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We welcome the publication of the Scottish Diabetes Survey which provides an annual summary of key issues and trends in diabetes care and treatment in Scotland. As in previous years, the number of people living with diabetes in Scotland is increasing. However, we are not seeing a great increase in the number of new cases, but rather people with diabetes are living longer with the condition.

At the end of December 2020 the Scottish Diabetes Survey reported that 317,128 people have been diagnosed with diabetes of all types in Scotland compared to 312,390 people diagnosed in 2019.

We are committed to ensuring that everyone living with diabetes in Scotland can access appropriate, high-quality, person-centred care. In February 2021, we published our Diabetes Improvement Plan refresh, which builds on the progress made since 2014 and sets out our priorities to deliver safe, effective and person-centred healthcare, treatment and support to those living with diabetes.

Our Type 2 Diabetes Early Detection, Intervention and Prevention Framework was published in 2018 and is designed to support those at risk of, or diagnosed with, type 2 diabetes. It provides guidance to NHS boards on the provision of evidence-based, person-centred targeted interventions across diabetes and weight management services.

In July 2019, the Scottish standards for the delivery of tier 2 and tier 3 weight management services to children and young people and to adults were published. These standards provide a detailed framework to drive forward consistent, equitable and evidence-based approaches across Scotland in the treatment of higher body weight and associated health risks.

The table below from Public Health Scotland shows the numbers of inpatient and day case hospital admissions with a primary diagnosis of diabetic ketoacidosis and the number of these admissions where the patient died in hospital.

Due to the way that complications of diabetes are coded in the international ICD10 coding system this only includes cases of diabetic ketoacidosis without coma. These figures do not include cases of diabetic ketoacidosis with coma, which cannot be identified separately from instances of diabetic coma without ketoacidosis.

We are committed to reducing the impact of inequalities on health outcomes for people living with diabetes, and equity of access is highlighted as a key priority in our Diabetes Improvement Plan refresh, published in February 2021.

We are working with key partners including NHS Boards, Health & Social Care Partnerships, Diabetes Scotland and people living with diabetes to ensure that evolving care models address existing health inequalities by integrating pathways with existing services and resources such as social work, mental health services, education and third sector.

As diabetes services evolve and include more virtual offerings, we will work to ensure that those people with diabetes who are unable to access services digitally are not disadvantaged as a result of digital exclusion.

On 3 November 2020 the Scottish Government published a rapid review of outbreaks to learn lessons for practices within care homes Coronavirus (COVID-19): care home outbreaks - root cause analysis - gov.scot (www.gov.scot)

In doing so, the report collated and evaluated local level experiences and responses to COVID-19 outbreaks within care homes. It identified a number of recommendations to support working practices to prevent transmission of COVID. We continue to work to ensure the recommendations are implemented and have recently set up a working group to examine whether further work is required given where we now are in the pandemic.

Providing consistent high quality, safe and effective personalised care for people is our top priority for our health and care services. We continue to take a public health and a clinical evidence based response to the pandemic. In doing so, this continually ensures working practices are fit for purpose, for example Infection Prevention and Control, Personal Protective Equipment and Testing to Protect which continue to be of paramount importance as we come to deal with the impact of the pandemic and apply lessons learned.

In addition, to support the needs and wellbeing of the social care workforce and unpaid carers, we have put in place a combination of measures including working practices which were outlined in the Adult Social Care Winter Plan available at the following link: Adult social care - winter preparedness plan: 2021-22 - gov.scot (www.gov.scot)

As we look to the future and rebuild and remobilise our social care sector in Scotland, we have a significant opportunity to ensure that staff and users of social care people are placed at the centre of the recovery. We are proactively developing an Older People’s Strategy and a Healthcare Framework for adults and older people living in care homes. These principles will also be critical as we establish a National Care Service in Scotland.

The Scottish Cardiac Audit Programme, within Public Health Scotland, have been actively seeking data submissions from all sites across Scotland that previously contributed to the UK National Cardiac Audit Programme, managed by the National Institute for Cardiovascular Outcomes Research (NICOR). This includes sites which carry out TAVI procedures.

The Heart Disease Action Plan 2021, sets out a strategic vision to address the impact of heart disease across Scotland. This means that the plan does not provide detailed information on specific conditions but instead identifies four priority areas. These are 1) tackling risk factors, 2) ensuring timely and equitable access to diagnosis, treatment and care, 3) addressing key issues within the cardiac workforce, and 4) ensuring effective use of data to support improvement.

The actions within these priority areas should impact across a number of cardiac conditions and therefore improve services for everyone with heart disease, including for people living with heart valve disease.

Scottish participation in the UK National Cardiac Audit Programme (NCAP), managed by the National Institute for Cardiovascular Outcomes Research (NICOR), was previously enabled through the Healthcare Quality Improvement Partnership (HQIP).

The Scottish Government had been working with HQIP since November 2018 to identify a mutually agreeable legal basis that would support Scotland’s continued participation in a number of UK wide audits, including the NCAP programme. It was not possible to identify one and as a result, throughout 2020/21 there was a phased withdrawal of Scottish Government participation in HQIP associated audits as an appropriate point was reached in each.

As replacement for the NCAP, in April 2021 we commissioned Public Health Scotland (PHS) to develop the Scottish Cardiac Audit Programme. PHS have been actively seeking data submissions from all sites across Scotland which previously contributed to the NCAP.

PHS are currently working with clinicians and patients across Scotland to undertake further development of the audit programme.

All 14 NHS Boards have hospitals providing acute stroke care. A map showing all hospitals that contribute data on stroke unit admission to the Scottish Stroke Care Audit can be found in the Scottish Stroke Improvement Programme report at: https://www.strokeaudit.scot.nhs.uk/index.html . Of those sites shown on the map, Stracathro, Stobhill, Vale of Leven, Queen Margaret, Falkirk Community Hospital and Stirling Community Hospital are shown because they contributed data solely on stroke rehabilitation.

The remaining hospitals provide acute beds for stroke patients, either in a unit which has solely acute beds with offsite stroke rehabilitation units for ongoing care, within an integrated stroke unit (combining acute and rehabilitation beds) or in a hyperacute unit. The seven smallest general hospitals define stroke unit admission as gaining access to the appropriate acute medical ward.

Further to the answer to question S6W-04701 I can confirm that the case review was undertaken by a small number of NHS Lothian clinicians who are all suitably qualified and experienced in their relevant fields. As none of the clinicians who undertook the review had previously looked after Mr Slorance there was no conflict of interest in undertaking the review.

The Scottish Stroke Care Standards can be found here: ( https://www.strokeaudit.scot.nhs.uk/index.html ). The current standard relating to brain imaging already sets out that 90% of patients should receive this within 12 hours of arrival at first hospital, unless there is a documented contraindication.

The Scottish Stroke Care Standards are regularly reviewed in line with current evidence and updated guidelines. We monitor the implementation of these standards through the Scottish Stroke Care Audit to ensure that stroke patients in Scotland are receiving high quality care.