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The membership of the Best Start Review Group and the Best Start Sub-Groups is published in Appendix E and Appendix F of the Best Start Report .

Dr Ian Wallace, at the time Medical Director at NHS Lanarkshire, was a member of the Best Start Review Group and the Neonatal Models of Care sub group.

It is not within Healthcare Improvement Scotland’s legal remit to assess decisions made nationally. Healthcare Improvement Scotland’s Community Engagement arm supports, ensures and monitors NHS Boards and Integration Authorities activity in relation to patient focus and public involvement in health services.

When decisions are made by the Scottish Government on NHS services, they are scrutinised through the Parliamentary process, the Health and Social Care Committee and Audit Scotland.

The Scottish Government’s Participation Framework provides information / guidance on relevant commitments to public participation that Scottish Government must adhere to. The Participation Framework supports Scottish Government to take decisions about how to open up opportunities for participation in ways that best suit the needs policy areas, the types of contribution being sought, and the characteristics and needs of the people being engaged with.

The locations of the three Neonatal Intensive Care Units was based on clinical evidence that the very smallest and sickest babies, including those born extremely premature (below 27 weeks), do best when they are cared for in larger specialist neonatal units which look after a lot of these babies, and have the right staff and services available on site to give them the very best care. The Best Start report recommended that we move to three of these units in Scotland, to meet the needs of our population.

The Options Appraisal Report , published on 25 July 2023 describes the process undertaken to determine the three final Neonatal Intensive Care Units, and the feasibility analysis and testing that followed the conclusion of that process. Annex A of the Report includes the criteria and weighting used for the Options Appraisal Process. Based on the evidence, the criteria focused on collocated clinical specialist services.

To support all parents who have babies admitted to neonatal care the Young Patients Family Fund provides funds to cover the cost of travel, subsistence and any accommodation required.

The Best Start recommendation to move to a model of three intensive care units in Scotland was based on evidence that this will improve outcomes for the smallest and sickest babies.

The Framework for Practice ‘Criteria to Define Levels of Neonatal Care including Repatriation within NHS Scotland’, published on 25 July 2023 describes the care that can be provided at each level of neonatal care. It outlines that Local Neonatal Units can continue to care for babies requiring short periods of intensive care in accordance with agreed pathways.

In addition the British Association of Perinatal Medicine published ‘ Optimal Arrangements for Neonatal Intensive Care Units in the UK’ in 2021, which provides a framework for practice for neonatal care. This sets out the optimal arrangements for neonatal intensive care to provide the lowest mortality and morbidity, and the best baby and parent experience.

The Best Start Report, published in 2017 followed a review of maternity and neonatal services in Scotland, and was based on research evidence, the views of clinicians and the views of service users. Based on data on birth data, the report recommended that we move to a model of three intensive care units in Scotland.

The process of determining which units should provide Neonatal Intensive Care followed an Options Appraisal process undertaken by an expert group, including clinical leads and service user representatives. The Royal Hospital for Children in Glasgow, Edinburgh Royal Infirmary and Aberdeen Maternity Hospital scored highest based on an agreed short list criteria, definitions and weighting. The group were asked to recommend three units and there was no consideration given to including a fourth unit.

The Scottish Government is committed to an infrastructure solution to address landslip risks at the A83 Rest and Be Thankful and shares the urgency communities and businesses place on maintaining and improving connectivity of this vital route.

The medium term solution consists of improvements to the existing Old Military Road through the Glen Croe corridor to make it a more resilient diversion route until the long term solution is in place. These improvements will improve the resilience of the diversion route, reduce journey times, and are the quickest to implement, of relatively lower cost and would have the least impacts overall across the range of criteria assessed of the medium term options considered.

A detailed programme for the proposed improvements is being developed. These include debris catch fences, temporary bunds, drainage improvements and widening and discrete realignment to improve bends and avoid flooding. It is expected that these works will be carried out on a phased basis starting later this year with Phase 1 which is realignment of the southern end of the route. It is anticipated that Phases 2 and 3 will commence in financial year 2024-25, subject to obtaining any necessary statutory authorisation consents. Construction of these phases is expected to take approximately 12 months subject to weather conditions.

The Scottish Government remains committed to medium and long term solutions to address the landslip risks at the A83 Rest and Be Thankful. This scheme is a priority for the Scottish Government, it is a key recommendation in STPR2, it is included in the Programme for Government 2023 to 2024 as well as the First Minister’s Policy Prospectus.

The recent exceptional rainfall on the A83 at the start of October resulted in seven landslides reaching the A83 trunk road, encompassing two very significant landslides at the A83/A815 junction, four landslides at Glen Kinglas and one small landslide at the Rest and be Thankful. Four further landslides were captured by hillside mitigation above the trunk road that includes pits, bunds and catch-fences, with two slips occurring at Glen Kinglas and two at the Rest and be Thankful.

The recent storm events in the areas have not impacted the development of the scheme, and we are still very much focussed on progressing this scheme as quickly as we are able to bring the benefits to those who use the A83.

The figure of 10-15% reflects data taken from the 2022 Care Home Census. The latest census will be published in due course and may reflect different data.

Reasons behind this figure include: the fact that registered beds do not necessarily equate to available beds for a wide range of reasons; a UK-wide staff shortage in the social care sector which has an impact on bed availability; different care home providers using different business models which can affect the number of people that can be admitted at any one time.

The statutory responsibility for delivering and commissioning services at a local level lies with local authorities, NHS boards and integrated health and social care partnerships. Publicly funded places in care homes are covered by the National Care Home Contract, which is negotiated annually between COSLA and Scottish Care. The information requested on the number of NHS funded beds that are currently empty is not held by the Scottish Government.

The Scottish Government is committed to an infrastructure solution to address landslip risks at the A83 Rest and Be Thankful and shares the urgency communities and businesses place on maintaining and improving connectivity of this vital route. At the recent Cabinet public discussion on 2 October in Inverary, the First Minister gave a firm commitment to a solution to the challenges at the Rest and Be Thankful, including a commitment for the funding.

Spending as set out in the Scottish Budget 2023-24 is confirmed which includes progressing the necessary detailed design work for the long term solution, currently progressing at pace. The detailed development and assessment of the preferred option will culminate in the publication of draft road Orders, compulsory purchase Orders and Environmental Impact Assessment Report for formal comment and we expect to publish draft Orders by the end of 2024.

Progress following publication of draft Orders will depend on the level and nature of any representations, including objections, to the published draft Orders. Procurement of a main works contractor for the permanent, long term solution can only commence upon completion of the statutory authorisation process.

The current estimated cost of the preferred option is approximately £405 million - £470 million (at 2023 prices). We will continue to develop and assess the scheme proposals in order to deliver the best value for taxpayers’ money.

Funding to take forward the construction stage of the long-term solution in future years will be determined as part of the annual Scottish Budget setting process and subsequent capital spending reviews.