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In Scotland, the Scottish Medicines Consortium (SMC) appraises the clinical and cost-effectiveness of newly-licensed medicines. Following a full submission from the submitting company, Merck Sharp & Dohme Ltd, the SMC published “accepted for restricted use” advice for Health Boards on the routine use of Keytruda ® for the treatment of persistent, recurrent, or secondary cervical cancer in NHS Scotland on 13 February 2023.

The decision to prescribe a medicine for an individual, and which medicine to prescribe, is entirely for the clinician in charge of an individual’s care, having taken into account their clinical condition, safety considerations and any relevant clinical guidance.

We will publish an update on each of the accepted Deer Working Group recommendations, alongside minutes from the December meeting of the Deer Management Strategic Board shortly. This will be available, alongside minutes of previous meetings, on the Board’s webpages here: Deer Management Strategic Board - gov.scot (www.gov.scot) .

NatureScot has a range of legislative powers available to them under the Deer (Scotland) Act 1996. A summary of how NatureScot has used those powers since 2017 has been provided in the following table:

As this is an operational matter for Scottish Water, I have asked Douglas Millican, Chief Executive, to respond. His response is as follows:

Scottish Water completed an exercise with the James Hutton Institute in 2021-22 to understand the current carbon capture on its landholdings and to baseline performance. This has enabled Scottish Water to identify areas where it can improve carbon performance. Scottish Water is planning to survey and restore all circa 4400Ha of poor condition peatland on its land that were identified in the baseline exercise. In addition, it is working with other landowners to identify peatland for restoration where the poor condition peat has an impact on raw water quality. This programme of work has been underway for several years with a focus on water quality, and now has added benefit of carbon reduction.

In parallel, Scottish Water has been reviewing all of its landholdings for their potential for woodland creation. In 2021-22 they created 100ha of new woodland and are developing several schemes to increase this. In developing the plans for each site, Scottish Water engages with its tenant farmers to ensure that the plans integrate with the needs of the tenant. Scottish Water’s largest land holding is the Loch Katrine estate, where over the last two years it has been working in partnership with Forestry and Land Scotland to develop a 10 year land management plan. This was submitted to Scottish Forestry for approval in February 2023. The draft plan proposes the creation of some 4600Ha of new woodland. This landscape scale plan has involved close working with communities and stakeholders such as the Loch Lomond and Trossachs National Park Authority.

Previous requests under the Freedom of Information (Scotland) Act 2002 and Environmental Information (Scotland) Regulations 2004 have provided information on the costs associated with the creation of the Deposit Return Scheme in Scotland and are published on the Scottish Government website. As of 18 May 2022 it cost the Scottish Government £182,722 to set up DRS including costs associated with preparing legislation, consulting, evaluation, and independent reviews and assurance. The Scottish Government is open to further requests for information under both FOISA (2002) and EIR (2004).

Previous requests under the Freedom of Information (Scotland) Act 2002 and Environmental Information (Scotland) Regulations 2004 have provided information on the costs associated with the creation of the Deposit Return Scheme in Scotland and are published on the Scottish Government website. As of 18 May 2022 it cost the Scottish Government £182,722 to set up DRS including costs associated with preparing legislation, consulting, evaluation, and independent reviews and assurance. The Scottish Government is open to further requests for information under both FOISA (2002) and EIR (2004).

Scottish Government is aware of recent difficulties experienced by some homecare providers. NHS National Procurement in partnership with Health Boards have worked closely with the homecare providers to improve service performance. All homecare providers are now demonstrating improved service levels.

Medicines homecare providers must demonstrate that they can meet the standards for registered pharmacies set by the General Pharmaceutical Council (GPhC). The standards are designed to create and maintain the right environment for the safe and effective practice of pharmacy and to improve the quality and safety of services provided to patients and the public. The GPhC inspect registered pharmacies to seek assurances that the standards are being met. Depending on the range of services provided, medicines homecare providers may also be registered with additional regulators such as the Care Inspectorate and the Medicines and Healthcare products Regulatory Agency.

The Scottish Government have not undertaken any assessment on the effects of inflation specifically within the medicines homecare service. Like a number of sectors, homecare providers have experienced challenges in recruitment and retention of staff, which has been one of the drivers of the service problems.

Delivery of a permanent and resilient solution to the landslip risks at the A83 Rest and Be Thankful is a priority and we continue to seek ways to achieve that as quickly as possible, noting that all of the options require complex civil engineering.

Transport Scotland continues to take forward the necessary design and assessment work at pace with a view to announcing a preferred route option this Spring. Following this further detailed design and assessment work on the preferred option, including an Environmental Impact Assessment, is required before we can complete the necessary statutory planning process to allow any land to be acquired and the project constructed.

Delivery of the long-term solution can only commence if it is approved under the relevant statutory planning process and thereafter a timetable for its progress can be set. We will continue to progress the necessary design work as a priority with a view to commencing work on the ground during the current parliamentary term subject to timely completion of the statutory process.

We are dutybound to properly follow the correct statutory planning process which rightly includes consultation with communities, landowners and others with a direct interest in the scheme. However, Transport Scotland continues to explore methods to reduce the timescales of each stage of the project, where possible, and progress work at pace on this essential project.

NHS National Procurement in partnership with the Health Boards are responsible for the provision of medicine homecare services and have met with affected providers on a weekly basis over a 12 month period to address services provision and monitor return to good service levels.

When service problems arise, through performance management arrangements linked to service level agreement and contracts, there is work with providers to agree an action plan and then closely monitoring delivery of performance improvements against that plan until service levels return to agreed standards.

The average time to onboard a patient to a homecare service varies by homecare provider. Within the Service Level Agreements with the homecare providers, a minimum of 5 business days is required between the provider receiving the registration documents and prescription for the patient and first delivery. Delivery may take slightly longer to areas of the Highlands and Islands due to the remoteness of the locations, although this varies by homecare provider. If treatment is required to be started more urgently than the homecare provider can deliver, then initial supplies can be made locally to patients through hospital pharmacies before the homecare service is set up.