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The Scottish Government has provided over £3.3 million since 2006 to Health Improvement Scotland (HIS) to support NHS Boards, to deliver sustained improvements.

From this funding, NHS Tayside have benefitted from Improvement Advisors who undertake diagnostic work and develop and implement an improvement plan to improve waiting times.

In addition, HIS are providing bespoke support to NHS Tayside to continue to help them to build on the detailed Demand, Capacity, Activity, Queue (DCAQ) diagnostic analysis that was carried out by ihub in 2018. The information from this continues to inform the improvement planning process.

In March 2019, HIS along with Scottish Government Officials, met with the Chief Executive and senior staff from NHS Tayside to support the development of a wider mental health improvement plan across psychological therapies and children and young people’s services, and HIS are providing support to services to implement this.

The Scottish Government continues to engage with NHS Tayside and other relevant organisations to ensure that appropriate resource is provided to ensure the delivery of high quality mental health services.

The 2019-20 Scottish budget included £53.8 million in NHS Boards baseline allocations for alcohol and drug funding. Allocations to individual boards are set out in the following table. We will be writing to Integration Authorities and ADPs in the coming weeks to outline Ministerial Priorities for 2019-20.

In financial year 2018-19, £17 million was allocated directly to ADPs through the Local Improvement Fund. The same amount remains available to Integration Authorities and ADPs in 2019-20. We will be writing to Integration Authorities in the coming weeks to confirm allocations.

Like its policies on other food matters, the Scottish Government’s position is informed by advice from Food Standards Scotland (FSS), which is in turn underpinned by scientific advice provided by the UK Scientific Advisory Committee on Nutrition (SACN) and, in this instance, the European Food Safety Authority (EFSA).

Scottish Government recognises that there have been long standing concerns that the addition of nitrates and nitrites to food and subsequent production of nitrosamines could lead to an increased risk of cancer, particularly colorectal cancer. However, FSS advises that there are a number of other mechanisms that could explain why processed meat consumption might promote carcinogenesis. For this reason, dietary advice relating to red and processed meat is based on limiting these foods in the diet for the purpose of reducing the risk of colorectal cancer and not specifically due to their nitrate or nitrite content.

Nitrites are important preservatives in certain meat products and their use in these products is regulated under EU food additives legislation which is reviewed regularly to ensure regulatory limits are at the lowest possible level to perform their required function. FSS considers that current evidence supports the safety of processed meat containing levels of nitrates and nitrites that comply with those regulatory limits.

The Scottish dietary goal for red and processed meat sets limits for the consumption of all red and processed meat for the purpose of reducing the risk to the population of colorectal cancer. In line with EFSA opinion and current scientific evidence, the position of the Scottish Government is that it is safe to eat processed meat containing nitrates and nitrites which comply with prescribed EU limits.

The Scottish Government, along with the rest of the UK is advised on all aspects of screening by the UK National Screening Committee (UK NSC) an independent expert advisory group. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria.

The UK NSC last reviewed screening for Chronic Obstructive Pulmonary Disease (COPD) in 2018 and did not recommend introducing a national screening programme. This is because current tests are not reliable in people who have no symptoms of COPD; and there is not enough evidence to understand whether medicines are effective for people with mild COPD which would be detected by screening.

Although the UK NSC does not currently recommend a national screening programme for COPD, all policies are reviewed regularly and screening for COPD will be reviewed again in 2021-22. Any change to the recommendation will be carefully considered by the Scottish Government.

The Scottish Government is advised by Food Standards Scotland (FSS) on food safety and standards. Neither the Scottish Government nor FSS has undertaken any analysis on the availability and cost of nitrite-free preservation/curing of products, such as bacon, by using fruit and spice extracts.

All food additives including preservative factors extracted from fruits and spices require authorisation by the EU based on scientific evidence for their efficacy and safety. Plant-based preservatives may take a variety of different forms and some are essentially naturally derived nitrates which, when consumed in foods, can be converted to nitrites and nitrosamines in the same way as permitted sodium and potassium nitrates.

With regard to our position on nitrates and nitrites in food, I refer the member to the answers to questions S5W-23695 on 26 June 2019, S5W-23693 on 21 June 2019, S5W-23537 on 10 July 2019, S5W-23315 on 4 June 2019 and S5W-22368 on 18 April 2019. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at .

In terms of school and hospital foods, procurement is a matter for local authorities and health boards respectively. The government’s role is to set the required national standards. With regard to school food, Ministers recently published a report setting out the detail of changes to be made to the school food and drink regulations, including red and red processed meat. NHS Health Facilities Scotland published revised national standards for food, fluid and nutrition for hospitals in 2016 which take account of the latest scientific advice on the amount of red and red processed meat for a healthy, balanced diet.

Access to pulmonary rehabilitation is a key recommendation in national clinical guidelines which we expect NHS Boards to follow, that is why it will form an important part of the Respiratory Care Action Plan for Scotland.

