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The national pancreatic cancer audit is an NHS England initiative and Scotland participates in UK audits (Scottish Cancer Registry data is provided by Public Health Scotland). The Scottish HepatoPancreatoBiliary Network (SHPBN) has reported HepatoPancreatoBiliary (HPB) cancer audits annually since 2010. The 2013-2019 audits are based on quality performance indicators, including some specific to pancreatic cancer. The annual audit reports are available on the SHPBN website. The 2020 audit report is currently in progress.

Through the National Cancer Plan we have placed an emphasis on the less survivable cancers, including pancreatic, and improving their outcomes. We have provided funding and are working with the SHPBN to redesign pancreatic and liver pathways.

We are working with NHS Scotland Health Boards to put in place delivery models for the 2021-22 seasonal flu vaccination programme to suit local circumstances, whilst maintaining a COVID-19 safe environment and maximising efficiency.

If someone is unable to attend for their flu vaccination, they can rearrange their appointment to a more convenient time or location on line at Rearrange your flu vaccine appointment | The flu vaccine (nhsinform.scot). If invited by their GP practice or local Health Board, they should rearrange their appointment with them directly. If cancelling the appointment, the Flu Vaccination Helpline on 0800 030 8013 can assist with this.

Consideration for people who do not have digital access has been built into our vaccination programme from the start. Communication has gone out via non-digital channels and we have also undertaken a door-to-door paper leaflet drop with important information on vaccines. COVID-19 vaccine leaflets are available in audio, BSL, easy read and large print as well as other languages.

Those who do not have online access can call the COVID-19 National Helpline on 0800 030 8013. The helpline allows people to check and, where required, reschedule appointments. All information and services on NHS Inform are available via this phone line. We encourage people to double check their GP holds correct address details, to make sure that any appointment letter reaches them.

For those who are eligible for flu and/or COVID-19 booster vaccines, we have ensured that:

• Those aged 70 and over or those who are clinically extremely vulnerable will receive a vaccine invitation by post or may be contacted by their GP.
• Letters will be sent to those aged 60-69 years of age inviting them for vaccination from late October.
• When the online booking portal becomes available for those in stage 2, people who do not have access to digital booking will also be able to book their vaccinations via the COVID-19 National Helpline.

Our forthcoming national marketing campaigns for both flu and COVID-19 booster will direct people towards both the online booking system as well as the phone line so no one should be left out.

Our Detect Cancer Early (DCE) Programme is aimed at increasing early diagnosis rates of Scotland’s most common cancers while reducing health inequalities. DCE launched a new overarching campaign – Survivors - in September 2018 to reduce fear of cancer and empower people to act early if they notice any possible signs of cancer.

An interactive symptom-checker tool has been developed on DCE’s website (getcheckedearly.org) to help raise awareness of key symptoms, including those associated with leukaemia (fatigue, weight loss, recurrent infections). The NHS Recovery Plan, published 25 August 2021, commits a further £20 million investment to the DCE Programme, which will include additional public awareness campaigns.

A clinical refresh of the Scottish Referral Guidelines for Suspected Cancer ( Scottish referral guidelines for suspected cancer - gov.scot (www.gov.scot) )has been completed, with revised guidelines published in January 2019. The Guidelines support primary care clinicians in ensuring those with symptoms suspicious of cancer are put on the right pathway at the right time. The Scottish Government continues to support Cancer Research UK’s Clinical Engagement Team to raise awareness of symptoms and best referral practice for all cancer types across NHS Scotland.

Scotland’s first three Early Cancer Diagnostic Centres (ECDC) are live, providing primary care with a new referral pathway for patients with non-specific symptoms i.e. fatigue, nausea, weight loss – this can often include patients with Haematological cancers.

Ambulance services around the UK, as well as the wider NHS, are experiencing unprecedented demand – largely because of COVID but also due to a combination of increasingly complex cases, staffing challenges and exceptionally busy emergency departments.

That is why we have already taken significant action both prior to and since the pandemic to put in place measures to ensure all Health Boards including NHS Lothian and our Ambulance service have a full range of support.

In July, NHS Lothian received their share of the additional £12 million provided to Health Boards to support non-COVID emergency care. This funding will be utilised to boost staffing and capacity levels to reduce waiting times for urgent and emergency treatment.

To address the unacceptable ambulance waits, we announced an additional package of support for the Scottish Ambulance Service, backed by an additional £20 million, which will help increase capacity and improve response times and staff wellbeing - this includes assistance from over 100 military personnel.

We continue to be in daily contact with NHS Lothian to support improvement work within the Board and the Health & Social Care Partnerships to minimise delays for patients no matter where they are in the system.

