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I refer the member to my the answer to question S6W-26340 on 19 April 2024, that clarifies that decisions on clinical pathways are not for the Scottish Government. Decisions on clinical pathways, and prescribing, are for clinicians, based on the best evidence available, through the appropriate clinical governance structures.

The timeline of the Health Boards informing the Scottish Government about their decision:

28 March (pm) - Medical Directors in NHS Lothian and NHS Greater Glasgow and Clyde wrote to the Chief Medical Officer (CMO) advising him that, following a consultation with senior medical staff, both Boards were pausing any new prescriptions for puberty hormone suppressants and cross sex medication for those under 18 years of age. This position followed an interim pause on referrals to paediatric endocrinology, following clinical advice, from mid-March by the Health Boards.

5 April - Ministers were informed of the proposed change in policy, following consideration of the implications of the letter.

9 April - The CMO responded to Medical Directors in NHS Lothian and NHS Greater Glasgow and Clyde confirming that this area is no exception to his expectation that Health Boards make decisions on the delivery of clinical care via agreed local governance processes, considering new and emerging evidence in a clinical field - and conveying his support for the Health Boards’ decision.

All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers.

Specialist NHS gender identity healthcare in Scotland is delivered by gender identity clinics. There are four NHS gender identity clinics in Scotland providing clinical assessment, treatment and specialist support to adults and a separate service for children and young people.

The role of community pharmacy in relation to gender identity healthcare primarily relates to the dispensing of prescriptions for medication prescribed as part of healthcare support for gender dysphoria.

Scottish Government does not hold information on how many pharmacies have dispensed prescriptions related to gender identity healthcare.

The Strategy Steering Group for Palliative Care (SSG), representing the wide range of partners involved in palliative care, chaired by a National Clinical Lead for Palliative Care, and supported by a Clinical and Professional Advisory Group (CPAG), has been crucial in the development of our new Palliative Care Strategy.

The Strategy Steering Group last met on 20 June 2024, to consider the latest version of the draft Palliative Care Strategy and provide further feedback. We anticipate that the draft Palliative Care Strategy and associated consultation will be published in the coming weeks.

The Scottish Government welcomes the innovation, continuous improvement and efficiency that Health Board delivery teams have demonstrated to make best use of resources and funding throughout our national vaccination programmes, which remain a key public health intervention.

The Scottish Government provided £80 million on an National Resource Allocation formula (NRAC) basis to cover local Board vaccine delivery costs for the full financial year 2023/24.

These funds were allocated to the following programmes, the largest of which was the winter Seasonal Flu & COVID-19 booster programme:

• Spring 2023 COVID-19 programme
• 6 months – 4 years at risk COVID-19 programme
• changes to the COVID-19 primary rolling offer
• COVID-19 vaccination out-with seasonal programmes for the clinically extremely vulnerable and for travel or visa purposes
• Winter Seasonal Flu & COVID-19 booster programme 2023

Boards also used this funding to deliver across the full range of other vaccine programmes. A breakdown of investment provided to each Health Board is as follows.

As part of the 2023-24 COVID-19 and flu winter vaccination programme NHS Scotland delivered over 3.57 million winter vaccines, including 1,387,766 COVID-19 vaccines, 1,647,596 adult flu vaccines and 538,580 child flu vaccines. Uptake dropped across almost all groups, but remained strong in the highest risk groups, with over 85% of care home residents and almost 85% of those aged over 75 vaccinated for both vaccines, the groups mostly likely to be admitted to hospital with these illnesses. We continued to surpass the World Health Organisation’s flu target of 75% uptake for those aged 65 and over, achieving 79.8%.

The primary aim of the vaccination programme remains the prevention of severe illness and the vaccine offer is to those most likely to directly benefit from vaccination, particularly those with underlying health conditions that increase their risk of hospitalisation. The data from last winter’s programme shows that uptake remained strong within these eligible groups and meets the primary aim of the winter programme.

There were however certain groups where uptake was far lower than expected, for both COVID-19 and flu, notably pregnant women, frontline health and social care workers and those at clinical risk, although uptake in those with a weakened immune system was better than for more general at risk conditions.

The emergence of the new, and theoretically more dangerous variant BA.2.86 in late summer 2023 resulted in us deciding to pull forward the programme to protect those at higher risk. We appointed those at higher risk into all and any spare appointments at the start and middle of the programme, meaning that those at lower risk, who had been prompted to book, found it hard to find spare appointments until November and December. It is difficult to quantify, but we believe that some individuals may have not come forward due to this difficulty.

The Scottish Vaccination and Immunisation Programme (SVIP) has already undertaken various pieces of work to understand why overall uptake has decreased and we have incorporated that learning into our planning for this winter campaign. Communicating why annual revaccination (or bi-annual in the case of COVID for higher risk groups) remains necessary and important is key, as is reiterating the value of these vaccines, and the real health risk to some people in contracting these viruses over the winter period.

We will continue to work closely with Public Health Scotland and the NHS Boards to ensure the successful delivery of Scotland’s vaccination programmes.

In the last five financial years Scottish Government has provided the following funding to South of Scotland Enterprise:

South of Scotland Enterprise – Budget Allocations 2020-2025

Since the publication of the 'Transforming Nursing Roles: Advanced Nursing Practice - Phase II' paper in 2021, NHS Education for Scotland (NES) has taken the lead for this work.

The minimum qualification of a PG Dip Advanced Practice is required by NHS Scotland employers for all new Advanced Nurse Practitioners (ANPs) and the specific clinical competencies identified for advanced nursing practice in acute, primary care/community, mental health, paediatric acute and neonatal settings are used as the standard for practice. In addition, a final 'sign-off' against these competencies, evidenced by a portfolio is required by most employers.

The introduction of 3.75 hours of non-clinical time per week has been implemented widely and enables ANPs to maintain and progress their knowledge and skills through a variety of continuing professional development activities.

The NES frameworks for clinical supervision were launched in 2023 and 2024 and support the clinical supervision needs of ANPs https://learn.nes.nhs.scot/3580/clinical-supervision.

In addition, the NES Advanced Practice Toolkit was revised in 2023 and provides a repository of relevant resources and weblinks for advanced practice for all professions. https://learn.nes.nhs.scot/63343.

We are supporting NHS Boards through our Urgent and Unscheduled Care Collaborative Programme to improve patient flow through our acute sites and reduce A&E delays. Key actions include: strengthening arrangements to avoid unnecessary hospital admissions such as Same Day Emergency Care services; optimising Flow Navigation Centres; enhancing the discharge process - focusing on discharge planning; and reducing length of stay.

Where new development proposals come forward, Scotland’s Fourth National Planning Framework (NPF4) ensures that 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.

Where the Electricity Works (Environmental Impact Assessment) (Scotland) Regulations 2017 apply to relevant applications made to Scottish Ministers, the effects of a proposed development on population and human health may, if appropriate and on a case-by-case basis, be considered in the overall assessment.