The Scottish Government takes the issue of Lyme disease very seriously and together with Health Protection Scotland (HPS), is committed to raising awareness and supporting those affected with this complex disease.

The Lyme Borreliosis group, which is part of the Scottish Health Protection Network, is actively working to raise awareness of ticks and tick borne diseases amongst health care professionals in Scotland. It has produced a number of educational resources to support staff which can be accessed through the National Education for Scotland website.

On 14 June 2019 the Chief Medical Officer wrote to all NHS Health Boards and GP practices highlighting the availability of these resources to staff. The group is also working to raise the profile of ticks and Lyme disease with the public in Scotland.

They have developed a number of resources to explain the risks from ticks and tick borne diseases. The ‘avoiding bugs and germs outdoors’ webpage on NHS Inform brings together in one place comprehensive advice on how to avoid infection. The Scottish Government will continue to actively promote these materials.

The National Agency for Sport, sport scotland, have undertaken various pieces of research over recent years to gain a better understanding of the barriers to participating in sport and physical activity. Whilst sport scotland have not commissioned research focussed solely on financial barriers, the range of commissioned research has collectively built-up a rounded understanding of the barriers and means of addressing these have informed their work.

Charges for Sports Facilities

Sport scotland produce an annual review of local authority charges for sports participation in Scotland. This research provides an overview of public sector charges for the use of indoor and outdoor facilities as well as swimming pools. It is based on a survey of the Scottish Local Authorities and Leisure Trusts, covering over 70 activities of facilities. More information on sport scotland's Charges for Sports Facilities can be found at: .

Wider Evaluations

During 2017-18, sport scotland commissioned three independent wider evaluations to look in depth at how their programmes deliver, alongside their partners, to support the sporting system. These evaluations covered coaches and coaching; schools and education; and clubs and communities. The wider evaluations helped sport scotland gain a better understanding what barriers to participation to sport and physical activity remain. Further information on these wider evaluations can be found at: .

Equality and Sport Research

In 2016, sport scotland published its Equality and Sport Research, funded by the European Human Rights Commission. The report explores equality in sport in Scotland and helped improve work in Scotland in relation to advancing equality, eliminating discrimination and fostering good relations. The report looks at who currently participates in sport, the barriers to participation, and suggests potential solutions. A series of learning notes was developed based on findings from the research. This research involved a review of relevant literature, surveys and discussion groups with people working in the sporting system in Scotland, and discussions with people with protected characteristics.

Further information on the Equality and Research Report can be found here:

Supplementary investment to Scottish Sporting Governing Bodies (SGBs)

In 2017, sport scotland commissioned an evaluation of the Scottish Government's £2m supplementary investment to SGBs aimed to expand their reach to the inactive and underrepresented in sport. It also looked to tackle inequality and discrimination in participation in sport and further enhance child protection measures. The evaluation identified barriers encountered and how SGBs are using a mix of approaches to break down barriers.

Further information on sport scotland’s evaluation of the £2m supplementary investment to SGBs can be found here:

Active Scotland Outcomes Framework (ASOF)

In August 2017 sport scotland commissioned research to evidence their contribution to the six outcomes in the ASOF. This work focused on their ‘schools and education’ and ‘clubs and communities’ portfolios. The research consisted of large scale surveys of school pupils and clubs members in schools and clubs we support. This was supplemented by a small number of focus groups with pupils and club members.

The research gathered:

• survey responses from 3,000 club members;
• survey responses from 14,849 school pupils; and
• views of 77 young people and adults through focus group discussions.

Through the research sport scotland are able to evidence the wider impacts of our programmes on participants and members. The infographic gives the high level findings against each of the six outcomes. This includes the distribution of participation by SIMD (deprivation) quintile.

Further information on sport scotland’s contribution to ASOF can be found here:

The Scottish Government, through HPS is committed to working with experts to keep evidence and guidance relating to the diagnosis and treatment of Lyme disease under constant review to ensure patients in Scotland receive care tailored to their individual needs and circumstances.

The Scottish Lyme Disease and Tick-borne Infections Laboratory at Raigmore Hospital in Inverness has recently been granted Reference Laboratory status which will provide additional funding for research and development into new tests for tick borne diseases and will help improve our understanding of this complex infection.

The Scottish Lyme Disease and Tick-borne Infections Laboratory will continue to work with experts at Public Health England and elsewhere to ensure that patients in Scotland have access to the most robust and scientifically justified testing regime available.

With regard to testing, it is acknowledged that there are gaps in the effectiveness of the tests which are currently available and work is underway to address the lack of sensitivity surrounding testing for the early stages of Lyme disease infection.

On 14 June 2019 the Chief Medical Officer wrote to all NHS Health Boards and GP practices highlighting the availability of a series of resources to staff. The letter shares current sources of public facing advice and information about Lyme disease as well as links to current guidance on diagnosis and management.