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The Scottish Access Collaborative Programme recently published a report setting out recommendations to sustainably improve chronic pain patient pathways and outcomes that will be taken forward with NHS Boards and Health and Social Care Partnerships. Based on the recommendations set out in the report, the Scottish Government are developing a quality improvement approach which will be developed in partnership with the Modern Outpatient Programme. Workshop participants will be involved to develop Driver Diagrams, aligned to the Scottish Pain model, before the end of July 2019.

Third sector colleagues are taking forward the establishment of a Chronic Pain Patient Reference Group, and a scoping meeting is being scheduled for August 2019. The Chronic Pain report will be distributed more widely across the chronic pain community and wider stakeholders over the coming weeks and it is anticipated that further connection events and learning opportunities will take place following the summer break to share good practice and to co-produce the implementation plan and progress actions.

My officials are in regular contact with NHS Lanarkshire about the dispute which has arisen between ISS UK, who sub-contract to provide facilities management services at University Hospital, Hairmyres under PFI arrangements, and their staff.

I wrote to ISS UK on 8 April and 2 May urging the company to engage fully with the Staff Side to resolve this dispute, but have not so far received a response. I have written again to ISS UK and GMB suggesting the involvement of ACAS as an independent body to try and resolve this dispute. I also met with the unions involved, Unison and GMB, on 23 May to hear their concerns.

There have been calls for the Scottish Government to provide direct financial assistance to the staff involved but it should be noted that, as the staff affected are employees of a private company, there is no mechanism to do so. Any such intervention would require primary legislation to be put in place.

Whilst not able to directly help staff financially, the Scottish Government was able to provide assurances that support will be provided for any bid by NHS Lanarkshire to bring contracted out services back in house when the present contract ends.

The Scottish Government has provided over £3.3 million since 2006 to Health Improvement Scotland (HIS) to support NHS Boards, to deliver sustained improvements.

From this funding, NHS Tayside have benefitted from Improvement Advisors who undertake diagnostic work and develop and implement an improvement plan to improve waiting times.

In addition, HIS are providing bespoke support to NHS Tayside to continue to help them to build on the detailed Demand, Capacity, Activity, Queue (DCAQ) diagnostic analysis that was carried out by ihub in 2018. The information from this continues to inform the improvement planning process.

In March 2019, HIS along with Scottish Government Officials, met with the Chief Executive and senior staff from NHS Tayside to support the development of a wider mental health improvement plan across psychological therapies and children and young people’s services, and HIS are providing support to services to implement this.

The Scottish Government continues to engage with NHS Tayside and other relevant organisations to ensure that appropriate resource is provided to ensure the delivery of high quality mental health services.

Delivery of access to free sanitary products in schools has been devolved to local authorities. This approach enables local authorities to shape delivery of access to free sanitary products in line with local need, encouraging innovative approaches and we expect local authorities to take account of their home-schooled population in considering delivery models. For example, they should ensure that the provision which is put in place for access at weekends and during the holidays is also accessible to home schooled children.

Furthermore, due to our £4 million investment announced in January, home-schooled and excluded pupils should now also be able to access free sanitary products from other local authority settings within their communities.

The 2019-20 Scottish budget included £53.8 million in NHS Boards baseline allocations for alcohol and drug funding. Allocations to individual boards are set out in the following table. We will be writing to Integration Authorities and ADPs in the coming weeks to outline Ministerial Priorities for 2019-20.

In financial year 2018-19, £17 million was allocated directly to ADPs through the Local Improvement Fund. The same amount remains available to Integration Authorities and ADPs in 2019-20. We will be writing to Integration Authorities in the coming weeks to confirm allocations.

The Scottish Government is advised by Food Standards Scotland (FSS) on food safety and standards. Neither the Scottish Government nor FSS has undertaken any analysis on the availability and cost of nitrite-free preservation/curing of products, such as bacon, by using fruit and spice extracts.

All food additives including preservative factors extracted from fruits and spices require authorisation by the EU based on scientific evidence for their efficacy and safety. Plant-based preservatives may take a variety of different forms and some are essentially naturally derived nitrates which, when consumed in foods, can be converted to nitrites and nitrosamines in the same way as permitted sodium and potassium nitrates.

With regard to our position on nitrates and nitrites in food, I refer the member to the answers to questions S5W-23695 on 26 June 2019, S5W-23693 on 21 June 2019, S5W-23537 on 10 July 2019, S5W-23315 on 4 June 2019 and S5W-22368 on 18 April 2019. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

In terms of school and hospital foods, procurement is a matter for local authorities and health boards respectively. The government’s role is to set the required national standards. With regard to school food, Ministers recently published a report setting out the detail of changes to be made to the school food and drink regulations, including red and red processed meat. NHS Health Facilities Scotland published revised national standards for food, fluid and nutrition for hospitals in 2016 which take account of the latest scientific advice on the amount of red and red processed meat for a healthy, balanced diet.

The Scottish Government, along with the rest of the UK is advised on all aspects of screening by the UK National Screening Committee (UK NSC) an independent expert advisory group. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria.

The UK NSC last reviewed screening for Chronic Obstructive Pulmonary Disease (COPD) in 2018 and did not recommend introducing a national screening programme. This is because current tests are not reliable in people who have no symptoms of COPD; and there is not enough evidence to understand whether medicines are effective for people with mild COPD which would be detected by screening.

Although the UK NSC does not currently recommend a national screening programme for COPD, all policies are reviewed regularly and screening for COPD will be reviewed again in 2021-22. Any change to the recommendation will be carefully considered by the Scottish Government.

The Scottish Government, through HPS is committed to working with experts to keep evidence and guidance relating to the diagnosis and treatment of Lyme disease under constant review to ensure patients in Scotland receive care tailored to their individual needs and circumstances.

The Scottish Lyme Disease and Tick-borne Infections Laboratory at Raigmore Hospital in Inverness has recently been granted Reference Laboratory status which will provide additional funding for research and development into new tests for tick borne diseases and will help improve our understanding of this complex infection.

The Scottish Lyme Disease and Tick-borne Infections Laboratory will continue to work with experts at Public Health England and elsewhere to ensure that patients in Scotland have access to the most robust and scientifically justified testing regime available.

With regard to testing, it is acknowledged that there are gaps in the effectiveness of the tests which are currently available and work is underway to address the lack of sensitivity surrounding testing for the early stages of Lyme disease infection.

On 14 June 2019 the Chief Medical Officer wrote to all NHS Health Boards and GP practices highlighting the availability of a series of resources to staff. The letter shares current sources of public facing advice and information about Lyme disease as well as links to current guidance on diagnosis and management.

The Scottish Government takes the issue of Lyme disease very seriously and together with Health Protection Scotland (HPS), is committed to raising awareness and supporting those affected with this complex disease.

The Lyme Borreliosis group, which is part of the Scottish Health Protection Network, is actively working to raise awareness of ticks and tick borne diseases amongst health care professionals in Scotland. It has produced a number of educational resources to support staff which can be accessed through the National Education for Scotland website.

On 14 June 2019 the Chief Medical Officer wrote to all NHS Health Boards and GP practices highlighting the availability of these resources to staff. The group is also working to raise the profile of ticks and Lyme disease with the public in Scotland.

They have developed a number of resources to explain the risks from ticks and tick borne diseases. The ‘avoiding bugs and germs outdoors’ webpage on NHS Inform brings together in one place comprehensive advice on how to avoid infection. The Scottish Government will continue to actively promote these materials.