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Secondary breast cancer – breast cancer that has spread to other parts of the body – is recorded on the Scottish Cancer Registry if it has occurred when the diagnosis is first made. The Scottish Cancer Registry uses a variety of sources of information to confirm stage at diagnosis and the quality of this work is assessed through audit and external quality assurance.

Public Health Scotland is part of an ongoing JRC-ENCR (Joint Research Centre – European Network of Cancer Registries) short life working group to improve and standardise collection of information on cancer recurrence. The aim of this work is to improve collection of secondary cancers that occur some time after the initial diagnosis. This will add to the information about secondary breast cancer at the time of diagnosis.

Several new and better sources of data on secondary cancers are being integrated into the national cancer intelligence platform at Public Health Scotland (PHS). For example, Systemic Anti-Cancer Therapy data for the whole of Scotland are now collated at PHS and these include information on whether treatments for breast cancer are for primary or secondary disease.

The National Cancer Quality Steering group have overseen the development of a newly proposed QPI on 'Recurrence Following Breast Cancer Treatment' in 2022.

I refer the member to the answer to question S6W-13150 on 17 January 2023. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at /chamber-and-committees/written-questions-and-answers .

The Scottish Government is committed to keeping The Promise by 2030. It is recognised that the experience of growing up in care can impact you for all of your life. Providing the right support to people with care experience through our Whole Family Wellbeing approach and the range of work identified in including trauma informed training, corporate parenting, education and employment.

The Implementation Plan sets out our commitment to ensure the voice of people with care experience is at the heart of the work we do to keep The Promise.

Keeping the Promise requires a collective approach across all of our services, including care, health, education and justice. The Scottish Government requires to lead from the front, working with partners across local government and third sector, to bring the transformational change required. The actions and commitments we will take are set out in our published in March 2022.

includes members with lived and professional experience and is responsible for holding Scotland to account on whether the Promise is being kept.

has been established to support organisations across Scotland to Keep The Promise. The Promise Scotland published its in July 2022. This includes a helpful timeline of work undertaken from the point The Promise Scotland was established.

The Scottish Government has published a child friendly version of the Promise Implementation Plan, developed with the support of Who Cares? Scotland and other stakeholders which is available on the .

The First Minister wrote an open letter to the Care Experienced community on the 22 October 2022 to thank all involved in preparing the Who Cares? Scotland publication and to acknowledge the points raised. The letter is available on the . The Scottish Government continues to work closely with Who Cares? Scotland and the points identified in the publication are informing the ongoing work to Keep The Promise.

The Promise Bill will be introduced to Parliament before the end of this Parliamentary session to make any further legislative changes required to Keep The Promise.

The Implementation Plan sets out our commitment to ensure the voice of people with care experience is at the heart of the work we do to Keep The Promise and we welcome all opportunities to engage. We will continue to work with local government, local Champions Boards, Who Cares? Scotland, The Promise Scotland and other partners to ensure that our approach to engagement is positive and impactful.

Healthcare Improvement Scotland (HIS) has taken a number of steps to ensure all staff are aware of, informed about and trained in trauma-informed practice and principles. The organisation has:

1. Signed up to the National Trauma Training Programme’s (NTTP) Leadership Pledge of Support, demonstrating their commitment to:

The National Trauma Training Programme (NTTP) consists of a range of training resources, including a framework which details the knowledge and skills required at each of the four practice levels. This Framework was created in part to enable organisations to deliver their own training or identify suitable training providers. As such, there will be a wide range of NTTP-aligned training that has been delivered to many members of the workforce that we do not hold central information about.

Training delivered by NES (NHS Education for Scotland) central team and the Transforming Psychological Trauma Implementation Coordinators (TPTICs) is recorded. Two different processes are used for monitoring and recording information about numbers accessing training, as set out below:

1) Monitoring and recording processes for face-to-face or screen-to-screen training across all four levels (informed, skilled, enhanced and specialist levels)

All information about face-to-face and screen-to-screen training at any level delivered by TPTICs and the central team is recorded by the TPTIC or central team member via an MS form. This includes information about the type and level of training, by whom and where it was delivered, duration, the number of people attending and their area of work. Because of the multi-agency focus of the NTTP, many of the training sessions bring together professionals working across various organisations and agencies. Reporting focuses on broader numbers and areas of work of attendees (whether justice, health, education, etc.), rather than by organisation, and as such does not differentiate between NHS and other public sector workers.

This information is collated centrally, and numbers of staff trained at each of the four levels are reported quarterly for performance tracking purposes.

2) Monitoring and recording of delivery of online training resources across Informed and skilled levels.

Informed (Level 1)

At the Informed level, the use of NTTP animations Opening Doors and Sowing Seeds, and the recorded workshops that accompany them are monitored through the number of views as indicated on the Vimeo platform. The numbers of views of the animations and workshops, and registrations for the workshops notes and tools are measured on a monthly basis.

This information is collated centrally, and numbers of staff accessing each of the informed training resources are reported quarterly for performance tracking purposes.

A key focus of developing the informed, online resources has been on making them easy to access. The animations and recorded workshops are freely available, meaning people accessing them do not need to supply their email address or employer. Likewise, the training resource for the Informed level will have been shown at in-person/online events, and uploaded to/ watched through various platforms, so it is not possible to capture exact numbers and details as to who has accessed this resource and whether they work for the NHS, another public sector organisation or elsewhere.

Skilled (Level 2)

Four modules to support Skilled practice training are provided on NHS Education for Scotland's Turas platform. To access these modules, it is necessary to have a Turas account.

The number of staff completing each of the four skilled workshops is collected from the Turas system on a monthly basis. This information is collated centrally, and numbers of staff completing each of the skilled modules are reported quarterly for performance tracking purposes.

In addition, Turas can provide further information about registered users who have accessed the modules. Two data sources are used by NES to monitor who has a Turas account. First, any individual can register for Turas and upon registration, and they may provide details of their sector, professional role and organisation. Second, richer data is available for the majority of NHS Scotland staff where Turas draws data from workforce information systems – these provide an accurate and up to date information about job role, department and organisation.

Enhanced (Level 3) and Specialist (Level 4)

There are no online training resources at the Enhanced and Specialist level, as this is intensive skills-based training which is delivered face-to-face/screen-to-screen.