We welcome the publication of the Scottish Diabetes Survey which provides an annual summary of key issues and trends in diabetes care and treatment in Scotland. As in previous years, the number of people living with diabetes in Scotland is increasing. However, we are not seeing a great increase in the number of new cases, but rather people with diabetes are living longer with the condition.

At the end of December 2020 the Scottish Diabetes Survey reported that 317,128 people have been diagnosed with diabetes of all types in Scotland compared to 312,390 people diagnosed in 2019.

We are committed to ensuring that everyone living with diabetes in Scotland can access appropriate, high-quality, person-centred care. In February 2021, we published our Diabetes Improvement Plan refresh, which builds on the progress made since 2014 and sets out our priorities to deliver safe, effective and person-centred healthcare, treatment and support to those living with diabetes.

Our Type 2 Diabetes Early Detection, Intervention and Prevention Framework was published in 2018 and is designed to support those at risk of, or diagnosed with, type 2 diabetes. It provides guidance to NHS boards on the provision of evidence-based, person-centred targeted interventions across diabetes and weight management services.

In July 2019, the Scottish standards for the delivery of tier 2 and tier 3 weight management services to children and young people and to adults were published. These standards provide a detailed framework to drive forward consistent, equitable and evidence-based approaches across Scotland in the treatment of higher body weight and associated health risks.

On 3 November 2020 the Scottish Government published a rapid review of outbreaks to learn lessons for practices within care homes Coronavirus (COVID-19): care home outbreaks - root cause analysis - gov.scot (www.gov.scot)

In doing so, the report collated and evaluated local level experiences and responses to COVID-19 outbreaks within care homes. It identified a number of recommendations to support working practices to prevent transmission of COVID. We continue to work to ensure the recommendations are implemented and have recently set up a working group to examine whether further work is required given where we now are in the pandemic.

Providing consistent high quality, safe and effective personalised care for people is our top priority for our health and care services. We continue to take a public health and a clinical evidence based response to the pandemic. In doing so, this continually ensures working practices are fit for purpose, for example Infection Prevention and Control, Personal Protective Equipment and Testing to Protect which continue to be of paramount importance as we come to deal with the impact of the pandemic and apply lessons learned.

In addition, to support the needs and wellbeing of the social care workforce and unpaid carers, we have put in place a combination of measures including working practices which were outlined in the Adult Social Care Winter Plan available at the following link: Adult social care - winter preparedness plan: 2021-22 - gov.scot (www.gov.scot)

As we look to the future and rebuild and remobilise our social care sector in Scotland, we have a significant opportunity to ensure that staff and users of social care people are placed at the centre of the recovery. We are proactively developing an Older People’s Strategy and a Healthcare Framework for adults and older people living in care homes. These principles will also be critical as we establish a National Care Service in Scotland.

The table below from Public Health Scotland shows the numbers of inpatient and day case hospital admissions with a primary diagnosis of diabetic ketoacidosis and the number of these admissions where the patient died in hospital.

Due to the way that complications of diabetes are coded in the international ICD10 coding system this only includes cases of diabetic ketoacidosis without coma. These figures do not include cases of diabetic ketoacidosis with coma, which cannot be identified separately from instances of diabetic coma without ketoacidosis.

We are committed to reducing the impact of inequalities on health outcomes for people living with diabetes, and equity of access is highlighted as a key priority in our Diabetes Improvement Plan refresh, published in February 2021.

We are working with key partners including NHS Boards, Health & Social Care Partnerships, Diabetes Scotland and people living with diabetes to ensure that evolving care models address existing health inequalities by integrating pathways with existing services and resources such as social work, mental health services, education and third sector.

As diabetes services evolve and include more virtual offerings, we will work to ensure that those people with diabetes who are unable to access services digitally are not disadvantaged as a result of digital exclusion.

The requested information is not centrally held. Data is published annually, by NHS Education for Scotland on the total medical agency spend by NHS Scotland Boards; and the total WTE hours and cost for Nursing and Midwifery bank and agency staff, but this data does not specify start dates. This information can be found on the following link: NHSScotland workforce | Turas Data Intelligence

Those who experience difficulties carrying out a LFD test can ask someone they trust to assist them with the swabbing and testing process. Walk-in asymptomatic test sites (ATS) can also advise people how to use a LFD test. After self-swabbing, the person hands their used swab to a site operative for it to be analysed.

