Seòmar agus comataidhean

I refer the member to the answer to question S6W-20393 on 14 September 2023. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers .

The Scottish Government recognises the importance of biodiversity and nature restoration, and the urgent need for action at home and abroad to tackle the twin crises of biodiversity loss and climate change. This is why our Global Affairs Framework makes clear that Scotland will play its full role, engaging with international networks on biodiversity protection and nature restoration to make positive contributions and cooperate with others.

Our biodiversity strategy sets out our vision to be nature-positive, halting biodiversity loss by 2030 and reversing declines by 2045. Achieving these goals will require significant efforts and – as part of these – we will continue to implement our international obligations, engage with international partners to cooperate and share best practice, and actively participate in multilateral fora where possible.

The information requested is not held by Scottish Government.

Public Health Scotland (PHS) have also informed SG that they do not hold the requested data. PHS have explained that they collect episodic data on both the waits that patients experience for treatment being provided by NHSScotland and the episodes of care that arise when these patients are treated within Scotland. However, data are not available on patients who personally choose to seek treatment that is not provided or funded by NHSScotland, whether this be NHS-funded treatment elsewhere in the UK or non-NHS funded healthcare within the UK or abroad.

Furthermore, the National Waiting Times Datamart, which captures some information related to the removal of patients from an NHSScotland waiting list, does not identify when a patient has been asked to be removed because they are seeking alternative arrangements for their treatment due to waiting times.

The Scottish Government do not currently have plans to add a section on chronic UTIs to NHS inform at this time. The NHS 24 Clinical Change Governance Group (CCGG) routinely assess new and updated clinical guidelines to ensure the clinical content on NHS inform is underpinned as far as possible with current clinical evidence. The group will continue to consider what improvements are required regarding information on UTIs based on any new evidence or changes to clinical guidelines or pathways that arise.

NHS inform does advise that if acute symptoms do not improve, get worse, or come back after initial treatment, the patient should return to their GP for further advice. Thereafter the GP should follow relevant clinical guidelines that outline how to treat and manage chronic UTIs for individual patients.

NHS Education for Scotland (NES) are responsible for managing all training provided to doctors in Scotland. NES ensure that all doctors receive high quality training in line with curricula that is set by the relevant Medical Royal College so that they are able to demonstrate that they have met all GMC curricular requirements, in order to practise independently as a GP in the UK.

The General Practice Specialty Training (GPST) programme lasts for 3 years with trainees typically spending 18 months in General Practice and 18 months in secondary care i.e. hospital settings.

All GP practices receive funding for protected time consisting of one session a month (usually within practice time) to allow GPs to maintain and develop their training and skills, and those of their practice teams.

Training currently provided to GPs on the diagnosis and treatment of UTIs include:

1. Educational activities during the first year of training under most GP Speciality Trainees (GPSTs), such as: tutorials, case based discussions, post consultation prescribing checks and referral reviews that are undertaken by their GP educational supervisors.

2. Management of UTI’s (uncomplicated lower UTI’s in females) in primary care also occurs through the Scottish Pharmacy First initiative. https://www.nss.nhs.scot/publications/pharmacy-first-scotland-urinary-tract-infection-uti/ .

3. The RCGP ‘Being a General Practitioner’ Curriculum Guide ( https://www.rcgp.org.uk/mrcgp-exams/gp-curriculum/clinical-topic-guides#kidney ) section on Kidney and Urology includes: Urinary tract infections in children and in adults including lower urinary tract infection, pyelonephritis and persistent/recurrent infection There are questions based on this clinical topic guide within the Applied Knowledge Test (AKT) and Simulated Consultation Assessment (SCA- OSCE style exam) which form essential components of the MRCGP exam.

4. SIGN 160: “Management of suspected bacterial lower urinary tract infection in adult women. A national clinical guideline. September 2020” is a readily available resource for all GPs in Scotland.

5. All GP practices receive an annual prescribing report which focusses on antibiotic prescribing and review of current guidelines on management of UTI’s in primary care. Each Health board has its own guidance - see below:

https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/emergency-medicine/diagnosis-treatment-and-management-of-uti-in-children-rhc-glasgow/

https://handbook.ggcmedicines.org.uk/guidelines/infections/urinary-tract-infections-utis/

6. Evaluation of the impact of Scottish Reduction in Antimicrobial Prescribing (ScRAP) programme on GP Practice management of patients with suspected UTI – is an example of initiatives regularly offered to GP practices to review their antibiotic prescribing. GPs through annual appraisal have to demonstrate annual QI initiatives and many include antibiotic prescribing in UTI’s and compliance with local and national guidelines.

7. Common reference sources used by GPs (GP notebook, NICE CKS guidelines, BNF, BMJ best practice) all have comprehensive sections on management of UTI in adults and children.

The Scottish Intercollegiate Guidelines Network (SIGN) is part of Healthcare Improvement Scotland (HIS) who operate independently of the Scottish Government, Health Boards and Integration Authorities with responsibility for updating SIGN guidelines.

Guidelines on management of suspected UTIs were developed by (SIGN) in September 2020 and the Scottish Government expects all NHS healthcare workers in Scotland to follow best practice when providing care for people with UTIs.

These support clinicians to provide advice to patients and carers on appropriate treatment, risks and lifestyle and behaviour issues which can support management and prevention of UTIs. The guideline also includes the diagnosis and management of recurrent UTIs in these groups.

SIGN guidance is bespoke to Scotland. In NHSScotland, where there is no SIGN guideline on a particular topic, healthcare professionals would be expected to look for another high quality, evidence-based guideline e.g from the National Institute for Health and Care Excellence (NICE).

Improving menopause care is one of the priorities of the Government’s Women’s Health Plan. There is now a specialist menopause service in every NHS Board, with a buddy system in place for the Island Boards. Women can access accurate and comprehensive information on NHS Inform, where the signs and symptoms of menopause is consistently in the top 10 of most viewed pages, and education and training for general practice is being developed.

The Scottish Government is providing additional investment of over £1 billion for health and social care in 2023-24, taking funding to a record high of over £19 billion. This funding is already supporting menopause services, as well as delivery of specific actions relating to women’s health as we continue to drive forward the implementation of the Plan.

We are determined to ensure that women who need it are able to access care and support for menopause, in primary and specialist care.

Work continues through the menopause actions of the Women’s Health Plan to facilitate women’s access to holistic care. This includes commissioning NHS Education for Scotland (NES) to develop a bespoke training package on menopause and menstrual health for general practice and others working in Primary Care.

The Women's Health Plan: Progress Report published in January 2023 and the recently published Women's Health Plan: Interim Progress Update 2023 provide comprehensive updates on progress of all the actions in the Women’s Health Plan.

Barnett consequentials are not ring-fenced for a particular purpose or allocated on an individual basis, rather the totality of funds available to the Scottish Government are considered for allocation in the Scottish Budget and subsequent revisions. The 2023-24 Scottish Budget document, which was laid before parliament on 15 December 2022 provided detail of all commitments funded from within that overall Budget envelope.

In-year changes to budgets, including allocation of any additional Barnett consequentials that have accrued since the Budget was laid will be set out in forthcoming Budget Revisions documents.