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The Scottish Government is committed to increasing the number and locations of Changing Places toilets (CPTs) in Scotland. The provision of CPTs in hospitals is important as they provide an accessible network across Scotland for people with complex needs attending hospital appointments.

The Scottish Government works closely with PAMIS, the only organisation in Scotland that works solely with people with profound and multiple learning disabilities and their families for a better life. PAMIS are continuing to progress the CPT campaign and have engaged with a range of stakeholders particularly in areas where there are limited or no CPTs. There are currently 167 CPT facilities across Scotland.

Additionally, the Minister for Local Government, Housing and Planning has proposed a requirement for CPTs in certain types of new large buildings, including hospitals, through review of Scottish building regulations for certain types of new buildings. These include: large enclosed shopping centres (30,000 m 2 and above); hospitals; leisure centres (particularly swimming pools); large stadia and arenas; and future-proofing schools.

NHS Lothian have confirmed that they are committed to implementing three CPTs in the new Royal Hospital for Children and Young People in Edinburgh. There is also CPTs planned for the redevelopment of the Royal Edinburgh Hospital and the new East Lothian Community Hospital. NHS Lothian are also currently reviewing existing hospitals with a view to accommodating CPTs.

The information held centrally is not recorded at this level of detail. The number of clinical nurse specialists in post can be found on the workforce statistics web site, with the most recent data as at 30th September 2017: https://www.isdscotland.org/Health-Topics/Workforce/Publications/2017-12-05/Clinical_Nurse_Specialists_S2017.xls . Note that this information is published annually in December.

Clinical nurse specialists make a valued contribution to delivering services and supporting patients and families who require specialist care. The Scottish Government has invested over £2.4 million annually in the Specialist Nursing and Care Fund since 2015.

The Scottish Government has overall responsibility for health and social care policy in Scotland; however, the statutory responsibility for delivering or commissioning services at a local level lies with local authorities, NHS Boards and integrated health and social care partnerships. Operational decisions, including whether there is a need for myeloproliferative neoplasms (MPN) specialist nurses, are therefore matters for these bodies.

The Scottish Government is not proposing to increase the interval between routine dental examinations for adult patients from six months to two years.

The Plan envisages the introduction of a new system of preventive care where the period between appointments is determined by the oral health of the patient. This means that some patients will be seen more frequently than six months if they have poor oral health while other may be seen less frequently if their oral health and general health justifies it.

This model is supported by National Institute and Clinical Excellence (NICE) guidelines on the frequency of dental check-ups. More information may be found at https://www.nice.org.uk/guidance/CG19 . The NICE guideline has been updated for 2018 and reaffirmed.

The intention is to move to an evidence-based new system of preventive care management where the interval between appointments is determined by the oral health of the patient.

At present patients may be seen every six months, although on average patients are seen around once per year. The new model is supported by the NICE guideline, and ensure that patients with poor or unstable oral health can be seen more frequently than every six months. For patients who repeatedly demonstrate that they can maintain their oral health and are no considered to be at risk, they will be offered the opportunity to attend less often.

The model of care we propose also includes an Oral Health Risk Assessment and personalised care plan for adult patients. We believe that these measures will ensure more engagement by the patient in managing their oral health in the future.

There are no plans to increase the interval between routine dental examination from six months to two years. As part of the new programme of preventive care we will over time be introducing an Oral Health Risk Assessment (OHRA) for adult NHS patients. This is a considerable enhancement on the current check-up regime where patients will receive tailored advice on how to manage and look after their oral health.

The OHRA is an important step forward and is also supported by the latest clinical evidence. The patient will receive a personalised care plan in relation to oral cancer, gum disease and decay according to their degree of risk. We believe that the assessment will also ensure a closer patient-professional relationship than at present.

We have consulted widely on these proposals following a major consultation exercise in 2016 and will continue to work closely with patient groups and dental professionals as we develop the way forward.

The Government does not plan to issue a formal consultation. We are working closely with the Scottish Medicines Consortium and other important interested public bodies and will publish the new arrangements before they come into effect from 1 October 2018.

The new pathway for “ultra-orphan” medicines was one of the recommendations of Dr Brian Montgomery’s Review of Access to New Medicines, which was informed by a wide ranging process of consultation that involved engagement events, small scale meetings and written submissions.

A table has been supplied to the Scottish Parliament Information Centre which provides the information you have requested (Bib number 59907).

The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland? was published in 2017 and aims to ensure the best outcomes for all pregnant women and their babies. One of its recommendations is that all women should have an appropriate level of choice in relation to place of birth and there are a number of choices that should be available to all women including birth at home, birth in an alongside or freestanding midwifery unit and hospital birth (recommendation 15).

An Evidence Review was published by Healthcare Improvement Scotland on 8 May 2018 which looked at the cost-effectiveness of C-reactive protein testing in primary care. National and international studies were reviewed and it was concluded that, while published evidence is available, it is not strong enough to support widespread adoption of C-reactive protein testing.

Regarding other tests, Procalcitonin is used mainly in intensive care units and trials are on-going in other settings. It is an expensive and non-specific test with conflicting evidence as to its usefulness.

In relation to fungal infections, The Scottish Antimicrobial Prescribing Group has requested a cost-effectiveness analysis of biomarker tests to inform antifungal treatment in Critical Care and Haemato-oncology which is expected to be completed in late 2018 or early 2019.

The Evidence Review was published at:

http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_-_evidence_notes/evidence_note_80.aspx .

Data relating to antibiotic use are available in the Scottish One Health Antimicrobial use and Antimicrobial Resistance Annual Report 2016, published by Health Protection Scotland in November 2017. The full report can be viewed at: http://www.hps.scot.nhs.uk/haiic/amr/resourcedetail.aspx?id=3378 .

These data demonstrate an overall reduction in antibiotic use driven by reductions in community prescribing and show that antibiotic resistance in key organisms is generally stable. The next report will be published in November 2018. National programmes of work are in place to address antimicrobial resistance and support antimicrobial stewardship.