Chamber and committees

As set out in my response to S6W-00871 on 5 July 2021 we’ve taken a number of steps to provide advice and support to people with chronic pain during the pandemic, including highlighting relevant information on the matter of injections to assist them in discussions with their clinician and Health Board.

In June 2020, joint guidance was issued by the Faculty of Pain Medicine (FPM) and the British Pain Society (BPS) in relation to pain interventions which stated: ‘decision[s] to resume injections should be based on a balance of risks and benefits for individual patients’ . This statement reflected the factors the FMP/BPS said should be considered when resuming pain interventions, including the local prevalence of COVID-19, reducing the risk to patients (specifically in relation to steroid injections) and prioritising lower risk aspects of pain services first. It also emphasised the importance of patient consent in relation to additional risks of attending hospital and receiving an injection during the pandemic.

Following this, the advice issued by the FPM in July 2020 again set out that there was insufficient evidence to assess the potential associated risks should a patient come into contact with COVID-19. It goes on to on to clearly state: ‘Our previous recommendations - “FPM & BPS Joint Guidance on Pain Interventions during the COVID-19 Recovery Phase” published on the 8th of June 2020 in conjunction with the British Pain Society […] still stand ’. The update also stated, when making treatment decisions, the: ‘risk benefit ratio [should] also [be] measured in the context of the local prevalence of the COVID-19 virus at that point in time.’ Our replies to correspondence about this matter therefore continued to include a link to the June 2020 guidance and in response to feedback from a member of the public in April 2021, we now direct people to the overarching FPM webpage containing both advice documents.

Neither Scottish Government officials or Ministers make or influence treatment or prescribing decisions as these are entirely for clinicians in charge of a patient’s care to make. When taking these decisions we expect clinicians to discuss risks and options fully with their patients taking into account relevant guidance, the impact of pain on people’s quality of life and any safety considerations.

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

Public Health Scotland (PHS) is not required to score its research publications on whether they criticise the Scottish Government. The process for publishing research reports is managed impartially and objectively, in line with scientific principles and recognised best practice.

A Communications Framework, jointly agreed by SG, PHS and COSLA, is in place that provides a high-level framework of good practice in relation to a broad range of communications activity, including communications relating to the publication of research publications. The framework does not impact on the independence of research publications. The framework stresses the operational autonomy of PHS and the key importance of mutual respect for our different roles and responsibilities.

PHS reports are routinely published on their website and can be found at the following web address: https://publichealthscotland.scot/publications/ .

An adverse event involving a very small number of women in a single NHS Board area was identified by the Board in the course of conducting its annual audit into invasive cervical cancers in December 2020. NHS National Services Division became aware of the incident in one NHS Board on 26 February 2021. They subsequently established an Adverse Event Management Team (AEMT), which met for the first time on 9 March 2021 to assess the implications for the wider screening programme and determine further action. Immediate control measures were put in place to prevent any new exclusions from being applied incorrectly. Scottish Government officials were also informed of the incident on 9 March and attended the AEMT meeting.

The Scottish Government does not hold this information centrally. Information on the number of NHS dental consultations can be found on Public Health Scotland at: https://publichealthscotland.scot/publications/dental-statistics-fees-and-treatments/dental-statistics-fees-and-treatments-statistics-as-at-march-2020/ .

The following table shows the number of cases submitted for annual invasive cervical cancer audits in the years from 2014 until 2018, which are the years where full data is available. For the year 2019 five health boards have provided data and 129 cases were reported; in 2020, one health board submitted 16 cases. The audit schedule for the 2019 period was affected by the impact of the Covid-19 pandemic on services as staff were redeployed to Covid duties. A catch-up schedule has been put in place to audit 2019 cases at the same time as 2020 cases and these will be reviewed this year. It is important to note that the cases are assembled annually and reviewed by a multidisciplinary team within each Health Board.

We have provided additional funding to NHS Boards where required to support prioritised care for individuals affected by the incident within the cervical screening programme.

Four Boards have requested funding to provide additional clinics as follows:

• Lanarkshire - £28,000
• Lothian - £8,098
• GGC - £5,000
• Fife: £2,700

No other Boards have requested funding, but we will keep the situation under review and will provide further funding if needed. Additionally, Jo’s Cervical Cancer Trust, who are helping support the response with their Helpline, have also received funding from the Scottish Government.

The Scottish Government does not hold this information centrally. Information on how many NHS dental consultations were emergencies is held with the individual dentist. However, the overall number of NHS dental consultations can be found on Public Health Scotland at: https://publichealthscotland.scot/publications/dental-statistics-fees-and-treatments/dental-statistics-fees-and-treatments-statistics-as-at-march-2020/ .

The British & Irish Lions rugby match was a flagship event approved by the Scottish Government through an events gateway process. Flagship events are internationally significant events which maintain Scotland’s longer-term profile as a host of major events, with an eye to recovery from the pandemic, and with appropriate Covid-19 mitigations in place. There are a very small number given the quite high bar of international significance.

Scottish Rugby submitted a comprehensive spectator proposal that was considered by Scottish Government Clinicians and the Chief Medical Officer before it was approved to enter the gateway process by the First Minister. The proposal for 25% capacity at Murrayfield was based on a fixed seating plan with seats sold in singles which required an exception for a reduction in physical distancing. Clinicians were satisfied with the comprehensive and robust plans that Scottish Rugby and the British Lions had in place and with the public health measures to help keep people safe. The proposal was considered at local level by City of Edinburgh Council at Event Planning & Operations Group Meetings which was also attended by others including Police Scotland and NHS Lothian.

It was made clear that fans should take a lateral flow test before attending to reduce the risk of spreading the virus. Flagship events provide an opportunity to monitor and learn from events operating with reduced physical distancing and a comprehensive range of mitigations like maximising points of entry and staggered arrival times to ensure that fans could attend safely for this outdoor event. The Scottish Government and event organisers will use this knowledge to support the wider restart of events across Scotland.

Validated information on referrals to NHS dentals hospitals is not held centrally.

However the member may find it useful to know that information relating to outpatient activity including total number of attendances by NHS Board and location of treatment can be found in the Acute Hospital Activity publication using the link below.

https://publichealthscotland.scot/media/4991/table-1-outpatient-activity-consultant-led.xlsx.

Invasive cervical cancer audits have been carried out annually by Health Boards for at least the last 20 years, although a new national methodology to standardise the information collected was introduced in 2014. These audits review the screening histories of people who develop invasive cervical cancer.