NHS Scotland's staffing levels are at a record high, with 25,000 more whole time equivalent staff members working in our NHS under this Government.

Supporting our National Health Service is a central part of the Scottish Government’s programme of work. This is backed by record investment of over £16 billion this year which includes funding to support wellbeing and capacity across our NHS workforce.

On supporting staff in relation to mental health issues: for the financial year 2021-22 the Scottish Government has announced an increased budget of £8 million - an increase of £3 million on last year - to provide ongoing support for the mental health and wellbeing of health and social care workforce across Scotland. This includes targeted support to the primary care and social care workforces of £2 million.

On staff wellbeing and safety, our Health Recovery Plan, published on 25 August, outlines that recovery of staff is intrinsic to our collective ambitions for renewing services. Investment in support for staff wellbeing is therefore an essential and vital component of the recovery plans.

On staffing issues, to support recruitment and free up capacity in the short term we will provide £2 million of financial support to NHS Boards to increase capacity within their recruitment teams and support international recruitment.

We will invest £11 million over the next 5 years in new national and international recruitment campaigns and establish a new national Centre for Workforce Supply. International recruitment of healthcare workers will build capacity in our health workforce and complement existing routes into NHS Scotland.

Work has been undertaken throughout the pandemic with national Regulatory Bodies to ensure that as many former nurses, doctors and allied health professionals who wish to return to work in NHS Scotland are able to do so. We will also support the aims of the Young Person’s Guarantee by increasing opportunities for young people to access employment in NHS Scotland and will explore a range of new initiatives, links with schools and increasing apprenticeships.

The Biodiversity Intactness Index is one of several indices devised to assess the current state of nature, with attribution to a range of drivers. The Biodiversity Intactness Index focuses on nature in the past, and the many pressures in the past over which we now have no control. The index is predicated on the history of land use in each country, with the UK having a long history of deforestation and agricultural intensification which resulted in a lower score relative to other countries.

We have committed to introduce a new Environment Bill which will include targets for nature restoration that cover land and sea based on an overarching goal of preventing any further extinctions of wildlife and halting declines by 2030, and making significant progress in restoring Scotland’s natural environment by 2045.

In December 2020, we published our Statement of Intent on biodiversity, which sets out our ambitions for biodiversity and announces our new biodiversity strategy, which will be published in autumn 2022. We will continue to consider the best mix of targets and indicators to measure success as we develop our strategy and response to the global post-2020 biodiversity framework.

The Biodiversity Intactness Index focuses on nature in the past, reflecting the many pressures in the past over which we now have no control. I am pleased to say that of the four UK nations, Scotland is highest in the list. However, our Statement of Intent on biodiversity published in December 2020 acknowledges that more needs to be done and sets out our ambition and our commitment to tackling the twin crises of climate change and biodiversity loss.

We have made a commitment to produce a new Scottish biodiversity strategy within a year of the Convention on Biological Diversity (CBD) Conference of Parties (COP15), to be held in October 2021 in Kunming, China. A delivery plan will follow, to be developed in conjunction with NatureScot. These will set out our proposals for delivering the step change in our action to address biodiversity loss which is required.

Through the ground-breaking agreement between the Scottish Government and the Scottish Green Party, we have committed to introduce a new Environment Bill which will include targets for nature restoration that cover land and sea based on an overarching goal of preventing any further extinctions of wildlife and halting declines by 2030, and making significant progress in restoring Scotland’s natural environment by 2045.

The Statement of Intent has already made several other key announcements, including:

• an ambitious commitment to protect 30% of our land for nature by 2030 (this has now been further strengthened with a commitment for 10% of land to be highly protected).
• endorsement of the Leaders’ Pledge for Nature, launched at the UN General Assembly in September 2020.
• our work on National Planning Framework 4 will develop new proposals to secure positive effects for biodiversity through development.

We have made significant funding commitments to protect and restore biodiversity.

• We will invest at least £500 million in the natural economy over the course of this Parliament, including: £100 million to increase forestry planting, £30 million to expand Scotland’s national forests and land, and £20 million to increase nursery stocks.
• We have committed £250 million for peatland restoration over 10 years as part of our climate change plan.
• We have committed £214 million through the Agri-Environment Climate Scheme (AECS) since 2015.
• In July 2021 we launched the Nature Restoration Fund, which provides an additional £10 million capital funding for projects that will restore nature, safeguard wildlife and tackle the causes of biodiversity loss and climate change. We have now committed to extending that Fund throughout this Parliament and allowing multiyear funding.
• The Nature Restoration Fund adds to almost £7 million already committed this year through the Biodiversity Challenge Fund.