I refer the Member to the contents of the letter issued to her by the First Minister on 4 October. A copy will be placed in the Parliament's Reference Centre (Bib number 62800).

An analysis of the obtained from the two toxicology providers in Scotland – NHS Grampian which provides approximately 10% of the analysis capability and Glasgow University which provides the rest – is set out in the tables below.

It should be noted however that the extent of toxicological analysis required will depend on the individual circumstances of each case and the extent and nature of substances that are found. Factors such as the need to research the effects of unusual drugs or instruct separate analysis for insulin quantification will result in toxicological reports taking longer to be finalised. 

Additionally, in determining the final cause of death, completion of the toxicological report is only one part of a process which involves a number of separate organisations before a final post mortem report can be issued.

Depending on the circumstances surrounding a death, the pathologist(s) may require a number of further investigations to be completed – including further toxicological analysis as well as input from other experts in the fields of neuropathology or histopathology for example – and the findings of all those enquiries must then be carefully considered by COPFS before a cause of death is confirmed.

GU TOXICOLOGY TURNAROUND TIMES

NHS GRAMPIAN TOXICOLOGY TURNAROUND TIMES

COPFS and the University of Glasgow agreed an Improvement Plan to reduce the toxicology waiting times. This plan defined performance targets and required the University of Glasgow to provide data to COPFS on a weekly basis. The required data was to highlight the laboratory’s progress with outstanding cases and new cases.

The Improvement Plan has been successful; the toxicology waiting times are now reduced and there is no delay in provision of those reports to the pathologists who require them to finalise the post mortem report.

An indication of the effectiveness of the improvement plan is that, in the week of 25 September 2020, there were 1351 open toxicology cases with University of Glasgow and in the week of 26 September 2021 there were 351 open toxicology cases.

In 2019 COPFS began to experience delays in the provision of toxicology reports from the University of Glasgow, the main contractor for this service. This was further compounded during 2020 due to the pandemic.

Once a toxicological report has been finalised, it is then considered by the pathologist(s) who conducted the post mortem, and thereafter a final post mortem report is issued to the appropriate team in COPFS, who require to review it in detail before the next of kin can be informed of the final cause of death.

Working with Glasgow University, COPFS put various measures in place to address both the backlog and the increasing number of new deaths requiring toxicological analysis. The measures included agreeing a new format of abbreviated report for some cases, and an Improvement Plan which set out weekly performance targets and ensured focused progression with both the backlog of cases and newly reported cases.

Successful implementation of the Improvement Plan in particular means that there is now no backlog of toxicology reports and toxicology analysis is being completed in the majority of cases within 8 weeks.

Ambulances are not single-crewed other than in exceptional circumstances, such as short notice unplanned staff absences, and every effort is made to double crew ambulances through rostered and relief staff, overtime or our bank staff.

Unfortunately as a result of COVID-19 there has been occasions where single crewing has had to be used as a result of late notice staff abstractions, however we are continuing to work with the Scottish Ambulance Service to reduce this where possible.

The following table outlines the number of single crew shifts, not ambulances each year since 2017/18.

The Scottish Government is committed to the early detection of cancer. We are in currently in the process of establishing Scotland’s first Early Cancer Diagnostic Centres which will see the creation of a person-centred fast-track pathway for patients with non-specific symptoms (i.e. weight loss, nausea, fatigue) suspicious of cancer. These centres have been in operation since June 2021 and are continually taking patients with plans for equitable access across Scotland over the course of this parliament.

An estimate of the number of patients who have missed an early diagnosis of melanoma can be made by using data from the Public Health Scotland (PHS) Covid Wider Impacts Dashboard ( https://scotland.shinyapps.io/phs-covid-wider-impact/ ). The data indicates there were a total of 1,131 individuals with pathologically confirmed specimens for malignant melanoma of the skin between 1 April 2020 and the week ending 21 st February 2021. This was 398 individuals fewer than in the same period one year before.

Therefore, the data suggests there have been around 400 fewer melanoma diagnoses overall during the time of the COVID-19 pandemic.

To date 791 paramedics have been recruited. Another 126 will come on stream in 4 months with more than 100 joining in early 2022.

Covid-19 has resulted in some delays to recruitment which will push the achievement of this commitment out to 2022 but revised plans indicate a high level of confidence in achieving this.

With increasing A&E attendances, demand and capacity concerns and the impact of Covid-19, it is important that we ensure the NHS is equipped with the resources it needs to meet the challenges of the future. By investing in a professional, highly skilled ambulance workforce, this will help deliver a better service for patients all across Scotland.

The Scottish Government recognises vaccines approved for use in the UK regardless of where they were administered to determine whether a person has completed their primary dose or whether they require additional doses to be fully vaccinated.

Those who have been vaccinated out-with the Common Travel Area (CTA) should obtain proof of their vaccination status from the country they received their vaccination. For domestic certification purposes, we will accept proof of vaccination from across the UK and Crown Dependencies as well as from members of the EU Digital Covid Certificate Scheme.

For those who have proof of vaccination status from out with the CTA and the EU, domestic certification rules for international visitors will align with current border rules. Visitors from international countries out-with the CTA and EU scheme will require to provide the same proof of vaccination status that is accepted for entry to the UK.

Those who have received a final dose of a UK approved vaccine in Canada at least 14 days before travel are currently recognised as fully vaccinated and can use their proof of vaccination for domestic certification purposes. More information on this can be found at: Coronavirus (COVID-19): international travel and managed isolation (quarantine) - gov.scot (www.gov.scot) .

GP practices are independent contractors and therefore decisions relating to telephony are at their discretion. On top of practices’ core funding allocation, the Scottish Government is making an additional £600,000 funding available this year for the Health Boards to allocate to GP practices for the purpose of upgrading or replacing telephony systems.

We have worked closely with a range of delivery and partner organisations to prepare, plan and respond to a range of issues and risks which may impact on NHS services. Planners and officials are using a range of modelling and intelligence to minimise potential impact of COP26 and to help protect NHS services across our communities.

Our planning has also used the experience and learning from previous large-scale events in Scotland, the UK and internationally including previous UN COP summits .

The Scottish Government publishes a weekly Research Findings which models the COVID-19 epidemic in Scotland. The Research Findings includes a section which estimates infections, as well as hospital and ICU bed demand from COVID-19. This gives an assessment of the impact of COVID-19 on the NHS in the next few weeks. This will provide information in the run up to COP26 and after the event has taken place.

The publications can be found on the Scottish Government website at the following link:

https://www.gov.scot/collections/coronavirus-covid-19-modelling-the-epidemic/