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The Scottish Government analyses a range of impacts, including on the economy, when considering Income Tax policy options during the annual budget process. We also closely monitor the impacts of our existing policies on revenues, taxpayers, and the economy. Scottish Income Tax performance remains strong – Scotland outperformed the rest of the UK in both tax and earnings growth for both 2022-23 and 2023-24. Scottish Income Tax policy for 2025-26 will be announced during the annual Budget process.

Scottish Government relies on estimates of the number of taxpayers by tax band using forecasts provided by the Scottish Fiscal Commission. The most recent estimate for 2024-25 was published in December 2023 and can be found here: Chapter 4 – Tax – Supplementary Figures. The Scottish Fiscal Commission will publish their five-year Economic and Fiscal forecasts alongside the draft Scottish Budget 2025-26 on 4 December which will include updated forecasts for 2025-26.

Income Tax data does not break down by public and private sector.

As set out in the Public sector: economic overview - gov.scot (www.gov.scot) publication, after tax, the average full-time public sector employee in Scotland earned around £1,500 more than the UK average in 2023, up from around £400 in 2019.

The National Specification includes requirements for Boards to fully engage with children, young people and families and to gather outcome data against these standards, including experience of service, and to report performance, quality and governance.

While there are no current plans to carry out a specific evaluation, we are working closely with all NHS Boards to support implementation of the CAMHS specification and to improve the service provided to children, young people and families, as well as improve performance across CAMHS. We remain committed to supporting all Boards to meet the standard that 90% of patients start treatment within 18 weeks of referral. We continue to provide enhanced support to those Boards not on track to meet the standard, providing access to professional advice, ensuring they have robust improvement plans in place and monitoring their implementation.

Since the Audit of Rejected Referrals was published in 2018, Scottish Government has undertaken a wide range of work to implement the recommendations in the report and take forward whole systems reform of children and young people’s mental health services.

One of the key actions we have taken to address the recommendations is to develop a CAMHS Service Specification: Child and Adolescent Mental Health Services (CAMHS): NHS Scotland National Service Specification (www.gov.scot) published on 2 February 2020, to set out clear standards for all CAMHS services in Scotland. This outlines how CAMHS services should be delivered and what young people and their families can expect from CAMHS. The National CAMHS specification includes a clear expectation that children and young people whose referral is not accepted for CAMHS are sensitively and appropriately signposted to a more suitable service, such as those provided by our community-based supports.

The subsequent publication of the Neurodevelopmental Specification in September 2021 also addresses actions from the Audit of Rejected Referrals and ensures that children and young people who have neurodevelopmental profiles with support needs, receive support that better meets their needs, based on the Getting It Right For Every Child (GIRFEC) approach.

Another action to address key findings in the report was establishing community mental health and wellbeing services across Scotland. Not all children and young people need specialist services like CAMHS, which can lead to referrals not being accepted. This is why we are providing local authorities with £15m per annum to fund community-based mental health supports for children, young people and their families. Local authorities report that, in the first half of 2023, more than 58,000 children, young people and their family members accessed community-based mental health support.

In addition, we have recently seen the best national performance against CAMHS waiting times since the 18 week standard was introduced in 2014. 1 in 2 children and young people referred to CAMHS now start treatment within 6 weeks, compared to 12 weeks pre-pandemic.

The Audit of Rejected Referrals highlighted that improved patient-level data was required to provide further insight and intelligence into system performance. Therefore, the Scottish Government has also commissioned national patient-level data to help with service planning and improvement, for measuring the true impact of investment, and for telling the stories of people seeking and receiving treatment in CAMHS. Directors of eHealth have been commissioned to upgrade data systems supporting CAMHS to enable the collection of patient-level data. This work is ongoing.

In parallel, and responding to recommendations in the report, Public Health Scotland have started publishing data from the CAMHS and Psychological Therapies National Dataset (CAPTND), including referrals to CAMHS by sex, age and SIMD as well as reasons for referral not being accepted. Boards are also working with PHS and Directors of eHealth to enable the collection and publication of additional information in 2025.

