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The Scottish Government remains committed to developing plans to deliver free breakfasts to all primary and special school children. Work is underway to map existing breakfast provision which is expected to be completed in Spring 2024. This will inform policy on school breakfasts, and a plan for breakfast provision, designed around the needs of children and families.

The Scottish Government remains absolutely committed to the founding principles of the NHS. As is the case across the UK, hospitals in the independent sector were contracted to provide additional capacity for NHS priority patients throughout the pandemic. NHS Scotland makes limited use of the independent sector, in contrast to the position in NHS England.

Our National Treatment Centres (NTCs) Programme is the single biggest increase in planned care capacity ever created in NHS Scotland; these centres are planning to deliver over 20,000 additional planned care procedures by 2024-25.

NHS Scotland’s Centre for Sustainable Delivery (CfSD) is also playing a central role in working with Health Boards to ensure that they are able to continually identify new ways to increase capacity, and to respond to demand through service innovation and redesign.

CfSD’s clinically-led Specialty Delivery Groups (SDG) have supported several new and innovative pathway developments, many of which are now being successfully scaled up across Scotland, including Active Clinical Referral Triage (ACRT), Patient Initiated Review (PIR) and Enhanced Recovery after Surgery (ERAS). These improvement programmes will support delivery of the targets and provide sustainable solutions for the future.

The NHS Scotland National Access Policy states that Health Boards should review reasons why patients may DNA or cancel appointments in order to take necessary steps to address issues and barriers as necessary including what support can be provided by Health Boards to reduce non-attendance. The policy can be found at The NHSScotland National Access Policy - gov.scot (www.gov.scot) .

Public Health Scotland data up to 30 September 2023 showed the Did Not Attend (DNA) rates for New Outpatients has reduced by 1% over the last year - from 7.7% on 30 September 2023 to 6.7% in the most recent quarter. While DNA rates for inpatient and day-cases has been consistently at 0.7% in each quarter over the same period.

We recognise the importance of transparent and regular communication with patients, which is why we have included a standard package of communications that all Health Boards should be providing in the revised Waiting Times Guidance . This includes what patients should expect and their responsibilities while they are waiting for their appointment, test or treatment.

The Scottish Government maintains an ongoing dialogue with all health boards to discuss performance and issues such as workforce arising across the system. The last series of quarterly Biannual Performance reviews with each of the territorial health boards, including NHS Ayrshire and Arran concluded in September 2023.

In addition, the Centre for Workforce Supply (CWS), at NHS Education for Scotland (NES), throughout October and November 2023, attended by Scottish Government officials, held medical insight meetings with each individual health board - including NHS Ayrshire and Arran. Commissioned by the Scottish Government, the aim of these were to better understand medical workforce gaps; scope out whether international recruitment could help with filling vacancies; identify any innovative supply initiatives currently underway; and understand what centralised support from the Scottish Government or the CWS could help Health Boards.

Text messages have been used routinely and positively for many years in NHS Scotland. Scottish Government’s Information and Risk Assurance Team has been working extensively with Health Boards and other NHS delivery partners in assessing the proportionality of using text messages for different purposes, including appointment reminders, medication adherence, health education, and remote monitoring.

The benefits often identified across different NHS organisations include reduction in non-attendance, improved patient engagement, increased adherence to treatment plans, and cost-effectiveness. The Information Commissioner’s Office (ICO) have previously stressed the importance of wording text messages appropriately and advice was given during the COVID-19 pandemic on messages not adding unnecessary confusion and being easy to read. We also recognise that the use of text messages is limited by critical privacy and security requirements and potential for misinterpretation.

The national Connect Me programme has been well received in allowing patients to report information like blood pressure readings via text message to receive feedback based on their condition. Alongside web and mobile app access, this importantly supports public choice in how they engage with NHS services whilst reducing the need for unnecessary appointments.

