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Scotland’s national health information service, NHS Inform aims to provide the people of Scotland with accurate and relevant information to help them make informed decisions about their own health and the health of the people they care for.

NHS Inform provides health information for people living with long COVID, chest, heart and stroke conditions, including advice on management of common symptoms, health-related anxiety and when to seek further information from healthcare professionals.

The Scottish Government is committed to ensuring that all adults who require rehabilitation have timely access to the right information and services by the end of 2025 through our Once for Scotland Rehabilitation Approach. This is supported by NHS Boards and Health and Social Care Partnerships, encouraging cross-sector working with third and leisure sectors to support community-based services and supported self-management. We are working with key partners to deliver this, and various measures are already in place to support delivery for people with chest, heart and stroke conditions.

Studies looking at the impact of respiratory infections on those with lung conditions have often demonstrated that this cohort are at greater risk of hospitalisation. We recognise that people with lung conditions often have pre-existing reduced lung function and if they become infected with COVID-19 or flu, are at a disadvantage from the onset.

As set out in Priority 5 of our Health and social care: winter preparedness plan 2023-2024, “Protecting people who may be most impacted by severe illness, hospitalisation or death from Covid-19 and flu, through vaccination, is a key means of protecting individuals from illness and reducing demand on our health and social care systems.”

Our successful vaccination programme means many people previously considered at highest risk of infection and severe disease, and the wider population, are now far less likely to become seriously ill from Covid-19 or flu.

However, a group of people do remain at high risk – primarily people who have a weakened immune system. These people should continue to follow the advice of their GP or specialist clinician, who best know their health condition and circumstances.

The Best Start Implementation Programme Board was tasked with taking forward implementation of the recommendations within Best Start. The Programme Board set up the Perinatal Sub Group and asked it to take forward the Neonatal Intensive Care work, including an options appraisal process to identify the final three units. The Perinatal Sub Group comprises clinical experts, including the chair of the Scottish Neonatal Consultants Group, the chair of the Scottish neonatal nurses group, the Scottish Clinical Lead for neonatology, the Scottish clinical representative from the National Neonatal Audit Programme, the neonatal consultant lead for the neonatal transport service, senior management representation from the Scottish Ambulance Service, a Head of midwifery, the Scottish Clinical Lead for Obstetrics, the Chief Executive of the neonatal charity, Bliss and is chaired by a Health Board Medical Director and Deputy Chief Executive.

The Expert Group that agreed the short list criteria and weighting for the options appraisal comprised the following experts (representing roles that held at that time):

• Helen Mactier, consultant neonatologist and Honorary Secretary of President of British Association of Perinatal Medicine (BAPM)
• Gopi Menon, consultant neonatologist and President of BAPM
• Alan Fenton, Consultant Neonatologist, immediate past President of BAPM, and Chair of Independent Advisory Group for the National Neonatal Audit Programme;
• Corinne Love, Consultant Obstetrician, Scottish Government Senior Medical Officer;
• Eddie Doyle, Senior Medical Advisor, Scottish Government Paediatrics and Neonatal.

The New Model of Neonatal Care is aimed at the most premature and sickest of babies and is based on a review of evidence carried out by Dr Anna Gavine, Dr Steve MacGillivray and Prof Mary Renfrew of the University of Dundee and a summary of the evidence review is published within The Best Start ( Appendix H ).

The evidence showed that outcomes for very low birth weight babies (VLBW) are better when they are delivered and treated in Neonatal Intensive Care Units with full support services, experienced staff and a critical mass of activity (expert recommendation defines this as care for a minimum of 100 VLBW babies a year).

This evidence has since strengthened with the publication in 2021 of the British Association for Perinatal Medicine (BAPM) Framework for Practice , which sets out optimal arrangements for neonatal intensive care.

As set out in the Programme for Government, we are committed to prioritising capital spending to achieve net zero and maintain high quality public infrastructure across Scotland. We have been consistently open about the challenges facing our capital investment plans and tough decisions will need to be taken at the 2024-25 Budget to ensure we remain fiscally sustainable.

The challenging economic conditions of the last few years resulting from Brexit and high inflation as well as the real terms fall in the capital grant allocation from the UK Government has significantly impacted our ability to deliver on all capital infrastructure commitments. Given the economic challenges we face, we have committed to refreshing the multi-year capital spending envelopes and resetting the infrastructure project pipeline, including road projects, alongside the 2024-25 Budget.

Funding allocated to Alcohol and Drug Partnerships (ADPs) is for both alcohol and drug treatment services. In 2022-23, £106.8 million was made available to ADPs, increasing to £112.9 million in 2023-24. This funding is used to ensure that local services meet the needs of people who experience alcohol and drugs harms.

On 7 September 2023 I supported a Member’s Debate Motion calling for investment in alcohol services - outlining the Government’s plan to reduce harm from alcohol misuse. The plan includes measures to improve access to treatment and support, including through stabilisation and crisis management, expansion in local assertive outreach services and increasing the availability of residential rehabilitation placements. The plan also includes working with partners and stakeholders to implement alcohol treatment standards – building on the forthcoming UK-wide Clinical Alcohol Treatment Guidelines which are currently out for public consultation until 8 December 2023.

Families told us, as part of the Best Start engagement process, that they wanted the best care possible for their babies. Evidence tells us that the very smallest and sickest babies will get the best outcomes if they care cared for in high volume units.

This change will affect families in many different parts of Scotland, and the Chief Executive of Bliss sits on the Best Start Programme Board and was a participant in the options appraisal process, representing the views of neonatal families.

Scottish Government will be consulting with families in the affected areas on implementation of the new model, so that we can take account of their concerns when the pathways and processes for the new model of care are designed. This will affect a very small number of families, however, it is important that we hear the voices of those families to input into design of service delivery.

Neonatal units will also continue to seek parent feedback locally to ensure opportunities to improve experiences of care for families are identified.

Health Boards are responsible for planning services to best meet the needs of their patients.

Service planning and design should take place at a local level and be informed by an assessment of the type, and level, of support required by patients who need to access those services.

The Scottish Government published Quality Standards for Adult Hearing Rehabilitation Services in 2009 which sets out a standard for the repair being carried out within 2 days of the repair service receiving the hearing aid.

It is for NHS Boards to ensure appropriate provision of a service for the timely repair of hearing aids for patients.