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Rights, Respect and Recovery sets a clear expectation that all people accessing services with a substance use condition should receive holistic, person-centred care. MAT standard 9 builds upon this, stating that ‘all people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery.’ The government is taking forward a number of measures to ensure that people with co-occurring mental health and substance use conditions receive this joined-up care.

We have funded Healthcare Improvement Scotland to test new models of care in five health boards – Tayside, Grampian, Lanarkshire, Greater Glasgow & Clyde, and Lothian.

The government also published a rapid review into mental health and substance use services in November 2022. This included a literature review, a survey of practitioners in substance use services, and a set of recommendations.

Finally, the government has recently commissioned Healthcare Improvement Scotland to produce an exemplar protocol which will set out how mental health and substance use services should work together. This will build on existing best practice and support local areas to implement the recommendations from the rapid review and the criteria of the MAT standards.

The area of forest that has been felled in Scotland is not monitored on an annual basis. Scottish Forestry is the Scottish Government agency responsible for the regulation tree felling and monitors the area approved for felling each year. After approval for felling is issued, the landowner has flexibility to decide on the timing of felling.

Felling approvals are issued in a number of ways, including as standalone Felling Permissions, where felling is approved for a two year period, and Long-term Forest Plans, where felling is approved for a ten year period. Local Authorities may also approve felling as part of planning permission, but these figures are not collated. As approvals can be valid for over several years, the area of forest felled in a particular year is not available.

For the last seven years, including private sector approvals and forests managed by Forestry and Land Scotland, the areas approved for felling are as follows. Of this area, 96-98% is for conifer forest:

The Programme for Government 2023-24 set out major new commitments on childcare including how we will test, for the first time, what an all-age childcare system will look like for Scotland in six councils.

We will work closely with those communities, our partners, and providers to consider how the early learning and school age childcare workforce can support these systems, and what they will need to do so. This will include consideration of regulatory issues, qualifications and professional development, which will take time to do fully and is why we will now set out our plans in 2024.

In the meantime, we will continue to work with the Framework Steering Group and other partners to support delivery of the actions being developed as part of the original plan. We have, for example, already developed a range of new learning resources, implemented a Protecting Vulnerable Groups (PVG) fee waiver and are starting work on a new national portal for professional learning.

The National Elective Coordination Unit (NECU) does not directly remove patients from NHS health board waiting lists. As part of the agreed pathway to support national waiting list validation, and to ensure a patient’s appointment requirements are accurately recorded, NECU’s digitally supported waiting list validation methodology collates the information provided by patients, before returning it to the NHS Board of residence for update within patient administration systems.

To ensure any removals from waiting lists are appropriate, the NECU system records patient responses and their reason for removal. NECU follow-up directly with all patients who have not responded or have not left a comment explaining why they wish to be removed. Similarly, for patients who are unsure of the nature of their appointment, NECU follow-up with the patient directly. Where there is a clinical query from the patient, this is highlighted and the clinical team within the NHS Board of residence are asked to follow-up with the patient. To action a removal, Health Boards review both the patient response and the comment to ensure the reason for removal is appropriate.

Throughout the waiting list validation activity, patients remain on their respective waiting list until the NHS Board agrees it is appropriate to remove the patient.

NECU’s validation process is digitally supported, however, it is not a digital only process. Although all patients are contacted by text message and invited to access a patient portal to record their response, patients who may be unable to access the digital platform are followed-up by the NECU patient coordination team by telephone. If the patient is unable to be reached by both text message and telephone, a recommendation is returned to the NHS Board of residence to send a letter to the patient asking them to contact their Health Board directly. No amendment to the patient’s waiting list entry is actioned until confirmation is received from the patient.

NECU will publish its first annual update in October 2023.

Waiting List Validation is not new. Local Health Boards routinely validate patients on waiting lists to ensure patient requirements are correctly recorded. The establishment of a national approach is based on existing principles. By adopting these principles, a patient would not be removed from a waiting list without contact either by text or phone call, and if required, a clinical consultation.

After a consultation, it may be agreed no treatment is required at the time of referral. However, if the clinical team believe that a further referral for the same condition is likely in the future, or if it is felt that treatment will be required but the patient is not quite ready for this, or if the patient wishes to defer a decision on treatment, the patient will have the ability to make an appointment for the same condition at a future time.

