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This was a productive visit, meeting with staff from Dr Gray’s Hospital, NHS Grampian, Scottish Ambulance Service (SAS) and the Keep MUM group on 3 August to discuss the changes to maternity and paediatric services.

Following those meetings I have written to the acting Chief Executive of NHS Grampian formally requesting submission of a detailed plan of how NHS Grampian intends to restore a full obstetric service to Dr Gray’s Hospital, with paediatric services in support. I have asked for this plan by 17 August. The plan should include a detailed timeline and milestones and be co-produced with relevant staff at Dr Gray’s, the Scottish Ambulance Service and members of the public, including KeepMUM. I have published my letter to NHS Grampian in SPICe [ Ref. BIB 59956 ].

There is no doubt that the prolonged dry period has compounded problems for farmers and crofters already coping with the wet weather of 2017 and subsequent late spring. Amongst other problems, the dry weather has limited the growth in grass used for making silage or livestock grazing purposes and this has resulted in the need for farmers and crofters to use up feed and fodder stocks that were being saved for use in the winter ahead. In other cases, it is reported that some farmers have had no choice but to sell on their livestock early.

That is why I have acted immediately to reintroduce a scheme to make available Basic Payment loans. The similar 2017 scheme delivered payments of more than £317 million to around 13,500 farmers and I expect this new scheme to be equally successful delivering much-needed support to those agricultural businesses facing additional costs and cashflow shortages following an unprecedented sequence of weather events.

More generally, the current situation continues to be closely monitored by the Agricultural Weather Advisory Panel which I established in December 2017. The Panel acts as a taskforce for rapidly sharing information, best practice and encouraging co-operation across industry, and in conjunction with the Farm Advisory Service is helping farmers and crofters respond effectively to challenging weather conditions, both in the short term and in building longer term resilience.

The Panel last met on 8 August when it discussed the short-term implications of continued dry and warm weather and their latest statement is available online at: https://beta.gov.scot/groups/agricultural-weather-advisory-panel/

NHS Grampian and the local Health & Social Care Partnership are committed to the continued provision of high quality, sustainable healthcare services in Moray, including those provided at Dr Gray's Hospital in Elgin. The Scottish Government will continue to support the local planning providers in this commitment.

The specific proposal to create a formal partnership with the Glasgow School of Art Design Innovation Team is being considered as part of the Scottish Government’s wider approach to regional planning and to the promotion of health innovation across the NHS in Scotland.

The Scottish Ambulance Service is actively recruiting to 8 new ambulance posts which will be based at Elgin Ambulance Station. A number of new students are due to attend ambulance training courses over the next 6 months and will commence operational duties in early 2019. Some of the Elgin posts will be taken up by these new recruits and the Service is also seeking to recruit already qualified ambulance staff to fill some of the posts and have had some interest around this.

As an interim measure additional ambulance shifts are being undertaken by local ambulance staff which is increasing operational resilience in Moray.

The decision to temporarily downgrade maternity and paediatric services at Dr Gray's Hospital was taken by NHS Grampian in the interests of patient safety. A risk assesment on the impact of these changes on the Scottish Ambulance Service is not something which would be undertaken by the Scottish Government.

I visited Dr Gray's Hospital earlier this month and met with staff from both NHS Grampian and the Scottish Ambulance Service. I know that the ambulance service has been in regular contact with NHS Grampian regarding these changes.

Scotland’s first Graduate Entry Medical programme (ScotGEM) will commence in autumn 2018. ScotGEM includes a ‘return of service’ bursary of £4,000 per year. The optional grant, worth £16,000 over the 4 year course, will be payable to all students who agree to work one year of service for each £4,000 claimed.

Currently, there are no other plans to introduce any similar additional measures. The effectiveness of this programme will be reviewed and will inform future considerations.

Table 1 provides the domicile of ‘newly-qualified’ doctors in Scotland and Table 2 provides the destinations of medical graduates 6 months after qualifying, based on a sample survey.

Newly-qualified doctors are defined as those doctors graduating from a Scottish medical school.

We are committed to tackling plastic waste, both by encouraging initiatives aimed at reducing its use and increasing recycling.

Examples of this support which is delivered through Zero Waste Scotland are:

• The Action on Plastic Fund for Zero Waste Towns is an extension of the Zero Waste Towns programme and will look specifically at cutting single use plastics and increasing recycling. Towns participating in the programme have also included anti-litter activity as part of their interventions.
• The Climate Challenge Fund is currently open again for applications. ZWS are investing European Regional Development Funding to boost the amount of waste and circular economy projects that the fund supports, and have a dedicated community action specialist to assist groups wishing to submit bids on waste/resources projects generally.
• Circular Economy and Resource Efficient Scotland funding is available for community groups that meet the eligibility criteria for organisations and interventions.

In addition to the above support, local authorities that have signed up to the Household Recycling Charter are also committed to providing plastic recycling services for the communities in their areas. These authorities commit to high standards of recycling provision and information about their services and can access support from ZWS to help with improvements.

There is a range of evidence that indicates that location is a significant factor in the training choices made by newly qualified doctors. NHS Education for Scotland has recently published its first education research and innovation report which outlines research undertaken to assess the extent to which factors, such as location, influence the career choices and preferences of doctors.

http://www.scotlanddeanery.nhs.scot/news/medical-directorate-education-research-and-innovation-annual-report-2018/

Published research studies on the impact of geography on trainee career choices include the following.

What factors are critical to attracting NHS doctors into specialty or core training? A discrete choice experiment. (Scanlan et al) 2018

What factors influence UK medical students’ choice of foundation school? (Miah et al) 2017

What do UK doctors in training value in a post? A discrete choice experiment. (Cleland et al) 2016

https://bmjopen.bmj.com/content/8/3/e019911

A number of specific actions are being taken that will contribute towards a more secure and sustainable medical workforce more representative of the communities it serves. These measures have been developed not only to address the more immediate recruitment and retention challenges faced by NHS Scotland Boards, and specifically in primary care services, but in response to strategic requirements to widen access into medical education in Scotland, and respond to demands for enhancing the skills of our GPs within a multi-disciplinary team model.

We are investing £23 million in an undergraduate medical education package comprising the 50 widening access places, a pre-medical entry programme with 40 places, and 55 places for Scotland’s first Graduate Entry Medical programme.

The Scottish Government’s National Health and Social Care Workforce Plan also commits to creating additional undergraduate medical places, and 85 places have been awarded to three of Scotland’s University medical schools.

Regarding selection criterion, the Scottish Government is also collaborating with the Scottish Funding Council which has issued Health related outcomes to University medical schools. The medicine outcomes include a commitment to:

• Retain more graduates of Scottish medical schools in Scotland and working for NHS Scotland throughout their careers.
• Encouraging more of our young doctors to enter GP and other shortage specialities.
• Simplify and clarify the admissions process across all the medical schools in Scotland.
• Increase the number of Scottish domiciled applicants to medicine.

Reach is a national programme which is supported by the Scottish Government via the Scottish Funding Council and focuses on schools with below average progression of pupils into higher education, and pupils from the 40% most deprived communities in Scotland. It aims to increase the number of applications, offers and entrants from students from disadvantaged backgrounds into high demand and competitive areas of study such as medicine.