Chamber and committees

The Options Appraisal Report , published on 25 July 2023 describes the process undertaken to determine the three final Neonatal Intensive Care Units, and the feasibility analysis and testing that followed the conclusion of that process. Annex A of the Report includes the criteria and weighting used for the Options Appraisal Process. Annexes C and D of the report outline the data that supported the Options Appraisal process.

Further detail on the methodology and the scoring of individual units can be found as part of the following Freedom of Information request:

Information relating to Options Appraisal Report: FOI release - gov.scot (www.gov.scot)

The 5 reports from the Neonatal Early Implementers have been placed in the Scottish Parliament Information Centre (BIB number 64669).

The Best Start emphasises parents as key partners in caring for their baby and aims to keep mothers and babies, and families together as much as possible in the crucial early weeks, with services designed around them.

The new model of care aims to minimise the separation of families, and to support parents with babies in neonatal care. We have a number of measures already in place to support families:

• Providing accommodation for parents to stay on or near neonatal units;
• Roll out of the Young Patients Family Fund (formerly the Neonatal Expenses Fund) to support families with the costs of travel, accommodation and food whilst their baby is in neonatal care;
• and
• Repatriating babies to their local neonatal units as soon as clinically possible.

Under the new model of care mothers in suspected extreme pre-term labour are transferred before they give birth (in-utero) to maternity units in the hospitals that have neonatal intensive care units. Experience from the Early Implementer Boards indicates that this will happen in the vast majority of cases. On occasion when it is not possible to transfer mothers before they give birth, the baby will be stabilised and transferred to a NICU by the specialist neonatal transport service ScotSTAR, and the mother will be transferred to the maternity unit in the same hospital as her baby.

The Scottish Government remains committed to medium and long term solutions to address landslip risks at the A83 Rest and Be Thankful.

Improvements to the existing Old Military Road through the Glen Croe corridor are being made to make it a more resilient diversion route until the long term solution to the problems at the Rest and Be Thankful is in place.

The current cost estimate for carrying out all phases of the medium term solution is £24million to £32million. Spending as set out in the Scottish Budget 2023-24, as approved by the Scottish Parliament, is confirmed and includes funding to commence the delivery of the medium-term improvements, which are expected to start later this year.

Funding to take forward the construction stages of Phases 2 and 3 of the medium term solution will be determined as part of the annual Scottish Budget setting process and subsequent capital spending reviews.

The Scottish Government is committed to an infrastructure solution to address landslip risks at the A83 Rest and Be Thankful and shares the urgency communities and businesses place on maintaining and improving connectivity of this vital route.

The medium term solution consists of improvements to the existing Old Military Road through the Glen Croe corridor to make it a more resilient diversion route until the long term solution is in place. These improvements will improve the resilience of the diversion route, reduce journey times, and are the quickest to implement, of relatively lower cost and would have the least impacts overall across the range of criteria assessed of the medium term options considered.

A detailed programme for the proposed improvements is being developed. These include debris catch fences, temporary bunds, drainage improvements and widening and discrete realignment to improve bends and avoid flooding. It is expected that these works will be carried out on a phased basis starting later this year with Phase 1 which is realignment of the southern end of the route. It is anticipated that Phases 2 and 3 will commence in financial year 2024-25, subject to obtaining any necessary statutory authorisation consents. Construction of these phases is expected to take approximately 12 months subject to weather conditions.

The Scottish Government remains committed to medium and long term solutions to address the landslip risks at the A83 Rest and Be Thankful. This scheme is a priority for the Scottish Government, it is a key recommendation in STPR2, it is included in the Programme for Government 2023 to 2024 as well as the First Minister’s Policy Prospectus.

The recent exceptional rainfall on the A83 at the start of October resulted in seven landslides reaching the A83 trunk road, encompassing two very significant landslides at the A83/A815 junction, four landslides at Glen Kinglas and one small landslide at the Rest and be Thankful. Four further landslides were captured by hillside mitigation above the trunk road that includes pits, bunds and catch-fences, with two slips occurring at Glen Kinglas and two at the Rest and be Thankful.

The recent storm events in the areas have not impacted the development of the scheme, and we are still very much focussed on progressing this scheme as quickly as we are able to bring the benefits to those who use the A83.

The Scottish Government is committed to an infrastructure solution to address landslip risks at the A83 Rest and Be Thankful and shares the urgency communities and businesses place on maintaining and improving connectivity of this vital route. At the recent Cabinet public discussion on 2 October in Inverary, the First Minister gave a firm commitment to a solution to the challenges at the Rest and Be Thankful, including a commitment for the funding.

Spending as set out in the Scottish Budget 2023-24 is confirmed which includes progressing the necessary detailed design work for the long term solution, currently progressing at pace. The detailed development and assessment of the preferred option will culminate in the publication of draft road Orders, compulsory purchase Orders and Environmental Impact Assessment Report for formal comment and we expect to publish draft Orders by the end of 2024.

Progress following publication of draft Orders will depend on the level and nature of any representations, including objections, to the published draft Orders. Procurement of a main works contractor for the permanent, long term solution can only commence upon completion of the statutory authorisation process.

The current estimated cost of the preferred option is approximately £405 million - £470 million (at 2023 prices). We will continue to develop and assess the scheme proposals in order to deliver the best value for taxpayers’ money.

Funding to take forward the construction stage of the long-term solution in future years will be determined as part of the annual Scottish Budget setting process and subsequent capital spending reviews.

The statutory responsibility for delivering and commissioning services at a local level lies with local authorities, NHS boards and integrated health and social care partnerships. Publicly funded places in care homes are covered by the National Care Home Contract, which is negotiated annually between COSLA and Scottish Care. The information requested on the number of NHS funded beds that are currently empty is not held by the Scottish Government.

The figure of 10-15% reflects data taken from the 2022 Care Home Census. The latest census will be published in due course and may reflect different data.

Reasons behind this figure include: the fact that registered beds do not necessarily equate to available beds for a wide range of reasons; a UK-wide staff shortage in the social care sector which has an impact on bed availability; different care home providers using different business models which can affect the number of people that can be admitted at any one time.

Scottish Government has asked Health Board Chief Executives within each region to nominate a lead Chief Executive to plan and deliver the changes to neonatal intensive care through the Regional Planning infrastructure. Health Boards will submit detailed implementation plans to the Best Start Programme Board and the NHS Chief Operating Officer, with the expectation that the National model is rolled out by 2025. To support planning, the Scottish Government has commissioned national modelling and capacity work.

The Best Start Implementation Programme Board is considering the future role of the Perinatal Sub Group (which undertook the Options Appraisal Process) to support implementation.

It is the responsibility of the Regional lead Chief Executives to determine whether they will set up implementation working groups and set their terms of reference and membership, and whether they will publish their papers. Timescales for completion of implementation have been set by the Scottish Government.