Chamber and committees

Between December 2019 to March 2022 Transport Scotland undertook regular meetings with trade unions, staff representatives and passenger/transport groups at which the subject of ScotRail services moving to a Scottish Government owned operator i.e. ScotRail Trains Limited from 1 April 2022 would have been discussed.

The former Minister for Transport, Mr Dey, met with the collective Rail Trade Unions twice and individually with them once, with the exception of RMT who declined to meet at the time. There was a third collective meeting schedule to take place on the day Mr Dey resigned.

I have had one collective Rail Trade Unions meeting and have held five individual meetings with Trade Union representatives. Public ownership was discussed at all these meetings along with other issues such as pay negotiations and industrial relations for example.

The former Minister for Transport also met with Transport Focus and I met with Transport Focus on 21 April where I provided an update on the transition from Abellio ScotRail to ScotRail Trains Ltd.

The SIGN guidelines recommend all diagnoses should ideally be made through a multi-disciplinary process and not done by a single clinician.

There is no requirement for the diagnosis to be made by any particular profession. This should be dependent on who has the skills and experience and may include Psychiatrists, Psychologists, Paediatricians and Speech and Language Therapists.

Not all health professionals will be trained to diagnose as this is a specialist skill, but it is the expectation of the Scottish Government that they should be aware of and have access to referral pathways.

By the end of Core Psychiatry training, trainees must be able to:

• receive a full psychiatric history from and perform a Mental State Examination (MSE) on patients within a range of mental and neurodevelopmental disorders across the lifespan in routine, urgent and emergency situations, incorporating appropriate terminology.
• assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate an understanding of how protected characteristics may impact on clinical presentation.

In order to successfully complete Core Psychiatry training, all trainees must undertake a neurodevelopmental sub-specialty placement, either Intellectual Disability (ID) or Child & Adolescent Mental Health Services (CAMHS), so they are aware of and will be familiar with the process of diagnostic assessment.

General practitioners are essential to recognition and assessment. Autism is covered in the GP Curriculum alongside a range of other neurodevelopmental differences. Clinical psychology doctoral trainees receive training in relation to assessment and intervention for people with neurodevelopmental disorders, including Autism. Undergraduate training ensures that any Speech and Language Therapist at any level can provide or contribute assessment information that could assist an assessment team in making a diagnostic decision.

The Scottish Government commissioned NHS Education for Scotland (NES) to produce the NES Autism training plan, to ensure that staff involved in diagnostic assessments across the lifespan have the right skills and knowledge, prioritising staff from across Scotland who are involved in diagnostic assessment.

Both adult and paediatric patients with Cystic Fibrosis (CF) can access a range of appropriate services via their local NHS Boards, Integrated Joint Board and specialist centres.

The National Services Division (NSD) of NHS National Services Scotland commission a number of highly specialist services for young people and adults with CF are delivered via multi-disciplinary teams, including clinical psychologists at 3 specialist centres around the country – in Aberdeen, Glasgow and Edinburgh. There are also outreach services in Dundee and Inverness. Paediatric CF services are delivered locally by NHS Boards like through the South-East Scotland Paediatric Cystic Fibrosis Service.

Due to the variable management required, much of the treatment required by CF patients is specialist and tailored to the needs of the individual patient. The Scottish Government therefore expects NHS Boards to treat CF patients according to individual need, this includes ensuring clinical psychologist and social work input when required.

The Scottish Government is committed to working to improve outcomes for people with rare conditions, including Cystic Fibrosis. We are developing an Scottish Action Plan for Rare Disease based on the four priorities of the UK Rare Disease Framework: faster diagnoses, increased awareness, better care co-ordination, and access to specialist treatments and care.

Due to the variable management required, much of the treatment required by Cystic Fibrosis (CF) patients is specialist and tailored to the needs of the individual patient. The Scottish Government therefore expects NHS Boards to treat CF patients according to individual need, this includes ensuring clinical psychologist and social work input when required.

Whilst the Scottish Government set out the wider policy within which NHS Scotland is expected to deliver services, we expect all NHS Boards to provide high quality care that is safe, effective and person-centred. This is a matter for NHS Boards locally. The information requested is not held centrally.

The Scottish Government is committed to working to improve outcomes for people with rare conditions, including Cystic Fibrosis. We are developing an Scottish Action Plan for Rare Disease based on the four priorities of the UK Rare Disease Framework: faster diagnoses, increased awareness, better care co-ordination, and access to specialist treatments and care.