While we have made significant progress in improving mental health and wellbeing services for children and young people since 2018, we continue to work closely with Boards to understand the reasons for non-accepted referrals and to ensure that the criteria in the CAHMS specification are being met. The Joint Strategic Board for Child and Family Mental Health provides oversight across all areas of children and families’ mental health, with the aim of ensuring we continue to improve and develop services to help children and young people in Scotland.

We are working closely with all NHS Boards to support implementation of the CAMHS specification to improve the service provided to children, young people and families, as well as improve performance across CAMHS. We remain committed to supporting all Boards to meet the standard that 90% of patients start treatment within 18 weeks of referral.

Local CAMHS teams continue to respond well to demand, with 1 in 2 children and young people referred to CAMHS starting treatment within 6 weeks, compared to 12 weeks pre-pandemic. In the first half of this year, we have seen the best national performance against CAMHS waiting times since the 18 week standard was introduced in 2014.

Recognising that performance does still vary across Health Boards, we continue to provide enhanced support to those Boards not on track to meet the standard. This includes providing access to professional advice, ensuring they have robust improvement plans in place and monitoring their implementation. This is in addition to a programme of routine engagement with all 14 territorial Health Boards.

We have directly allocated £120 million to NHS Boards and Integrated Joint Boards for a new Enhanced Mental Health Outcomes Framework in 2024-25. The Framework provides a single, flexible funding stream to support continued improvements and better outcomes across a range of mental health and psychological services in line with the Mental Health and Wellbeing Strategy, including CAMHS and implementation of the CAMHS Specification.

We continue to work with NHS Boards to monitor the Service Specification’s implementation, to improve services and enhance support for children and young people and their families.

As with all services for children and young people, CAMHS and the community mental health and wellbeing services work within the context of a multi- agency system and the Getting it right for every child (GIRFEC) model and principles. At the heart of the GIRFEC process is an assessment of need and creation of a single child’s plan. The meeting at which the joint (multi-agency and multi professional) plan is agreed is called The Child’s Plan meeting. Anyone involved with the child or young person can call a Child’s Plan meeting, and all relevant children’s services and others are involved.

Through our 10-year cancer strategy, the Scottish Government continues to have a focus on the less survivable cancers, including brain tumours, and improving their outcomes. We will assess the suitability of any new diagnostic tests specifically for brain tumours as the evidence develops.

The Scottish Government is taking various actions to help ensure the right patient is on the right pathway at the right time, and they receive an appropriate diagnosis as early as possible. These actions include:

• A clinical review of the Scottish Referral Guidelines for Suspected Cancer
• Publication of a new Headache Referral pathway, which lists red flag symptoms that indicate the need for urgent and/or emergency assessment to exclude a secondary cause, such as a brain tumour
• Publication of a Clinical Management Pathway for adult brain tumours, to ensure consistency, equity of treatment and care, and improve outcomes across Scotland.

Brain cancer is one of 11 priority testing pathways with Scottish Government funding provided to NHS National Services Division (NSD) in 2023 to commission enhanced genomic testing for patients with brain cancer in Scotland. NSD are working with the laboratory service on an implementation plan for this testing.

There are no diagnostic tools, such as blood tests, currently available in NHS Scotland to assess brain tumours in primary care.

However, the new Headache Referral pathway can be used as a triage tool across Scotland based on presentation at General Practice. The pathway lists red flag symptoms that indicate the need for urgent and/or emergency assessment to exclude a secondary cause, such as a brain tumour, and is suitable for use within remote and rural settings.

Further to this, the National Centre for Remote and Rural Health and Care (NCRRHC) was launched in October 2023. The Centre is working in an efficient, innovative way with health and social care providers that serve all of Scotland’s remote, rural and island populations, aiming to improve the capability and sustainability of primary and community care-based service delivery.