The Scottish Government regularly holds cross-portfolio meetings to discuss matters related to public health. The overall governance for cross-portfolio engagement on population health and its drivers is the Care and Wellbeing Portfolio. The most recent cross portfolio meeting under this governance was the Place and Wellbeing Programme Board (which sits within the Care and Wellbeing Portfolio) which last met on 7 December. Matters discussed included progress on how health and social care bodies can operate as effective anchor institutions and contribute to improved public health, as part of the wider community wealth building agenda.

The Care and Wellbeing Portfolio Board, which provides oversight of a portfolio of work to improve population health; address inequalities and improve system sustainability, last met on 26 July 2023.

At that meeting the Board considered joint work across Economy/Health and Social Care Portfolios and Public Health Scotland on economic inactivity and the impact it has on Scotland’s economy and population health. The Board also discussed the Verity House Agreement and the shared priorities of tackling poverty, transforming our economy through a just transition to deliver net zero and, delivering sustainable, person-centred public services. 

The Board next meets on the 24 January 2024 and is scheduled to consider long term planning around population health.

Additionally, the Scottish Government has regular cross-portfolio meetings about wider determinants that contribute to improving public health - including the Tackling Child Poverty Programme Board, the Fair Work Oversight Group and the Ministerial Population Taskforce.

We understand there is a role for private healthcare in delivering planned care however, the Scottish Government is absolutely committed to keeping our NHS true to its founding principles and providing the best value for the people in Scotland. We have invested in nursing and midwifery staffing, which already at a record high has increased further by 1.6% from September 2022 to 65,269.8 WTE. The Allied Health Professional workforce (excluding paramedics) has seen similar growth to 11,857.7 WTE in September 2023, representing a 3.6% increase since last year.

The Scottish Government does not hold information about the number of NHS Scotland staff who may have left their position to take up alternative employment in the private healthcare sector.

We are fully committed to taking action to support the recommendations of the Alternative Pathways to Primary care and to our key aim of ensuring people can access the right care, in the right place, at the right time.

In particular, since 2018, we have significantly expanded the multi-disciplinary primary care workforce, with total staff of 4731 WTE working in multi-disciplinary services including physiotherapy, pharmacy and phlebotomy, at March 2023.

There was an increase of 518 WTE staff overall between March 2022 and March 2023, giving the average practice access to more than 5 multi-disciplinary team members.

However, recognising that implementation gaps remain, we are now also introducing an additional ‘phased investment programme’ working with a small number of areas to demonstrate what a model of full multi-disciplinary team implementation can look like in practice, over an initial 18 month period.

The findings from this work will inform a long-term Scottish Government investment for all areas.

Tackling health inequalities and improving population health remain clear, ongoing aims of the Scottish Government, that directly support our cross cutting missions of Equality, Opportunity and Community. We continue to pursue and promote a “health in all policies” approach as we recognise the building blocks of good health require concentrated action across government to maximise income and address socio-economic factors.

We are making progress and have prioritised tackling key drivers for poor health, including poverty and deprivation through a range of measures. This includes investment of £3bn across a range of programmes to support low income households, delivering the Scottish Child Payment, delivering Best Start Bright Futures to tackle child poverty, free school meals and the council tax reduction scheme. We are also delivering Community Link Workers and Welfare Rights Advisors to offer advice on housing, social security and employability issues within GP practices across our rural and deprived communities.

We are also taking forward work to support and encourage positive health behaviours and assuring the impact of our interventions are appropriately considered. This includes conducting Health Inequality Impact Assessments across our Diet and Healthy Weight Delivery Plan, our Alcohol Framework and any future policy planning as we implement our Tobacco and Vaping Framework.

The Scottish Government will continue to work closely with its partners, including Public Health Scotland, at a national and local level to explore ways to drive improvements in health and embed health considerations within wider future policy making. Over the coming months, we will be working closely with our partners across the health and social care system, local authorities and wider stakeholders to develop long term planning for population health and integrated health and social care services.