

To date, there have been 27 referrals to secondary services including housing, addiction recovery and mental health services. In addition to these referrals, the facility continues to support individuals in accessing appropriate recovery pathways and re-engaging with services they had previously accessed but had since disengaged from.

NHS Greater Glasgow and Clyde, and Health Boards across Scotland, provide access to fertility services for those within their population who may be unable or finding it difficult to conceive.

Falling birth rates are a demographic trend replicated across many high-income countries, with significant future implications for our economies, communities and public services.

The Family Friendly Nation strand of our 2021 Population Strategy sets out our ambition to ensure Scotland is the ideal place to raise a family, and to support people to have the number of children they wish to have. We are clear that it is not for government to attach value judgements to different families.

In delivering this Strategy, during 2024 the Ministerial Population Taskforce undertook new analytical work to further explore family friendly policies internationally. This was presented to the Taskforce in December 2024 and next steps are now being undertaken to scope their application within the Scottish policy context.

Women’s Health is a priority for this government which is why Scotland was the first country in the UK to publish a Women’s Health Plan in August 2021.

Women’s health encompasses a wide range of topics and conditions and the areas of focus for the next phase of the Women’s Health Plan are still to be determined.

Timely access to gynaecology services will be a priority, and early discussions indicate pelvic health and optimising future health as potential areas of focus.

We have also started work to bring together an updated evidence base and gather views from women and girls, and from our stakeholders. Future aims and priorities are being developed in collaboration with them and alongside the most up-to-date evidence base.

The Scottish Government is committed to ensuring that anyone living with arthritis is able to access the best possible care and support. We expect health care professionals and NHS Boards to deliver high quality person-centred care to those living with arthritis in line with best practice guidance. The NICE (National Institute for Health and Care Excellence) clinical guidelines on management of arthritis are available on its website and can be found at: Arthritis | Topic | NICE.

We will work collaboratively with other partners, including the Centre for Sustainable Delivery (CfSD), to ensure there are appropriate pathways for women with arthritis.

The Scottish Government is committed to ensuring that anyone living with pain is able to access the best possible care and support. Through our commitment to deliver the actions outlined in our Pain Management Service Delivery Framework implementation plan we are seeking to amplify the voices of people who may face inequality on the basis of their sex. We will work collaboratively with other partners to ensure there are appropriate pathways for women with pain and painful conditions.