Chamber and committees

We are continuing to invest in social care. Over the past decade a significant amount of work and investment has gone into supporting older people and people with disabilities to live well in their own homes for longer.

Integration authorities manage £9 billion of funding that was previously managed separately by health boards and councils. In 2019-20 we are increasing our package of investment in social care and integration to £711 million, an increase of 29% on last year.

We know that change is needed in social care support and that is why on 12 June, the Scottish Government launched a national programme to support local reform of social care support. It is being jointly led with COSLA, whose members are responsible for delivering and procuring these vital public services.

The Scottish Government is in regular dialogue with the Coalition of Care and Support Providers in Scotland (CCPS) and Scottish Care on a range of issues, including contracting, and they have had a central role in shaping the work that is required to improve the support and care that people require. CCPS and Scottish Care are members of the Ministerial Strategic Group for health and community care (MSG) charged with delivery of joint SG/COSLA review of integration and the reform of adult social care.

The Scottish Government is continuing to invest in integration and social care. In 2019-20 Integration Authorities will manage over £9 billion of funding which was previously managed separately by health boards and councils. We are increasing our package of investment in social care and integration to £711 million, an increase of 29% on last year, underlining our commitment to supporting older people and disabled people and to paying staff the real living wage.

This information is not held by Scottish Government but is held locally by integration authorities and local government who are responsible for commissioning and procuring local social care services. The Scottish Government is in regular dialogue with the Coalition of Care and Support Providers in Scotland (CCPS) and Scottish Care on a range of issues, including contracting and sustainability, and they have had a central role in shaping the work that is required to improve the support and care that people require.

This was a survey undertaken of 3680 people from 30 medical schools across the UK and is not clear how many of them were from Scotland.

The Increasing Undergraduate Education in Primary Care Group, chaired by Dr John Gillies, was set up to make recommendations on increasing undergraduate education in primary care. Currently only around 9% of the clinical curriculum is taught in primary care and the aim of the group was to consider how this could be increased.

The group will publish its report later this summer, setting out its recommendations.

The Scottish Government has population surveys underway to understand the prevalence of childhood adversities in the adult population (with inclusion of ACEs questions in the current 2019 Scottish Health Survey) and in the child population (with information on a range of adversities and resilience measures collected in the Growing Up in Scotland (GUS) study and due to be collected in the new Health and Wellbeing Census from 2020). We do not have any plans to introduce a programme of ACEs screening nor do we advocate “ACE scoring” of individuals to determine need or predict outcomes.

We are progressing a wide range of actions to prevent ACEs and support children, as well as adults, negatively impacted by adversity and trauma. Under the Getting it right for every child approach (GIRFEC), services working together with families, children and young people should consider and assess wellbeing needs based on eight indicators of wellbeing and can also draw on the GIRFEC National Practice Model, which provides a framework to understand a child or young person's circumstances (including risks and effects of adversity) and consider what support they might need. We are also working with NHS Education for Scotland (NES) to implement a National Trauma Training Programme to enable the Scottish workforce (interacting with children and/or adults) to understand adversity and trauma and work in ways which minimise distress, overcome barriers and build trust.

As part of plans to progress trauma-informed approaches and to better support adults impacted by adversity and trauma, we are supporting NHS Health Scotland to undertake a pilot of ACE Enquiry in primary care settings (five Deep End GP practices). ACE Enquiry is a process where trained practitioners sensitively encourage optional disclosure of ACEs by adults as part of a trauma-informed and person-centred service to inform the most appropriate treatment and support, where required. ACE Enquiry is usually distinguished from health screening programmes, which typically involve testing to identify a specific condition or disease within a population or patient cohort and, where identified, offer the relevant information and further tests or treatment. The emphasis with ACE Enquiry, however, is on understanding people’s experiences and discussing with the individuals whether and how any childhood adversities impact on the individual’s life now, whether support or help is needed, and if so, discussing the most appropriate options.

