Chamber and committees

The antenatal booking appointment is usually the first contact point between the primary or named midwife and pregnant women. We expect all women to have an initial assessment of their health, obstetric and social needs completed, and be offered appropriate screening referrals and other care options by the 12th full week of pregnancy.

The Scottish Government Local Delivery Plan standard for early access to antenatal care states that at least 80% of pregnant women in each Scottish Index of Multiple Deprivation (SIMD) quintile will have booked for antenatal care by the 12th week of gestation. This standard has been met or exceeded consistently since 2013-14. Public Health Scotland published its latest annual statistical report on antenatal booking, Antenatal Booking in Scotland , in March 2023, which shows that 92.8% of pregnancies were booked by 12 weeks in the year ending 31 December 2022.

During the first trimester, all mainland NHS Boards within Scotland are able to offer surgical abortions, although access to surgical abortion is limited in some Health Board areas.

Currently no Health Board in Scotland is able to provide second trimester surgical abortions; if a patient is unable to access a medical abortion locally in the second trimester (over 20 weeks’ gestation), their Health Board will refer them to a service in England for treatment.

All mainland Health Boards now offer abortions for all patients up to at least 20 weeks’ gestation in line with the recommendations in the 2022 Healthcare Improvement Scotland Sexual Health Standards.

The abortion statistics for England and Wales show that from January to June 2022, 19 patients resident in Scotland were treated in England or Wales who were over 20 weeks’ gestation and 5 patients who were between 13 and 19 weeks’ gestation. It is not possible to confirm how many of those patients sought treatment in England or Wales by choice and how many were referred there by their Health Board.

We understand that there will be rare occasions where waiting times mean that women under 20 weeks’ gestation are required to travel to England as they would not be able to access the service in Scotland before 20 weeks. We are working with BPAS to seek data on this, but the majority of patients needing to travel are over 20 weeks.

We continue to encourage Health Boards to ensure that patients close to 20 weeks’ gestation are prioritised for appointments.

The great majority of abortions in Scotland are early medical abortions, where one or both medications are taken at home. These patients do not require bed spaces. Only a small minority of abortion patients require inpatient treatment, mostly as a day patient.

Whilst factors, including access to a bed, may sometimes cause a delay, Health Boards do their best to ensure patients can access abortion treatment as quickly as possible.

The COVID-19 pandemic has impacted on all NHS services to an extent, including abortion services.

The Scottish Government is committed to improving access to abortion services and the Women’s Health Plan includes a range of measures which aim to achieve this. Several abortion-related actions within the Women’s Health Plan have been progressed, including:

• making telemedicine consultations a permanent option for patients,
• continuing to allow women under 12 weeks’ gestation to take mifepristone and misoprostol at home where that is clinically appropriate and also now allowing women to take mifepristone at home at later gestations in certain circumstances,
• ensuring patients are offered the progestogen-only pill with their abortion medications, and
• working with stakeholders and Gillian Mackay MSP to introduce the Abortion Services (Safe Access Zones) (Scotland) Bill into the Scottish Parliament.

The Scottish Government commissioned NHS National Services Scotland (NSS) to develop a specification to deliver a national service for abortions between 20 to 24 weeks gestation within Scotland. NSS has been discussing its specification with NHS Boards and is also exploring other delivery options for the service. We anticipate that the long-term action within the Plan to review the provision of abortion services in Scotland will be considered as part of the forthcoming review of abortion law.

The Scottish Government is committed to its obligations under the Article 5.3 of the WHO Framework Convention on Tobacco Control.

In line with the WHO Guidelines for implementation, the Scottish Government Tobacco Control Team is undertaking a number of measures to support compliance. This includes, but is not limited to:

• Continuing to raise awareness of Article 5.3 across Scottish Government, Local Government and related bodies.
• Asking consultation respondents to make a declaration of any links to the Tobacco Industry within tobacco and vaping consultations, including the 2022 consultation on tightening rules on advertising and promotion of vaping products. and the recent 4-nations consultation on mandating quit information messages inside tobacco packs.
• Sharing UK Government guidance on engagement with the tobacco industry with internal and external stakeholders.

Further information on implementation of Article 5.3 will be included in our refreshed Tobacco Action Plan which will publish later in autumn.

The Social Care (Self-directed Support) (Scotland) Act 2013: statutory guidance states that if a supported person is dissatisfied with their care, their local authority should make the person aware that they can make use of the local authority's complaints procedure.

Supported people, their families and carers have the right to access a simple, timely and accessible formal complaints procedure if they feel they have been unfairly or unreasonably treated, or if they wish to challenge a decision that the local authority has made about their support. Local authority complaints processes therefore must be compliant with the 2013 Act.

The Social Care (Self-directed Support) (Scotland) Act 2013 (2013 Act) Statutory Guidance states that:

“The Statutory Guidance accompanying the Public Bodies (Joint Working) (Scotland) Act 2014 sets out guidance for effective commissioning and procurement processes, including the putting in place of procurement plans providing specific detail to direct those responsible for contracting services.

In addition, best practice guidance on the procurement of care and support services provides further guidance on how procurement considerations can support SDS, where a public contract is the chosen form for funding social care provision.

The authority should seek to use the flexibility within the procurement regulatory regime to meet the legal duties of the 2013 Act. Local authorities should consider how best to develop a procurement strategy that ensure that the ability to ‘self-direct’ is not lost, and that the number of providers is not reduced unnecessarily.

If a supported person chooses to use option one and receive a direct payment they may then also choose to employ a personal assistant. The Social Care (Self-Directed Support) (Scotland) Act 2013 Statutory Guidance states that, of the four SDS options, "Option 1 requires a level of responsibility that is greater than some of the other options. The local authority should make this point clear to the supported person. It should be transparent but it should also be supportive, explaining the additional support and information that can make the direct payment work for the supported person. The authority should ensure the supported person is offered independent advice and support where appropriate."

As part of their duty of care, the authority social worker should explain direct payment responsibilities to the supported person, relatives and relevant circles of support where applicable. They should also explain the additional support and information that the person can receive in order to manage their payment.