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The Scottish Government welcomes the recently published ESPAUR report which details progress on tackling Antimicrobial Resistance (AMR) in England as part of the UK AMR Strategy 2013-2018. Health Protection Scotland will publish its next Scottish One Health Antimicrobial Use and Antimicrobial Resistance (SONAAR) Report in November 2018, which will provide similar details of progress with tackling AMR in Scotland. The previous SONAAR report, published in November 2017, can be viewed here: https://www.hps.scot.nhs.uk/resourcedocument.aspx?id=6900 .

The Scottish Government continues to support a broad programme of activities in collaboration with national stakeholders to tackle AMR across human and animal health. This includes surveillance of antimicrobial use and resistance, quality improvement interventions to optimise prescribing of antimicrobials, education of health and care staff, and campaigns to increase awareness of AMR and the appropriate use of antibiotics aimed at patients and the general public.

Work is well underway to implement the 76 recommendations contained within The Best Start: A Five Year Forward Plan for Maternity and Neonatal Care in Scotland. The recommendations have been split into those suitable for local and national implementation and a lead on local implementation has been identified in all 14 NHS Boards.

The five Early Adopter Boards identified to lead on early implementation of a suite of recommendations relating to continuity of carer and local delivery of care are making good progress and are aiming to roll this new model of care out across their Boards during 2019. The remaining Boards will start their planning for continuity of carer and local delivery of care shortly.

A full written update on progress will be available at the end of the year and will be placed in SPICe.

Workforce data on Health Visitors is published by ISD Scotland.

1. Information on health visitors from 2007 to 2014 can be found on the statistics web site at: https://www.isdscotland.org/Health-Topics/Workforce/Publications/2017-12-05/Non-Medical_Trend_S2017.xls

2. Information on health visitors from 2015 onwards can be found on the statistics web site at: http://www.isdscotland.org/Health-Topics/Workforce/Publications/2018-09-04/Nursing-and-Midwifery.asp .

Health Visitors were part of a review of community nurses data. Therefore, information on the Health Visitor workforce after March 2015 is not comparable with previous years

We have engaged continuously with all Health Boards since the commitment to the delivery of the additional 500 Health Visitors in place by the end of December 2018 was made. The information provided to date suggests we are on track to meet this commitment.

Note: The Nursing and Midwifery dashboard (link in point 2. above) shows the number of Health Visitors since March 2015. You can see this on the Trend tab by setting the

• NHS Board filter to the Boards you wish (NHS Scotland and the territorial Boards),
• Sub Job Family filter to Health Visiting,
• Qualified/Support filter to Qualified,
• AfC Band filter to Bands 6 and above.

You can view the figures by Whole Time Equivalent or Headcount, and also by a chart or table.

Information broken down by patient age group is not available.

The most recent figures for both routine and urgent wheelchair repairs, broken down by service area for the 12 months up to September 2018, are available at http://www.retis.scot.nhs.uk/wheelchairquality.html under ‘Quality Ambitions Data’.

The number of patients on the waiting list on 30 June 2018 - latest published information - for an urology operations or procedure at Edinburgh Western General Hospital was 922 of which 363 had been categorised by the referrer as urgent and 559 as routine. In the quarter ending 30 June 2018 the median wait for a urology patient to receive inpatient or day case procedure was 65 days.

I am aware that patients requiring treatment across Scotland, including the urology service at Edinburgh Western General Hospital, is below the level I expect which is why I published on 23 October 2018, the Waiting Times Improvement Plan to direct more the £850 million investment to substantially and sustainably improve elective care waiting times, including urology, over the next 30 months. The main areas of the Improvement Plan is to increase capacity across the system, increase clinical effectiveness and efficiency as well as designing and implementing new models of care.

There will also be work undertaken to build on the significant additional recruitment and training which is ongoing across medical and nursing professions including enhancing workforce capacity in key specialties including urlogy. I expect that by Spring 2021 that all patients requiring inpatient or day case treatment to be treated within the 12 weeks legal treatment guarantee, including urology patients to be treated in the Edinburgh Western General Hospital.

This data is not centrally held by ISD because the recording of data is subject to variation due to the complexity of this area. As it stands, there is not a way of identifying attempted or completed suicides within Mental Health Units in the Scottish Morbidity Record (SMR) dataset, however, ISD has an ongoing programme of data quality assurance to improve the quality of data collected.

The Oral Health Improvement Plan (OHIP) is a major piece of public health reform and when it is fully implemented it will provide the framework for improved oral care for the Scottish population. The nature and size of the improvement plan means that it is essential to undertake its implementation in stages. We must ensure that the pace of change is pragmatic and maintains stable service delivery for patients and dental practices while maintaining pace with the changes we need to make to implement the Plan in a reasonable timescale.

Initial work has identified a series of early priorities across the programme, for example we have already implemented Occupational Health arrangements, which will benefit all the staff working in dentistry. A key element of the implementation plan is for Directors of Dentistry in Health Boards to provide strategic leadership across all aspects of dental service provision. We can report that the majority of Health Boards have in place interim Directors and we are working to ensure that the substantive roles are in place as early as practicable.

We have also prioritised the development of a Community Challenge Fund, to enable third sector partners to work with communities in deprived areas to improve oral health outcomes. We can report that management arrangements for the Fund will be in place before the end of this year and actual schemes on the ground in spring next year.

Officials are also currently liaising with key stakeholders on arrangements for the care home based element of the new domiciliary care arrangements, including identifying the training programme requirements, which are planned to be in place in the Spring next year. The intention is to develop a programme for General Dental Practitioners with enhanced skills in domiciliary care to meet the oral health needs of older people resident in care homes.

Prior to the publication of the Oral Health Improvement Plan (OHIP) we consulted widely with both patients and dental professionals. This included an online consultation exercise, a series of roadshow events for dental professionals around Scotland, and a number of focus groups for members of the public. We received 427 responses to the consultation exercise; 564 dental professionals attended the roadshow events; and 113 members of the public participated in the focus group activities.

The results of the consultation can be viewed at: https://beta.gov.scot/publications/scotlands-oral-health-plan-scottish-government-consultation-exercise-future-oral/

As we take forward actions from the OHIP we will continue to consult with dental professionals, patients and other relevant stakeholders at appropriate stages of the implementation process.

Clinical waste collection and disposal continues as normal for NHS Scotland and we are not aware of any issues. In the event of disruption to clinical waste management services at NHS sites across Scotland, all NHS Boards have contingency plans ready to put into place.

The plans ensure that there is sufficient storage capacity for clinical waste to be stored safely on site for a period of 72 hours. Emergency waste management arrangements will be procured centrally in order to protect waste management services for the NHS across Scotland following the 72 hour period.

Authorities in England alerted Scottish Government to issues regarding the company’s management of clinical waste at its sites in England on 9 August.

Since then Scottish Government have been working with Scottish Environment Protection Agency(SEPA) and NHS National Services Scotland (NSS) to monitor the situation and have sought assurances with NHS Boards that they have contingency plans in place.

NHS Scotland, working with SEPA , have developed contingency plans which firmly maintain environmental protections. SEPA is clear that compliance is non-negotiable and is robustly monitoring sites in Scotland.

Scottish Government continues to monitor the situation in England and any potential impact on services in Scotland.