Chamber and committees

A report recently published by Public Health Scotland on 5 May confirmed that uptake for bowel screening continues to exceed the Healthcare Improvement Scotland standard of 60%. The Scottish Government is aware that continued work is required to improve uptake, and to make the process as straightforward as possible for individuals to complete.

Education and accessible information is one strand of this work. Both the online NHS Inform bowel screening content and the leaflets issued with bowel screening kits have been revised to respond to user feedback on clarity and accessibility. In addition, both the Scottish Government and the NHS will use Bowel Cancer Awareness Month in April to further raise awareness of the importance of bowel screening.

Increasing uptake requires supporting education efforts with a relentless focus on reducing inequalities. The Equity in Screening Strategy was published last year, with a vision for equitable access across the full screening pathway, including in the bowel screening programme. This, in combination with a new Equity in Screening Network, will help NHS Boards to find effective ways to address inequalities in uptake, and increase participation in the bowel screening programme.

Since 2017, the Scottish Government has provided £1 million funding annually to address screening inequalities. Part of this fund has been distributed to NHS Boards, allowing them to support initiatives catering to their specific populations. The remainder of the screening inequalities fund was used for national initiatives, such as the development of the Screening Intelligence Platform (ScIP). This will provide an efficient, single point of access to linkable data from all of the National Screening Programmes, including bowel screening. This will therefore help to inform and support the work of public sector bodies to increase participation in bowel screening.

There has been no national formal assessment of contraceptive availability and choice however the Scottish Government is committed to ensuring that people across Scotland have timely access to contraception, and to information which allows them to make informed decisions about their own sexual and reproductive health. This is recognised as a priority in our Sexual Health and Blood Borne Virus (SHBBV) Action Plan 2023-26, and we have allocated multi-year funding to a range of projects in both community and NHS settings that will help to deliver this goal. The projects include exploring the delivery of more sexual and reproductive health care (including contraception) through community pharmacies, developing information resources, and expanding access to post-partum and post-abortion contraception. Details of these projects were published alongside the SHBBV Action Plan on 28 November 2023.

This information is not held centrally by the Scottish Government.

A report recently published by Public Health Scotland provides details of the most recent statistics for the bowel screening programme, which includes the uptake differences between areas of different socioeconomic status. The overall uptake continues to exceed the HIS standard of 60% of the eligible population, but there continue to be inequalities in the return rates for bowel screening kits, including between the least and most deprived communities in Scotland.

Since 2017, the Scottish Government has provided £1 million funding annually to address screening inequalities, part of which has been distributed to NHS Boards to fund initiatives catering to their specific populations.

The funding is also used for national initiatives, such as the development of the Screening Intelligence Platform (ScIP), which aims to simplify the process of gathering and analysing all screening data. This will allow greater insight into screening inequalities across a range of characteristics, including socioeconomic status, and supporting efforts to increase screening uptake across all groups.

In addition, the Equity in Screening Strategy was published last year. This set out a vision for equitable access across the full screening pathway, including in the bowel screening programme. It is accompanied by the implementation of an Equity in Screening Network that allows those who work across screening to share evidence, best practice and learning around screening inequalities. This will enable NHS Boards to consider proven interventions to address inequalities in uptake, and therefore increase participation in the bowel screening programme.

Patient care and service delivery are the statutory responsibility of local healthcare providers. NHS Boards are responsible for working with their partners to plan and provide health services which meet the needs of their populations. Use of the independent sector has been an option open to all Health Boards to help address short-term capacity issues.

Within the wider policies set out by the Scottish Government, NHS Scotland is expected to deliver services that provide high-quality care that is safe, effective, accessible and person centred. It is NHS Boards and healthcare professionals locally who have responsibility for service delivery, including antenatal classes, to meet the needs of their local population and service users.

Our expectation is that NHS antenatal classes will include information for parents on bonding with their baby, which supports the mental health of both parents and babies. The precise content of antenatal classes is likely to vary between NHS Boards and antenatal class groups, to better respond to the particular needs of local service users.

Midwives discuss mental health and general wellbeing with all women during antenatal and postnatal care appointments, ensuring that all women have access to advice and support throughout their pregnancy journey. These discussions may include the management of pre-existing mental health issues; the identification and management of emergent mental health issues during the antenatal and/ or immediate postnatal period, and possible postnatal changes which women may experience, such as “baby blues”. Following birth, these conversations continue with families during each contact with Health Visitors and Family Nurses.

All pregnant women are also provided with a copy of Ready, Steady, Baby! , a guide to pregnancy, birth and early parenthood up to one year, as part of their routine antenatal care. This includes information on mental health and wellbeing to help provide information for families, as well as signposting to further sources of support. The information in Ready, Steady, Baby! is available in translation and alternative formats, including an Easy Read resource, to ensure the information is accessible for women and families across Scotland.

We are clear in our expectations that all women, at all times, receive high-quality and person-centred maternity care tailored to their needs, with quality and safety for mothers and babies central to decision-making. To understand the quality and safety of maternity care and identify where improvement should be made, we are closely following data published by Public Health Scotland (PHS). Occurrences of third- and fourth-degree perineal tears (also referred to as obstetric anal sphincter injury (OASI)), a leading cause of faecal incontinence following childbirth are recorded by PHS as part of its Maternity Inpatient and Day Case - Scottish Morbidity Record (SMR02) dataset and can be viewed via its Scottish Pregnancy, Births and Neonatal Dashboard .

We are also aware of the research and evidence endorsed by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives on obstetric anal sphincter injury and recognise that further work is required to improve care for women who experience incontinence including follow-up care and specialist care. Obstetric anal sphincter injury is on the agenda at various meetings bringing together senior leaders in Scotland’s maternity care.

The Scottish Government is committed to continuous improvement in maternity safety across Scotland, in partnership with NHS Boards and clinicians and service users, to deliver the best and safest person-centred care for mothers and babies. We are aware of the evidence around implementing care which aims to reduce risk of developing stress incontinence. We regularly facilitate meetings and events bringing together senior leaders in maternity services to discuss evidence aimed at improving services and provide learning opportunities.

All pregnant women are also provided with a copy of Ready, Steady, Baby! , a guide to pregnancy, birth and early parenthood up to one year, by their midwife as part of their routine antenatal care. Ready, Steady, Baby! includes information on and signposting to additional materials regarding stress incontinence and pelvic floor muscle exercise for women, both during pregnancy and following birth, which can help to reduce the risk of stress incontinence following childbirth.

Information on pelvic health is also available on the Women’s Health Platform on NHS Inform. This includes information on urinary incontinence in women and is publicly available to both service users and healthcare professionals.

Although it is the statutory duty of local authorities to manage their school estate, the Scottish Government will convene a working group - including representatives from COSLA, community organisations and sports organisations - to explore how community access to facilities, such as the school estate, can be enhanced. The first meeting of this group will take place in March.

Schools in Scotland have the flexibility to decide on the content of their physical education lessons. The Scottish Government does not specifically evaluate the extent to which swimming lessons form a part of those decisions.

We know that some local authorities offer swimming lessons as part of their physical education classes. In other cases, schools may take into account a range of factors, including the time that is required to travel to a swimming pool, in deciding against offering swimming lessons as part of PE.

However, the Scottish Government has been working with Scottish Swimming, Education Scotland and other stakeholders to develop interventions and approaches to provide opportunities for children to become confident, competent and safer swimmers.