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A consultation on the Bill’s proposals ran from 29 August 2022 to 5 December 22, where a wide range of views were received. On 22 June 2023, the Scottish Government published the Agriculture Bill - Analysis of Consultation Responses which details the findings of this extended engagement.

As is convention, following consultation on proposed legislation, Ministers are considering the views received to inform a new Agriculture Bill which will be introduced in 2023. In turn, Parliament will consider the proposals and provide further comment on draft proposals, accordingly.

An underlying principle of the new National Strategy for Palliative and End of Life Care for Scotland will be equitable and timely access to palliative care as needed by each person of any age, living with any illness, in all places.

As part of this work we are reviewing the information and evidence we have, and need, to develop the strategy. This includes gathering data on current and projected needs for palliative care at a population level, mapping services and support across Scotland, and building on our understanding of people’s experiences of palliative and end of life care.

The outputs of this work will give us a clearer picture of the delivery and accessibility of palliative care across Scotland, including in remote and rural areas, and will allow us to develop evidence-based actions to ensure that people have equitable access to general and specialist palliative care if and when they need it, regardless of where they live.

On 22 June 2023, the Scottish Government published the Agriculture Bill - Analysis of Consultation Responses which details the findings of this extended engagement and total number that attend the events.

NHS Education for Scotland (NES) are responsible for managing all training provided to doctors in Scotland. NES ensure that all doctors receive high quality training in line with curricula that is set by the relevant Medical Royal College so that they are able to demonstrate that they have met all GMC curricular requirements, in order to practise independently as a GP in the UK.

The General Practice Specialty Training (GPST) programme lasts for 3 years with trainees typically spending 18 months in General Practice and 18 months in secondary care i.e. hospital settings.

All GP practices receive funding for protected time consisting of one session a month (usually within practice time) to allow GPs to maintain and develop their training and skills, and those of their practice teams.

Training currently provided to GPs on the diagnosis and treatment of UTIs include:

1. Educational activities during the first year of training under most GP Speciality Trainees (GPSTs), such as: tutorials, case based discussions, post consultation prescribing checks and referral reviews that are undertaken by their GP educational supervisors.

2. Management of UTI’s (uncomplicated lower UTI’s in females) in primary care also occurs through the Scottish Pharmacy First initiative. https://www.nss.nhs.scot/publications/pharmacy-first-scotland-urinary-tract-infection-uti/ .

3. The RCGP ‘Being a General Practitioner’ Curriculum Guide ( https://www.rcgp.org.uk/mrcgp-exams/gp-curriculum/clinical-topic-guides#kidney ) section on Kidney and Urology includes: Urinary tract infections in children and in adults including lower urinary tract infection, pyelonephritis and persistent/recurrent infection There are questions based on this clinical topic guide within the Applied Knowledge Test (AKT) and Simulated Consultation Assessment (SCA- OSCE style exam) which form essential components of the MRCGP exam.

4. SIGN 160: “Management of suspected bacterial lower urinary tract infection in adult women. A national clinical guideline. September 2020” is a readily available resource for all GPs in Scotland.

5. All GP practices receive an annual prescribing report which focusses on antibiotic prescribing and review of current guidelines on management of UTI’s in primary care. Each Health board has its own guidance - see below:

https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/emergency-medicine/diagnosis-treatment-and-management-of-uti-in-children-rhc-glasgow/

https://handbook.ggcmedicines.org.uk/guidelines/infections/urinary-tract-infections-utis/

6. Evaluation of the impact of Scottish Reduction in Antimicrobial Prescribing (ScRAP) programme on GP Practice management of patients with suspected UTI – is an example of initiatives regularly offered to GP practices to review their antibiotic prescribing. GPs through annual appraisal have to demonstrate annual QI initiatives and many include antibiotic prescribing in UTI’s and compliance with local and national guidelines.

7. Common reference sources used by GPs (GP notebook, NICE CKS guidelines, BNF, BMJ best practice) all have comprehensive sections on management of UTI in adults and children.

The Scottish Government do not currently have plans to add a section on chronic UTIs to NHS inform at this time. The NHS 24 Clinical Change Governance Group (CCGG) routinely assess new and updated clinical guidelines to ensure the clinical content on NHS inform is underpinned as far as possible with current clinical evidence. The group will continue to consider what improvements are required regarding information on UTIs based on any new evidence or changes to clinical guidelines or pathways that arise.

NHS inform does advise that if acute symptoms do not improve, get worse, or come back after initial treatment, the patient should return to their GP for further advice. Thereafter the GP should follow relevant clinical guidelines that outline how to treat and manage chronic UTIs for individual patients.

The following table shows the number of homes approved from applications received from (a) registered social landlords (b) local authorities since the National Acquisition Plan was announced on 19 July 2023. This information is to 24 August 2023:

The Scottish Government does not hold information on the number of contract inflation claims made by house builders and contractors. This contractual information is held between grant recipient and house builders and/or contractors.

The Scottish Medicines Consortium ( SMC) has collaborated with The National Institute for Health and Care Excellence (NICE) on a multiple technology appraisal (MTA) of all COVID-19 treatments (known as TA878). NICE guidance for technology appraisal TA878 was published on 29 March 2023. The SMC published equivalent guidance in Scotland, recommending nirmatrelvir plus ritonavir (Paxlovid ® ) for restricted use within NHS Scotland, for the treatment of patients with increased risk for progression to severe COVID-19 as defined in the independent advisory group report commissioned by the UK Department of Health and Social Care .

The NICE and the SMC are currently collaborating on a partial rapid review of TA878 , and considering whether to recommend nirmatrelvir plus ritonavir (Paxlovid ® ) for the treatment of additional risk groups. The draft guidance from this partial rapid review, published on 17 August 2023, recommends that access to nirmatrelvir plus ritonavir (Paxlovid ® ) is extended beyond the current cohort, to individuals aged 70 years and over, and those with diabetes, obesity (BMI of 35 kg/m 2 or more), or heart failure. If there are no appeals from key stakeholders, the final NICE guidance is expected to be published on 13 September 2023, and will be incorporated into the original NICE technology appraisal guidance TA878. Following this, the SMC will publish equivalent guidance for NHS Scotland.

This advice is based on an assessment of the clinical and cost effectiveness of nirmatrelvir plus ritonavir (Paxlovid ® ) at a population level based on the best available evidence. The Scottish Government continues to closely monitor the outcomes of any further research to ensure that any decisions to make nirmatrelvir plus ritonavir (Paxlovid ® ) available to eligible individuals in Scotland in the future are based on the best available evidence.

The Scottish Government provides funding annually to Health Boards for smoking cessation and prevention services. The funding is provided as part of a wider Outcomes Framework allocation, whereby budget is provided to Health Boards to cover a range of outcomes. It is up to Health Boards to decide how much of this funding to allocate to each outcome. The published Scottish Budget for 2023-2024 includes £74.1 million for the Outcomes Framework.

The information requested is not held by Scottish Government.

Public Health Scotland (PHS) have also informed SG that they do not hold the requested data. PHS have explained that they collect episodic data on both the waits that patients experience for treatment being provided by NHSScotland and the episodes of care that arise when these patients are treated within Scotland. However, data are not available on patients who personally choose to seek treatment that is not provided or funded by NHSScotland, whether this be NHS-funded treatment elsewhere in the UK or non-NHS funded healthcare within the UK or abroad.

Furthermore, the National Waiting Times Datamart, which captures some information related to the removal of patients from an NHSScotland waiting list, does not identify when a patient has been asked to be removed because they are seeking alternative arrangements for their treatment due to waiting times.