People identified as contacts of a case who are unable or do not have the support to carry out LFD testing can call the National Contact Tracing Centre on 0800 030 8012, for advice.

Additionally, for people with access to a smart phone, an expansion to the existing 119 Be My Eyes service was launched on 27 January to assist asymptomatic visually impaired people and anyone else who needs support, to conduct a rapid lateral flow self-test independently.

Instructions for use for LFD self-tests used in the National Testing Programme are also available in large print and easy read and can be accessed here: Acon Flowflex , Innova and Orient Gene .

Regular testing for people without symptoms is voluntary and for some people it may not be appropriate for testing to take place at all. Those who work most closely with the individual will be best placed to decide whether testing will be appropriate, taking into consideration the needs of the individual.

a) NHS Staffing

In all areas of NHS Scotland, a great deal of effort is going into ensuring that services have sufficient capacity to deal with COVID-19, manage other risks and resume planned services as safely and effectively as possible. Although NHS Scotland’s staffing levels are at a record high, following nine years of consecutive growth, we are fully aware of the difficult circumstances that Boards and frontline staff are working in. That is why we have announced a record £300 million of new investment in measures to help services deal with system pressures over winter.

Measures we are taking as part of this investment include the recruitment of 1,000 additional healthcare support staff to support patients in hospitals and in community health teams, as well as £4.5 million of funding to attract registered nurses to Scotland. This activity is supplemented by an additional £1 million to enhance Boards’ capacity for recruitment.

Decisions on local staffing requirements and recruitment are the responsibility of individual NHS Boards. However, Scottish Government officials are continually engaging with NHS Boards to identify particular areas of concern.

(b) Social Care Staffing

The Scottish Government launched a national recruitment campaign on 8 November to attract more people to the social care sector. This campaign emphasises the value of a career within social care by showcasing the benefits of the sector beyond pay, and towards the extrinsic and intrinsic rewards of the role.

Officials are working at pace with SSSC and other key sector partners to develop a national induction programme to support new entrants into Adult Social Care; to promote career opportunities and deliver policies on fair work, upskilling and developing the workforce. This commitment is crucial to improving the experience of the social care workforce and addressing long standing recruitment issues in the sector.

As a result of lobbying efforts from the Scottish Government, the Home Office have temporarily extended the Shortage Occupation List for EU workers. Social care workers, care assistants and home care workers are to become eligible for a health and care visa for a 12-month period.

The Scottish Government will continue to push for a migration system tailored to Scotland’s needs, including a Scottish Visa, and work with partners and employers to develop proposals that suit their requirements.

(c) Public Transport Staffing

For bus service staffing, Transport Scotland and Scottish Government Officials are continuing to work closely with bus service sector representatives and other partners to help facilitate solutions to the staffing pressures brought by the COVID-19 pandemic compounded by the consequences of EU Exit. This has included work to help connect local employability partnerships with bus service operators as well as ensuring that the sector is represented in the Labour and Skills Shortages Action Plan process.

For rail service staffing, due to an increase in COVID-related absences and subsequent disruption in December, ScotRail has put a temporary timetable in place to provide a more stable and reliable service. ScotRail staff COVID-related cancellations have now reduced significantly following the successful introduction of a reduced timetable on 4 January. Around 8% of services have been withdrawn in this temporary timetable – largely additional peak services – leaving a more reliable core timetable in place. It is planned to retain the revised timetable until the end of the month, but ScotRail will keep this under review to balance staffing resources and demand from passengers as best as possible.

Where it is clinically appropriate to do so, patients of all ages will be examined with a stethoscope to listen for breathing and heart sounds. They may also have ECG electrical recordings of their heart rate, blood tests and have access to other investigations such as Echocardiograms, rhythm monitors and blood pressure recordings, should these be required.

Primary care professionals have access to multiple sources of education and update regarding heart valve disease and management both at undergraduate and postgraduate level. Through local interface groups local pathways to support diagnosis and management have been developed at board level with opportunities for specialist advice and rapid referral where required.

Scottish Government has no current plans to carry out a public awareness campaign on heart valve disease.

Priority 2 within the Heart Disease Action Plan makes clear our commitment to developing nationally agreed pathways of care for all cardiac conditions.

This work is underway. It is led by our recently appointed Heart Disease Improvement Coordinator, who is engaging with clinical colleagues across Scotland to understand service provision, identify needs and collate examples of good practice to inform this programme of work.