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The Scottish Government does not currently have any plans to develop a standard post-diagnostic support pathway for ADHD. The National Neurodevelopmental Specification: Principles and Standards of Care for Children and Young People sets out the standards for all services to support children and young people with neurodevelopmental support needs, including ADHD. The Scottish Government is also working with the National Autism Implementation Team (NAIT) to develop national Adult Neurodevelopmental Pathways.

In addition, local authorities have duties under the Additional Support for Learning Act (Scotland) 2004 to identify, provide for and review the additional needs of their pupils. Under the Act an additional support need can arise for any reason and a diagnosis of ADHD is not required before support is put in place.

The Scottish Government is clear that support should be put in place to meet a child’s requirements when they need it. This includes community-based supports and where additional support is needed for learning. However, we recognise that in the case of ADHD, medication can be helpful, and a diagnosis is required to access this. We are working with Boards to ensure that children, young people and adults can access diagnostic services in a timely manner.

The Scottish Government does not currently have any plans to publish national service standards for ADHD assessment, treatment and support.

The National Neurodevelopmental Specification: Principles and Standards of Care for Children and Young People sets out the seven standards for all services to support children and young people with neurodevelopmental support needs, including ADHD.

The Specification takes a needs-based approach to providing neurodevelopmental support. It is underpinned by principles of GIRFEC and intended to be delivered by all children’s services partners through a multi-agency approach.

The Scottish Government does not hold this information centrally.

However, we acknowledge that work is needed to improve the quality of data on neurodevelopmental support and services, including a better understanding of current levels of need and the level of support people currently receive.

We are working with Health Boards and local authorities to improve our understanding of available data, and how this could be used to support improvements for adults, children and families.

The most recently available Local Authority analysis from the Scottish House Condition Survey (SHCS) is from 2017 to 2019

Table 1 shows the estimated number of dwellings that use heating oil, or LPG as their primary heating fuel, broken down by Local Authority.

Table 1: Estimated number of households using LPG and Oil as primary heating fuel 2017-19.

There is an extensive programme of work already in progress to support NHS Boards to reduce waiting times for all planned care procedures, including cataract surgeries.

This year, we have allocated more than £110 million to health boards to help tackle the longest waits for procedures and operations and this includes an investment of more than £12 million for ophthalmology.

The Centre for Sustainable Delivery’s (CfSD) National Eyecare Workstream also works with Scottish Government to support optometrists in the care for patients with cataract. In January 2022, we commissioned CfSD to establish the Scottish National Cataract Short Life Working Group to address current challenges in cataract surgery in Scotland.

This multi-professional group co-developed an agreed set of principles for delivering higher volume cataract surgery in operating theatres on a sustainable basis and assist in future proofing cataract services.

This work has led to the publication of Improving the Delivery of Cataract Surgery in Scotland: a Blueprint for Success which can be accessed here: https://www.nhscfsd.co.uk/media/5sofmknr/cataract-surgery-blueprint-2022.pdf.

Scottish Ministers must take into account all the views presented when considering applications for onshore wind projects. The merits of each proposal are considered on a case-by-case basis. A careful balance must be struck between the potential impacts of the development and the associated environmental, economic, renewable energy and climate change benefits.

Where new development proposals come forward, our Fourth National Planning Framework (NPF4) ensures the impacts of proposals on communities and nature, including cumulative impacts, are important considerations in the decision-making process. All applications are subject to site specific assessments.

Established in 2014, the National Eyecare Workstream was set up to influence and embed change in the way that eyecare services are delivered in Scotland. The workstream focuses on using capacity and capabilities differently within and across Primary and Secondary Care, drawing together the different strands of work that contribute to building a sustainable service.

Throughout its duration, the National Eyecare Workstream has supported extensive data collection and analysis of hospital eyecare services, including future capacity and demand for cataract surgery. In 2018, taking into account population growth and demographic change, demand for cataract surgery was forecast to grow by up to 47% to 2035.

More recently the Royal College of Ophthalmologists has projected an increase in demand of 25% in the next 10 years and 50% over the next 20 years.

The National Eyecare Workstream has been working with Health Boards to streamline each stage in the cataract pathway to ensure maximisation of all available resources across the country.

