Chamber and committees

The New Model of Neonatal Care is aimed at the most premature and sickest of babies and is based on a review of evidence carried out by Dr Anna Gavine, Dr Steve MacGillivray and Prof Mary Renfrew of the University of Dundee and a summary of the evidence review is published within The Best Start ( Appendix H ).

The evidence showed that outcomes for very low birth weight babies (VLBW) are better when they are delivered and treated in Neonatal Intensive Care Units with full support services, experienced staff and a critical mass of activity (expert recommendation defines this as care for a minimum of 100 VLBW babies a year).

This evidence has since strengthened with the publication in 2021 of the British Association for Perinatal Medicine (BAPM) Framework for Practice , which sets out optimal arrangements for neonatal intensive care.

As set out in the Programme for Government, we are committed to prioritising capital spending to achieve net zero and maintain high quality public infrastructure across Scotland. We have been consistently open about the challenges facing our capital investment plans and tough decisions will need to be taken at the 2024-25 Budget to ensure we remain fiscally sustainable.

The challenging economic conditions of the last few years resulting from Brexit and high inflation as well as the real terms fall in the capital grant allocation from the UK Government has significantly impacted our ability to deliver on all capital infrastructure commitments. Given the economic challenges we face, we have committed to refreshing the multi-year capital spending envelopes and resetting the infrastructure project pipeline, including road projects, alongside the 2024-25 Budget.

Funding allocated to Alcohol and Drug Partnerships (ADPs) is for both alcohol and drug treatment services. In 2022-23, £106.8 million was made available to ADPs, increasing to £112.9 million in 2023-24. This funding is used to ensure that local services meet the needs of people who experience alcohol and drugs harms.

On 7 September 2023 I supported a Member’s Debate Motion calling for investment in alcohol services - outlining the Government’s plan to reduce harm from alcohol misuse. The plan includes measures to improve access to treatment and support, including through stabilisation and crisis management, expansion in local assertive outreach services and increasing the availability of residential rehabilitation placements. The plan also includes working with partners and stakeholders to implement alcohol treatment standards – building on the forthcoming UK-wide Clinical Alcohol Treatment Guidelines which are currently out for public consultation until 8 December 2023.

Families told us, as part of the Best Start engagement process, that they wanted the best care possible for their babies. Evidence tells us that the very smallest and sickest babies will get the best outcomes if they care cared for in high volume units.

This change will affect families in many different parts of Scotland, and the Chief Executive of Bliss sits on the Best Start Programme Board and was a participant in the options appraisal process, representing the views of neonatal families.

Scottish Government will be consulting with families in the affected areas on implementation of the new model, so that we can take account of their concerns when the pathways and processes for the new model of care are designed. This will affect a very small number of families, however, it is important that we hear the voices of those families to input into design of service delivery.

Neonatal units will also continue to seek parent feedback locally to ensure opportunities to improve experiences of care for families are identified.

Health Boards are responsible for planning services to best meet the needs of their patients.

Service planning and design should take place at a local level and be informed by an assessment of the type, and level, of support required by patients who need to access those services.

The Scottish Government published Quality Standards for Adult Hearing Rehabilitation Services in 2009 which sets out a standard for the repair being carried out within 2 days of the repair service receiving the hearing aid.

It is for NHS Boards to ensure appropriate provision of a service for the timely repair of hearing aids for patients.

The Scottish Government published Quality Standards for Paediatric Audiology Services (2009) and Quality Standards for Adult Hearing Rehabilitation Services (2009) which both state that patients (and their families in the case of children) should be given a copy of their ‘Individual Management Plan’ following visits to services.

It is for Health Boards to ensure that this takes place in line with the quality standards set out.

The range of experts that have been involved in the Best Start and the Options Appraisal Process represent the leading expertise on this issue and are fully competent to reach an objective decision. I have no doubt that the process of determining where the final three units should be located was independent and robust, and can see no reason to commission a further review.

Over the period 2019 to 2021, all UK nations saw an increase in the number of alcohol-specific deaths. The increase for the whole of the UK over this period was 27.4% with the increase for Scotland being 22.1%. The Office for National Statistics (ONS) suggests, on their website, that the impact of restrictions related to COVID-19 may be a factor in the increase in alcohol-specific deaths seen across the UK.

The Scottish Government has a range of alcohol harm prevention and treatment policies and interventions intended to reduce harm. Recent research estimated our world-leading Minimum Unit Pricing (MUP) policy has saved hundreds of lives, and likely averted hundreds of alcohol-attributable hospital admissions each year and is having an effect in our most deprived areas. We are currently consulting on the Scottish Government’s preferred position on MUP which is a continuation of the policy and, in the event of continuation, at a price of 65 pence per unit of alcohol. On support and treatment, in 2022-23, we made £106.8 million available to Alcohol and Drugs Partnerships to support local and national treatment initiatives. We have been involved in a UK-wide group on reviewing and updating clinical guidance for alcohol treatment, which is now out for consultation . We are exploring the evidence around Managed Alcohol Programmes, and we are undertaking a review of the Alcohol Brief Intervention programme to ensure the programme is as impactful as possible in Scotland.

We are aware that stigma can act as a barrier preventing people from seeking treatment. This is why we are taking actions to reduce the stigma around alcohol misuse.

For example, last year we ran a national campaign to increase people’s awareness that a drug or alcohol problem is a health condition, which requires help and support and not judgement. We also referenced stigma on the NHS Inform website , which reinforces the message that a drug or alcohol problem is a health condition requiring help.

In addition, we published a cross-government Stigma Action Plan , aimed at tackling the stigma of substance use. We are working with a range of partners and stakeholders to co-design the next phase on the details of the actions outlined in the plan.

We also welcome the ‘See Beyond, see the lives’ campaign , which recognises the importance of supporting the families of people with problem substance use, who are often stigmatised and excluded from support, despite experiencing harms in their own right. In delivering the actions in our stigma action plan we will work with families to ensure that we can tackle the specific types of stigma that they experience both in accessing services and support and in daily life.

Moreover, we are planning to ensure treatment standards for alcohol, informed by the UK-wide clinical guidelines, will introduce new approaches to treatment, including non-stigmatising service delivery.