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The Scottish Government having discussed the situation with NHS Lothian understand the Board's decision to delay opening of the new hospital.

Their decision has been made in order to protect the commissioning period to ensure that the new facility is fully safe and ready to accept patients and staff. This follows their recent review of construction progress and quality. During any commissioning period there are significant works to carry out such as fully equipping the hospital, staff recruitment familiarisation and induction, snagging where required, testing of equipment and facilities and adequately stocking of the hospital. The Board wish to ensure a smooth transition of their clinical teams to the new facility reducing any risk to patient and staff safety.

The Scottish Government will be working closely with the Board to ensure that no further delays arise and agree with the Board's decision at this point in time not to set a definite specific revised date for opening. NHS Lothian will be closely monitoring the situation over the next few weeks and once they have certainty, will release a new opening date.

Registration arrangements at GP practices in Scotland regarding who can register a baby or child are based on national regulations. (GMS Schedule 5, Part 2, Regulation 15).

The regulations state that an application for registration with a GP practice may be made on behalf of any child:

• by either parent, or in the absence of both parents, the guardian or other adult person who has care of the child,

• by a person duly authorised by a local authority, where the child is in the care of a local authority under the Children (Scotland) Act 1995(1); or

• by a person duly authorised by a voluntary organisation, by which the child is being accommodated under the provisions of that Act.

The Scottish Government is determined to meet all of the commitments outlined within our cancer strategy ‘Beating Cancer: Ambition and Action’. Since the current cohort of students commenced their training in January 2017, a total of 9 students have participated. Arrangements are in place with Glasgow Caledonian University to deliver the increased endoscopist provision, supported by Scottish Government funding and the university are actively engaging with NHS Boards and students to market the endoscopy modules for future cohorts. We expect to meet the 40% commitment in early 2018.

This information is not held centrally by the Scottish Government

The 2005 universal core program, Health for All Children (Hall 4) sets out the minimum routine screening, surveillance and health promotion checks which all children and young people should receive. A New Look at Hall 4 (2011) sets out the way forward for the successful delivery of Health for All Children (Hall 4) in the early years. This now requires to be delivered in the context of duties and provisions set out in the Children and Young People (Scotland) Act 2014, supporting guidance and the Getting it Right for Every Child (GIRFEC) policy. The programme set out in Hall 4 can be delivered by any member of the primary care or wider Child Health Support Team, including General Practitioners, Family Nurses, Early Years Support Workers or Health Visitors.

The Universal Health Visiting Pathway, published in October 2015, outlines a core home visiting programme as a minimum standard to be offered to all families with pre-school children. The programme consists of 11 home visits to all families, 8 of which are in the first year of life. It also sets out 3 Child Health Reviews between 13 -15 months, 27-30 months and 4-5 years. We expect full implementation of the universal health visiting pathway by 2020.

The 27-30 month review, introduced in April 2013 is offered to every child in Scotland reaching the appropriate age. The most recent publication of statistics on the child health 27-30 month review was published in February 2017. Figures for 2013-14, 2014-15 and 2015-16 are provided in the accompanying excel workbooks. http://www.isdscotland.org/Health-Topics/Child-Health/Publications/2017-02-07/2017-02-07-Child-Health-27m-review-Summary.pdf?

Information on admissions to hospital after overdosing on opioids is provided in the following table.

Table 1: Number of people¹ admitted to acute hospitals in Scotland² after overdosing on opioids³, and the number who subsequently died⁴; calendar years⁵ 1999 – 2016.

Source: ISD Scotland Scottish Morbidity Record 01 (SMR01)

Ref: IR2017-01333.

Notes:

1. Patients are counted once each year, regardless of the number of admissions to hospital they may have had in that year.

2. Includes patients admitted to acute hospitals in Scotland, irrespective of admission type and patient’s country of residence. Does not include admissions to psychiatric hospitals.

3. Up to six diagnoses can be recorded within each hospital episode record. This analysis is based on records with opioid overdose diagnoses in any position and within any episode within the patient’s stay. Diagnoses are coded using the World Health Organization's International Classification of Diseases 10th Revision (ICD10). The following ICD10 codes were used to identify opioid overdose, defined as poisoning by:

T40.0 – Opium

T40.1 – Heroin

T40.2 – Other opioids

T40.3 – Methadone.

