In summer 2023 we engaged with stakeholders including clinicians, third-sector organisations and people with lived experience of chronic pain. Feedback received was used to inform the development of the updated Pain Management Service Delivery Framework – Implementation Plan.

Annex A – response to feedback in the Plan highlights common areas of feedback we received throughout our engagement period and outlines our response to this.

The recent quarterly increase in the rate of neonatal mortality is concerning.

We have asked Healthcare Improvement Scotland (HIS) to look into the increase in neonatal mortality reported in 2021-2022, and although this report has been slightly delayed, we expect HIS to report early in 2024.

Whilst this report will not examine the cases included in the most recent rise, we expect that the findings of that report will help us understand why neonatal mortality may be increasing, and we will look to act on those findings.

The Scottish Government aims to publish our new palliative and end of life care strategy for consultation in Spring 2024.

Our refreshed Diabetes Improvement Plan outlines our commitment to further increase access to diabetes technologies to all who would benefit.

We would expect the prescribing clinician to discuss the most appropriate device for the individual and their circumstances. Where a mobile phone is not available, manufacturers provide receivers which are compatible with the devices.

Between 2016 and 2022, the Scottish Government invested £29.6 million of additional funding to support the increased provision of diabetes technologies, and we continue to work with stakeholders to ensure this is equitable across Scotland.

Neonatal cot capacity is managed on a network basis through a daily call attended by all Neonatal Units. The availability of beds is not solely down to the availability of neonatal cots, but also maternal beds and the availability of specialists to support both mother and baby. This ensures that for any woman or baby who requires immediate delivery, suitable arrangements are made.

The Options Appraisal Report , published on 25 July 2023 describes the process undertaken to determine the three final Neonatal Intensive Care Units. Annex D of the report outlines the cot availability for each Neonatal Unit.

Additional information can found on the hospital’s websites or requested directly.

The NHS Scotland Academy (NHSSA) provides training opportunities across five programme areas: National Workforce Programmes; National Endoscopy Training Programmes (NETP); National Perioperative Training Programmes; National Imaging Training Programmes; NHS Scotland Youth Academy and the NHSSA Skills & Simulation Centre. Within these programme areas, NHSSA facilitates over 30 training courses. More information, including a full list of courses, can be found on the NHSSA website - www.nhsscotlandacademy.co.uk/education-and-training

In the last 12 months, NHSSA has provided additional training opportunities for 5,918 new and existing staff.

The learning modules “Preparing for work in Health and Social Care in Scotland”, designed to support incoming staff, have been completed by 3,941 learners in the last 12 months.

In financial year 2022-23, NHSSA was provided with £3.5m in funding.

Our approach to planning and delivering health and care services needs to change to enable the step-change we need in our services. Our Policy Prospectus and Programme for Government is explicitly clear that reform is required and sets out initial actions we are taking.

Work is already underway to progress reforms to ensure long term sustainability, reduction of health inequalities, deliver services closer to home, further harness the benefits of digital technology, and the improvement of population health outcomes in Scotland. We engage frequently with health boards, the public, health and social care staff and other key stakeholders across a range of issues to develop our thinking.

The Deputy First Minister announced in her statement on the budget on 19th December that the Government will be taking forward a National Conversation on the future of the NHS. The Deputy First Minister set out the principles of public ownership of our NHS and ensuring services are available free at the point of need.

The Cabinet Secretary will set out in more detail in the new year how the Government will progress this work.

This will be a collaborative process across the health and social care system, alongside stakeholder and citizen engagement as a core principle. The Scottish Government will continue to build on engagement already in place with services, clinicians, professionals, service-users and citizens in 2024 to collectively build our long-term planning for health and social care in Scotland.

The recommendations for the new neonatal model of care are underpinned by strong evidence that population outcomes for the most premature and sickest babies are improved by delivery and care in units looking after a critical mass of these babies, with experienced staff, and with full support services.

The Best Start recommended that Scotland should move from the current model of eight Neonatal Intensive Care Units (NICU) to a model of three units supported by the continuation of current NICUs redesignated as Local Neonatal Units (LNU’s).

As part of the next phase of the work Scottish Government have commissioned Consulting firm RSM-UK to undertake detailed modelling work to fully map the capacity requirements across the system to inform capacity building and implementation of the new model.

The Scottish Ambulance Service will be included as part of the modelling work. We expect that mothers in threatened extreme early labour, or those whose babies will need surgery, will be identified pre-birth and will birth in the maternity unit alongside the NICU. The Perinatal Network has been leading some work, and recently published guidance on transfer in these cases.

The Scottish Government does not hold this information.

As has been established practice for many years, the staff and vehicle required to move critically ill patients is determined based on circumstances and clinical need. Our specialist neonatal transfer service (ScotSTAR) will transfer those babies by air or road in specialist ambulances equipped to care for neonates.

ScotSTAR will be introducing a Standard Operating Procedure (SOP) which will have variations between emergency and scheduled/planned transfers. NHS Grampian will be on the outer limits for drivers but expectation would be that the journey will be done without a break.