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Scottish Water is working in partnership with the Scottish Environment Protection Agency (SEPA) in the Chemical Investigation Programme (Scotland). Through environmental investigation this project identified chemicals of concern, their sources and concentrations leaving the sewerage system and how they should be addressed in the most sustainable way. The CIP 2 (Scotland) has provided a clear decision making framework for how compliance with the Environment Quality Standards Directive (2008/105/EC) and the subsequent revision (2013/39/EU) is to be addressed. To support this, an extensive monitoring programme of Priority Substances, substances with Environmental Quality Standards set by UK Technical Advisory Group on the Water Framework Directive (UKTAG)/Scottish Government (referred to as UKTAG Substances), substances of interest to SEPA (referred to as Watch List Substances), additional pharmaceuticals and sanitary determinands was conducted at 20 Wastewater Treatment Works (WwTW) within Scotland. At each site, sampling took place at the inlet to the WwTW, the final effluent discharge, and within the receiving watercourse upstream and downstream of the WwTW. The sampling programme took place between 2015 and 2020.

Pharmaceuticals are considered ‘contaminants of emerging concern’ and monitoring and assessing the risk to the water environment for many of these substances is still in the development phase. 23 pharmaceuticals were investigated during CIP2 Scotland. Following analysis with the PNEC (Predicted no effect concentration) the agreed approach with SEPA for 14 pharmaceutical was no further action. The agreed approach with SEPA for the 9 pharmaceuticals that were identified as substances of concern was to carry out a process optimisation study and to control them through source control. The next stage of this research, CIP3 Scotland, aims to carry out further sampling in relation to emerging pharmaceuticals and process optimisation trials at the WwTW in order to understand whether better treatment can be achieved at existing assets.

Scottish Water is also a member of the One Health Breakthrough Partnership ( www.ohbp.org ) which aims to reduce levels of pharmaceutical substances in the environment.

I refer the member to the answer to question S6W-01510 on 4 August 2021. I can now update that the cervical screening marketing campaign was launched on 11 October 2021. Although the primary focus of this campaign will be on encouraging those eligible to attend their cervical screening appointment when invited, the campaign will also provide information on screening intervals and the benefits of testing for human papilloma virus. Beyond this campaign, we will continue to work with our partners to identify further opportunities to communicate these important messages.

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/chamber-and-committees/written-questions-and-answers

Sports sponsorship entails a range of alcohol advertising and promotional activity, which we know is seen by children and young people across Scotland. The findings of this report undertaken by researchers at the University of Stirling highlight just how much children and young people are exposed to alcohol marketing in a sports context.

We know this exposure creates positive attitudes towards drinking alcohol and can encourage them to start drinking alcohol or to drink more alcohol.

Whilst recognising the impact Covid-19 has had on the sporting sector as well as the importance of sponsorship income, we would encourage sports teams and organisations to diversify sponsorship away from alcohol brands. We applaud Scottish Women’s Football for the stance they have taken not to accept sponsorship from the alcohol or gambling industries.

We have committed to publicly consulting on a range of potential alcohol marketing restrictions to protect children and young people in Scotland. We are considering all methods of alcohol advertising and promotion in developing proposals for the public consultation which will be published in 2022.

Scottish Government recognises the important role of prompt defibrillation in improving outcomes from Out-of-Hospital Cardiac Arrest (OHCA).

We are a key partner in Save a Life for Scotland (SALFS). The partnership published an updated OHCA strategy in March 2021. This sets out actions to improve outcomes from OHCA, including actions to improve the accessibility of defibrillators and increase defibrillation rates across Scotland. SALFS work in collaboration with local community groups, including those in rural and island communities, to ensure the implementation of the strategy addresses local needs.

The purchasing and placement of defibrillators is the responsibility of individual businesses, local authorities, organisations or community groups. For any groups or organisations interested in providing access to a defibrillator, the Scottish Ambulance Service (SAS) have details of providers and organisations that may offer funding towards the purchase of a defibrillator.

We are working closely as part of the SALFS partnership to build the evidence base required to make strategic decisions about the placement of defibrillators, to encourage their registration with Scottish Ambulance Service and to increase public confidence and knowledge around defibrillation. We believe that these actions will help us to increase bystander usage of defibrillators from 8 to 20% over the lifetime of the strategy.

The number of patients who have waited over 12 weeks for Trauma and Orthopaedic surgery in NHS Highland are published by Public Health Scotland (PHS) on a quarterly basis. These details are available on PHS’s website and can be found in table 1.2 through the following link: https://www.publichealthscotland.scot/media/8811/newop_aug21.xlsx

Scottish Government officials are in regular contact with NHS Highland to support the service management team with the delivery of orthopaedic elective procedures within the Health Board.

In response to the pressures on NHS services caused by the pandemic, which we are still firmly in the midst of, the First Minster launched the NHS Recovery Plan, on the 25 August. The Plan sets out the Scottish Governments key headline ambitions and actions to be developed and delivered now and over the next 5 years, including an increase in both inpatient and outpatient capacity across the Country. The plan is backed by more than £1 billion of investment over the next five years.

As part of this, we are investing over £400 million in a network of National Treatment Centres, one of which will be located in NHS Highland. When fully operational, the National Treatment Centres will provide increased capacity for surgeries and procedures across 14 specialties, including hip and knee surgery.

GP practices have remained open, accessible and at the forefront of our community services to deal with non-COVID-19 medical care throughout the pandemic. As outlined in the NHS Recovery Plan, a key aim is to work with our GPs to continue to restore face-to-face practice consultations as quickly and safely as possible, while ensuring everyone can continue to make use of eHealth services if that is their preference.

Public Health Scotland have published guidance on social distancing and infection control measure in health settings, changing the 2 metre social distancing rule to 1 metre, enabling more patients in waiting rooms, while continuing to ensure that vulnerable patients and staff are kept safe. In addition, specific guidance to general practices has been published making it clear that there is no longer a need to triage every patient, although they should continue to screen patients for Covid before seeing them face-to-face. We will continue to take advice from public health experts and clinicians when reviewing these measures.

With these recently announced changes I would expect the number of face-to-face appointments to increase.

While high quality data from across the health system is collected, we are working with stakeholders to improve the quality of data we can collect from GP practices to ensure it is robust.

We have continued to meet routinely with GPs and their representatives, and hear regularly from patients, to help build intelligence around appointments and pressures in GP practices throughout the pandemic, and are currently working together with NSS and PHS on a more advanced digital solution for capturing this information moving forward.

The Vaccination Transformation Programme (VTP) is funded via the Primary Care Improvement Fund, which began in 2018 and will have provided £250 million to health boards up to the end of financial year 2022. The extended flu programme and COVID-19 vaccination programme (including boosters) are outside the scope of this fund, however work to deliver these programmes has helped to build Health Board capacity to vaccinate and complete the VTP.

Ambulances are not single-crewed other than in exceptional circumstances, such as short notice unplanned staff absences, and every effort is made to double crew ambulances through rostered and relief staff, overtime or our bank staff.

Unfortunately as a result of COVID-19 there has been occasions where single crewing has had to be used as a result of late notice staff abstractions, however we are continuing to work with the Scottish Ambulance Service to reduce this where possible.

The following table outlines the number of single crew shifts, not ambulances each year since 2017/18.

The NHS Scotland COVID Status app was released on
‎ 30 September. The App allows users to display their vaccination status for international travel and to gain entry to late night venues and large events within Scotland. To date it has been downloaded over 600,000 times.