Multiple substances may be involved in a drug-related overdose, therefore hospital records can include more than one drug poisoning code.

The ICD-10 code selection listed above does not specify if the overdoses were due to illicit drug or prescribed drug use.

All types of underlying causes for overdose are taken into account, including accidental poisoning, intentional self-poisoning, assault by drugs and undetermined intent.

4. People with hospital discharge type ‘death’.

5. Calendar years are assigned based on patient’s date of admission to hospital.

Generally GPs should not refuse a person registration unless there are exceptional circumstances. According to the national regulations either parent can apply for registration on behalf of a child. The regulations also allow for a non-parental guardian to be able to register a child.

One possibility where a parent (either mother or father) would not be allowed to register a child with a GP practice is if the child lived outwith the practice area (i.e. they are living with the other parent or another guardian). This would be reasonable grounds for refusal under the regulations.

It is also possible that in certain circumstances i.e. a custody dispute, a court could make an order prohibiting one parent from registering the child, or an order saying where the child should be registered.

This information is not held centrally, it is a matter for individual Health Boards.

The information that is available is given in the following table. This was produced from a National Records of Scotland (NRS) database which covers all the drug poisoning deaths that are counted by the Office for National Statistics (ONS) “wide” definition. Figures for 1999 are not available because 2000 is the first year for which that database holds information.

The following are among the opioids (including opiates), or compounds containing opioids, most often reported as being involved in deaths registered in Scotland from 2000: buprenorphine, co-codamol, co-proxamol, codeine, dextropropoxyphene, diamorphine, dihydrocodeine, heroin, methadone, morphine, oxycodone, propoxyphene and tramadol.

The table distinguishes between deaths for which only opioids were reported (e.g. deaths for which the cause was given as “heroin toxicity” or “heroin, methadone and dihydrocodeine intoxication”), and deaths for which both opioids and one or more other types of drug were reported (e.g. deaths for which the cause was given as “adverse effects of heroin, pregabalin, tramadol, diazepam and etizolam” or “etizolam, gabapentin, amitriptyline and codeine intoxication”).

For each year, the table shows more deaths than the “Any opiate or opioid” column in Table 3 of “Drug-related Deaths in Scotland in 2016” (which was published by NRS on 15 August 2017). This is because some of the ONS “wide” definition deaths for which opioids were reported are not counted as “drug-related” for the purpose of NRS’s statistics: for example, deaths due solely to co-codamol, co-proxamol, dextropropoxyphene, or tramadol before it was controlled under the Misuse of Drugs Act. More on this is available in “Drug-related Deaths in Scotland in 2016” (e.g. paragraphs A3 of Annex A and F5 of Annex F).

Drug poisoning deaths (ONS “wide” definition) registered in Scotland for which one or more opioids (including opiates) were reported*, 2000 to 2016

* the basis of these figures and why there is a break in the series are explained in the paragraph which follows.

There is a break in the series between 2007 and 2008. This is due to the revision of the form on which pathologists provide NRS with more complete information about the substances that were present in a body:

• up to 2007, the form asked for the “principal drug or solvent found in a fatal dose” and “any other drugs or solvents involved in this death”, and the figures are based on all the substances which the pathologists reported;

• from 2008, the form asks for the drugs or solvents (a) “…implicated in, or which potentially contributed to, the cause of death” and (b) “… any other[s] which were present, but which were not considered to have had any direct contribution to this death”, and the figures cover only substances which the pathologists reported under (a), which is the standard basis for NRS’s figures for drugs reported for 2008 onwards.

More information about these matters is available in “Drug-related Deaths in Scotland in 2016” (e.g. paragraphs 2.3 to 2.5).

The Effective Prescribing Programme was established by NHS National Services Scotland, NHS Boards and the Scottish Government to facilitate and support the quality of prescribing and medicines use. The following are the current areas of focus:

• Implementation of Prescribing Strategies

• Effective use of biological medicines

• Clinical consensus to guide best practice in prescribing in particular clinical areas

• Effective use of prescribing support tools

• Effective use of liothyronine

Future areas have yet to be considered and agreed.