Article 26 of the UN Convention on the Rights of Persons with Disabilities ( Article 26 – Habilitation and rehabilitation | United Nations Enable ) sets out several obligations relating to habilitation and rehabilitation.

These obligations have the stated aim of enabling “persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life”, through timely access to “multidisciplinary assessment of individual needs and strengths” to “support participation and inclusion in the community and all aspects of society.”

The Scottish Government are committed to ensuring that people who have had a stroke receive the best possible care as quickly as possible. We know that early assessment of rehabilitation need following an acute stroke, and the delivery of rehabilitation by a multi-disciplinary team, are important elements of improving outcomes and these are priorities within the Scottish Stroke Improvement Plan (2014).

Through the Scottish Stroke Improvement Programme (SSIP), NHS boards are required to demonstrate their provision of access to acute therapy assessment, access to inpatient stroke therapy, access to community stroke therapy and the availability, by days per week, of community therapy input.

Article 26 also requires the provision of appropriate training for professionals working within habilitation and rehabilitation, as well as the “availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities”.

Through SSIP reviews, NHS boards are also required to demonstrate that health and social care staff in hospital and community settings are trained to a level appropriate for their involvement in stroke care. Where appropriate, highly-trained specialist staff involved in the rehabilitation process are best placed to advise on the provision of assistive devices and technology that may be of benefit to people affected by stroke.

The most recent Scottish Stroke Improvement Programme annual national report ( Scottish stroke improvement programme 2021 national report - Scottish stroke improvement programme - Publications - Public Health Scotland ), which includes data from the Scottish Stroke Care Audit (SSCA), was published on 29 June 2021.

This annual report reflected the impact of the COVID-19 pandemic on the provision of stroke services, as well as the incredible work that NHS Scotland staff in stroke services continued to deliver in unprecedented circumstances.

This report shows us the high level of care provided for stroke patients throughout the Covid-19 pandemic. It is positive that, despite the pandemic, performance improved in a number of key areas.

We remain focused on ensuring that people who have had a stroke receive the best possible care as quickly as possible to enable them to live longer, healthier and independent lives.

As committed to in the Genome UK: shared commitments for UK-wide implementation 2022 to 2025 document, the Scottish Government is committed to developing and publishing a Scotland specific Genome UK implementation plan by the end of 2022.

The Scottish Stroke Improvement Programme Lead, who conducts the annual review process, meets with NHS boards on behalf of Scottish Government. This engagement allows us to understand the provision of stroke services, including training and staff capacity across NHS boards, and where challenges or opportunities for sharing good practice exist.

Scottish Government representatives also sit on the National Advisory Committee for Stroke (NACS), where specialists from NHS boards across Scotland provide expert advice and recommendations relating to Scottish Government policy for the provision of stroke care. NACS has recently developed the Progressive Stroke Pathway ( Strokes: progressive stroke pathway - gov.scot (www.gov.scot) ), which was published on 22 March 2022. This document sets out an ambitious vision of what a progressive stroke service in Scotland should look like.

The rehabilitation sub-group of NACS, which is made up of specialists across a range of disciplines from various NHS boards in Scotland, played an important role in helping to shape the Progressive Stroke Pathway recommendations relating to stroke rehabilitation services. On the back of this input, the Progressive Stroke Pathway makes a number of recommendations relating to the provision of stroke care, and the contributions of appropriate training and staff capacity in helping deliver this.

We will continue to engage regularly with these specialists from across Scottish NHS boards as we move into the implementation phase, considering the recommendations made in the Progressive Stroke Pathway.

The Scottish Government does not hold information containing a detailed breakdown of stroke rehabilitation services provided in individual health boards.

The Scottish Government has committed £6.2 million to genomics for the financial year 2022-23. This is in addition to the funding allocated to the 4 genetic laboratories in Scotland by NHS Boards through NHS National Services Division (NSD) commissioning arrangements.

The Scottish Government fully recognises the role of genomics in improving patient outcomes. We have provided funding to NSD to establish a Transformation Team led by a Lead Clinical Scientist alongside resource that specialises in transformative programme management and Data Analytics. The Team will be operational from June 2022.

This team will be responsible for delivering the rapid adoption of a number of genetic tests for cancer across the genetic laboratories as well as developing an action plan for the implementation of the recommendations from the Genetic Laboratory Major Service Review.

The transformation team will work within NSD and support the Scottish Government to develop our long term plans for genomics medicine in Scotland.