In May 2021, the National Eyecare Workstream commissioned the Centre for Sustainable Delivery (CfSD) to deliver a Short Life Working Group (SLWG) to focus on improving efficiency and productivity within cataract only theatre sessions in line with the latest guidance from the Royal College of Ophthalmologists. This SLWG has supported several new and innovative pathway developments, including high volume cataract surgery in ring-fenced sessions and delivering one cataract every 30 mins. In parallel with this, the National Eyecare Workstream is undertaking clinically-led peer reviews which supports new and efficient ways of working and shares best practices across the country across a number of ocular sub-specialties, including cataracts.

A number of ophthalmic surgeons are now undertaking immediate sequential bilateral cataract surgery to prevent patients having to travel twice for surgical intervention enabling both cataract surgeries to be performed on the same day, one after the other. In a number of Health Board areas, non-medical staff have been upskilled to pre-assess and list patients for cataract surgery freeing-up ophthalmologists’ time to undertake duties only they are qualified to do e.g. perform cataract surgery.

The National Eyecare Workstream has also undertaken a workforce review across the entirety of NHS eye care services in Scotland. This was required to support workforce and service planning, and to ensure ongoing workforce sustainability. The final report, published in 2023, is available here: https://www.nhscfsd.co.uk/media/pjwntap4/national-ophthalmic-workforce-review-may-2023.pdf

In addition, our National Treatment Centres (NTC) programme provides additional protected elective capacity and infrastructure to meet the needs of the aging population, which is projected to grow by 25-30% between 2015 - 2035. We have allocated an additional £2.6 million to National Treatment Centre (NTC) Highland to deliver thousands of additional orthopaedic and ophthalmic operations every year, with approximately 61% of the additional funding intended to support ophthalmic procedures.

This is part of our wider investment of £110 million to address long waits for planned care, which includes over £12 million funding for ophthalmology services.

A number of Health Boards also have additional cataract slots at Golden Jubilee National Hospital.

Cataract surgery remains one of the most frequently performed surgical interventions across NHS Scotland. However, our health service has experienced unprecedented pressures over the past few years including the long-term impacts of the pandemic, seasonal and staffing pressures and unprecedented levels of inflation across the public sector. This has inevitably disrupted the NHS’s ability to carry out routine procedures, meaning longer waits for many patients.

The Scottish Government is committed to delivering reductions in waiting times, and has this year allocated an additional £12 million funding to NHS Boards for ophthalmology services.

The Scottish Government is responsible for setting the overall policy direction of health services, and for working with and funding NHS Boards and local authorities to ensure they plan and deliver appropriate local services. However, it is the responsibility of local Health Boards and Health and Social Care Partnerships (HSCPs) to put in place services to meet local needs, including assessment and access to treatment and support for ADHD.

Health Boards and HSCPs are accountable for the delivery of their services locally. The Patient Rights (Scotland) Act 2011 and supporting legislation, provides a specific right for people to make complaints, raise concerns, make comments and give feedback. The Act also places a duty on NHS Boards to thoroughly investigate and respond to any concerns raised, to take improvement actions where appropriate and to share learning from feedback received. When a person has concerns about their treatment or care, this should be addressed at a local level through the NHS complaints handling procedure. When that is not possible, the Scottish Public Services Ombudsman (SPSO) is the second and final stage in the complaints process.

Scottish Government officials also engage regularly with Health Boards and HSCPs to discuss the delivery of services.

The Scottish Government has directly allocated £123.5 million to NHS Boards and IJBs for the Enhanced Mental Health Outcomes Framework in 2025-26. This provides a single, flexible funding stream to support continued improvements and better outcomes across a range of mental health and psychological services in line with the Mental Health and Wellbeing Strategy. This includes funding for adult and child neurodevelopmental services, including services providing ADHD assessments.

In addition to investment through Health Boards, we will also be providing £500,000 additional funding in 2025-26 to improve access to neurodevelopmental support for children and young people, including for ADHD assessments. This is in addition to £250,000 of funding in 2024-25 to improve neurodevelopmental assessment and support for children and young people, including improving access to ADHD assessments.