We committed in our Integrated Health and Social Care Workforce Plan (December 2019) to create 225 more Advanced Musculo-Skeletal Practitioners in Primary Care.

This is to support the embedding of multi-disciplinary teams in primary care settings and enable people to be seen by a specialist physiotherapist at the very earliest opportunity.

A total of 37 students were recruited in 2021-22, and a further 52 were recruited in 2022-23. It is anticipated that 50 students will be recruited in each of the next 2 academic years, meaning we are on track for meeting this commitment by 2025-26.

The first cohort of students will graduate in September 2023 and a number will be located in NHS Ayrshire and Arran.

The Scottish Government is committed to ensuring everyone who is eligible to vote can do so and is working with partners to look at potential new ways to increase registration levels amongst under-represented groups including young people and foreign nationals.

The Scottish Government is considering responses to our recent consultation on electoral reform, including on how to improve registration levels, and I intend to meet with the Head of the Electoral Commission in Scotland to discuss the report and its recommendations in greater detail.

The launch of our National Mission on Drugs in January 2021 has meant that some of the commitments set out in the Rights, Respect, Recovery Strategy and the action plan for it, refreshed in December 2020, are being delivered in a different way. Many of the milestones are being delivered through the National Mission and others are being picked up as part of more recent Government commitments.

The Prison to Rehab pathway was established in the summer of 2020 to support individuals into residential rehabilitation services during the unprecedented time of the COVID-19 pandemic.

We conducted an internal review of the pathway in 2021-2022 which was complimented by an evaluation from one of our commissioned third sector organisations, the Scottish Recovery Consortium. The published evaluation can be viewed here . The review and the evaluation informed a new version of the Prison to Rehab protocol to ensure it continued to be fit for purpose. This was published in March 2023 and can be viewed here here .

The launch of our National Mission on Drugs in January 2021 has meant that some of the commitments set out in the Rights, Respect, Recovery Strategy and the action plan for it, refreshed in December 2020, are being delivered in a different way. Many of the milestones are being delivered through the National Mission and others are being picked up as part of more recent Government commitments.

Quality improvement methodology is being embedded across Scotland through the implementation of the Medication Assisted Treatment (MAT) standards.

The MAT Standards Implementation Support Team (MIST), based within Public Health Scotland, was set up to support local areas to build improvement-based capacity and capability so that they will be able to implement and sustain the MAT standards locally.

MIST helps local areas with quality improvement work which has focused on establishing that local areas have written procedures in place, have numerical information and data available and have a means in place to gather experiential data. All of which are required to help drive improvement.

Healthcare Improvement Scotland (HIS) is also supporting local areas and works closely with MIST in providing practical quality improvement assistance and advice to local areas.

HIS will shortly begin delivery of its full quality improvement assistance to local areas to build on the first phase of quality improvement work MIST has undertaken. HIS also provides close links between its other relevant workstreams on residential rehabilitation, prison healthcare and mental health and addictions services.

Alcohol remains a priority for Scottish Government and we are treating our policies to reduce alcohol and drug deaths as twin public health emergencies in Scotland.

This is why we established a National Mission to improve and save lives, at the core of which is ensuring that every individual has access to, and choice in the type of recovery and treatment they need.

We are working to ensure people with alcohol use disorder receive the care and support in the same way that people can access for problematic use of drugs. The forthcoming Alcohol Treatment Guidelines will help ensure support for alcohol treatment, in a similar way to how the Medication-Assisted Treatment Standards ensure this for people impacted by opiates.

Following publication of the UK-wide guidelines it is our intention to draft a paper on specific alcohol treatment standards for Scotland.

Through our National Mission we are investing in residential rehabilitation that will benefit people experiencing alcohol and/or drug addiction.

At present, we have no plans to establish and evaluate tests of change for alcohol treatment in the justice system.

The Scottish Prison Service is currently refreshing its Alcohol and Drug Recovery Strategy, this will ensure alcohol intervention and support are included in any recovery pathway planning across our establishments. It is anticipated that the strategy will be published later this year.

We are also supporting the UK Government on reviewing and updating clinical guidelines for alcohol treatment. The guidance will look to introduce new approaches to treatment and will apply to a broad range of settings including justice settings. The guidelines are expected to be published for consultation this year.

Following finalisation of the alcohol treatment guidelines, Scottish Government will review and use these to ensure that our justice systems are providing consistent and good care to those with problematic alcohol use.