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All NHS territorial boards in the Highlands and Islands region have been allocated funding as part of the additional £200m Operational Improvement Plan investment to deliver and expand their Hospital at Home services.

All territorial boards are currently providing a Hospital at Home service. Some of these services are more established while others are still developing. What matters most is that these services are proportionate to the population's needs and effectively connected to community support, enabling people to receive safe and timely care, in the most appropriate location.

The Scottish Fire and Rescue Service (SFRS) continues to employ permanent Community Safety Advocates across Scotland, who work alongside colleagues in local areas to undertake important community safety and prevention work.

SFRS continues to invest significantly in their prevention work, which is reflected in both the current Service Delivery Review and the recent publication of the SFRS Strategy 2025-2028 | Scottish Fire and Rescue Service.

The 2022 independent review on the role of incineration in Scotland’s waste hierarchy states that in the short-term, incineration will have a role to play in managing our waste as we transition to a circular economy.

As we continue to increase our reuse and recycling rates, we will produce even less waste, however we will still need an appropriate way to manage our unavoidable and unrecyclable waste.

That’s why the Scottish Government’s Fourth National Planning Framework (NPF4) makes clear that development proposals for energy-from-waste facilities will not be supported, except under limited circumstances.

We have also been working with local authorities, through Zero Waste Scotland, to reduce the length of energy from waste contracts, and remove the requirement for guaranteed tonnages – giving local authorities the flexibility to respond to changes that will support Scotland’s move to a circular economy.

Our sixth Rapid Cancer Diagnostic Service for people with non-specific symptoms of cancer open in NHS Forth Valley in May.

The Centre for Sustainable Delivery is now working with Boards across Scotland to embed learning and work on non-specific symptoms pathways across Scotland.

In line with the publication of the recently revised Scottish Referral Guidelines for Urgent Suspicion of Cancer in July this year, the Centre for Sustainable Delivery have confirmed that all NHS territorial Health Boards now have pathways in place for those presenting with non-specific symptoms of cancer.

The Scottish Government has carried out long-term emissions projections for electricity generation, which include energy-from-waste emissions, which will be published as part of the Climate Change Plan Analytical Annex in due course. There are currently no long-term projections for emissions from energy-from-waste on a per site basis.

There have been several independent evidence reviews on potential health impacts from municipal waste incineration:

• Health Protection Scotland (2009) review on incineration and reported human health effects concluding that “providing that any existing or new incinerators operate in accordance with current regulations governing emissions, the scope for any adverse human health impacts associated with their emissions should remain minimal”.
• Public Health Scotland (2022) rapid evidence review focused on municipal solid waste incineration, commissioned to support the Government’s Independent Review of the Role of Incineration in the Waste Hierarchy. The findings of this rapid review reinforced the conclusions drawn in the 2009 HPS report above, concluding that it is “still reasonable to conclude that any risk to human health associated with emissions from newer incinerators, operated within the current regulations, is very likely to be less than was the case previously…”.
• UK-level synthesis by UKHSA (2025), concluding that “modern, well-run and well-regulated municipal waste incinerators are not a significant risk to public health, as contributions to local pollutant concentrations are small”.

As part of the permitting regime, SEPA requires a Human Health Impact Assessment with every PPC incineration permit application, and it publishes application documents for public and statutory consultation. SEPA also consults the relevant NHS Health Board to ensure potential public health impacts are considered.

SEPA sets and enforces stringent permit conditions, including continuous emissions monitoring, periodic stack testing, and ambient air quality assessments. SEPA tightened emissions limits for Scottish plants in line with the 2019 Waste Incineration BAT Conclusions, with compliance required by 3 December 2023.

The Scottish Government does not allocate specific amounts of funding for individual activities such as community safety advocates. Decisions on how the £412.2 million allocated to the Scottish Fire and Rescue Service for 2025-26 is spent is a matter for the SFRS Board and Chief Officer.

The Scottish Government recognises the value of a long term, evidenced-based indicative residual waste treatment cap to help inform planning and investment decisions as Scotland transitions towards a circular economy, as part of an overall strategic approach (Recommendation 5 of the Independent Review on the Role of Incineration in Scotland’s Waste Hierarchy (the Review) published May 2022).

That is why, as set out in Scotland’s Circular Economy and Waste Route Map to 2030, we have committed to develop an indicative cap through Scotland’s Residual Waste Plan (RWP), due for publication in 2027.

In line with the Review’s recommendation, any cap will be indicative and consider all residual waste capacity, including landfill and other treatment options. It should account for waste streams that must be incinerated by law, such as those containing persistent organic pollutants (POPs), and allow for sufficient contingency to account for uncertainties in the data, the trajectory of residual waste arisings, and policy development and delivery.

The Scottish Environment Protection Agency (SEPA) is the regulator for municipal waste incineration. SEPA already publishes summary data on pollutant releases via the Scottish Pollutant Release Inventory (SPRI), site-specific monitoring data on its public register and also requires operators to make up to date emissions information available to the public via their own websites.

Published figures from Healthcare Improvement Scotland estimated that Hospital at Home services for Older and Acute Adults prevented 15,470 people being admitted to hospital in 2024-2025, reducing pressure on unscheduled care and delayed discharges.

Board level data for the Older Adults pathway is a matter for Healthcare Improvement Scotland who collate and manage this data collection.

Officials are working with PHS Scotland to develop a new national data set for Hospital at Home activity and related admission alternative services. Data collection is due to commence later this year and will be expanded to include other Hospital at Home pathways such as heart failure, respiratory, paediatrics and Outpatient Parenteral Antibiotic Therapy (OPAT). Public Health Scotland plan to publish figures as this develops during 2026.