Evaluations of ACE Enquiry (undertaken to date outside of Scotland) have found that the enquiry process is acceptable to the practitioners and adults involved. Evaluations have also found that people reporting ACEs typically do not require further support from services, but further work is needed to more fully measure the impact of enquiry on service demand and individual health outcomes. There is also some tentative evidence to show that where individuals identify and recognise the impact of childhood adversity and trauma on their lives, that this can empower them to make positive life changes for themselves and their families. The Scottish Government recognises that the evidence base regarding ACE Enquiry is still developing, but supports testing of its potential and further development of the evidence. The NHS Health Scotland pillot will be evaluated and will contribute to the evidence about how practitioners can work with an understanding of an individual’s life story to inform and improve their care.

I refer the member to the answer to question S5W-23801 on 27 June 2019. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

I refer the member to the answer to question S5W-23801 on 27 June 2019. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

A Ministerial statement on the Tackling Child Poverty Delivery Plan, First Year Progress Report, was provided to Parliament on Wednesday 26 June.

The progress report is available on the Scottish Government's website, https://www.gov.scot/publications/tackling-child-poverty-delivery-plan-first-year-progress-report-2018-19 .

The Scottish Government is committed to improving the safety of cyclists and pedestrians as set out in Scotland’s Road Safety Framework. All roads authorities have a duty of care to ensure that infrastructure installed is safe and fit for purpose, and we are actively working with local authorities through Sustrans and Cycling Scotland to ensure that the infrastructure being delivered as part of the Active Travel budget is delivered to the highest standard to help make walking, cycling and wheeling a safe and realistic choice for everyday journeys. It is for individual local authorities to ensure the safety of the roads and other transport infrastructure for which they are responsible.

The Scottish Government is determined to do all that it can to prevent childhood adversity and to support children and adults affected by adversity. As part of the Getting it Right for Every Child (GIRFEC) approach, we are progressing actions to better prevent childhood adversity and support children and young people negatively affected. In addition, we are progressing actions to better support adults impacted by early life adversity and trauma.

The term ACEs was originally developed in the US in the 1990s in a survey of adults which explored the health impacts of adverse childhood experiences. The findings from this survey, and ACE surveys undertaken in other countries including in England and Wales, provide a helpful evidence base for understanding, at a population level, the impact of childhood adversity on a range of health and wellbeing outcomes in adulthood.

The substantial evidence from ACEs surveys undertaken internationally has a well proven central premise that adversity in childhood, especially in multiple forms, has significant potential to impact on developmental and longer-term outcomes. It is this clear finding from the ACEs research, along with other sources of evidence, which is informing Scottish Government policy to address childhood adversity. We do not regard this as adherence to a “standard model” which prescribes a certain approach or activity.

The Scottish Government recognises that actions to address ACEs require both support for individuals and families (in particular supportive relationships), as well as action to address the societal and structural factors that give rise to or contribute to childhood adversity. We take this forward as part of the GIRFEC agenda. Our approach is therefore framed within broader work to reduce poverty and inequalities, including societal women’s inequality. There are a wide range of policies in place to address these including the Child Poverty Act and Equally Safe, the delivery plan to prevent and eradicate violence against women and girls. It is in this broad context that we are working across all areas of Government and with partner organisations to prevent and respond to adverse childhood experiences. Furthermore, the Scottish Government does not limit action on childhood adversity to the 10 most commonly cited ACEs. We are adopting an approach which seeks to address the wide range of adversities which can cause toxic stress and potentially have a detrimental impact on people’s lives, including, for example, bereavement, bullying, community violence and homelessness.

While the ACE population surveys show that childhood adversity is a risk factor for a range of poorer outcomes as an adult, we are clear that childhood adversity does not automatically equate with negative outcomes at an individual level. Our commitment to address childhood adversity is about recognising the well-established risks at a population level, seeking to prevent that adversity as far possible and, where it does occur, to provide support to individuals affected to minimise any negative impacts.

Key to addressing childhood adversity is developing a trauma informed and responsive workforce across Scotland, capable of recognising where people are affected by trauma and adversity, capable of responding in ways that prevent further harm and which supports recovery, and in ways which address inequalities and improve life chances. This trauma-informed approach goes beyond any single model or study. The Scottish Government has committed £1.35m over three years to design and deliver a National Trauma Training Programme coordinated by NHS Education for Scotland (NES). The Programme is founded on the Transforming Psychological Trauma: Knowledge and Skills Framework (2017), which was informed by a wide range of evidence and consultation, including the views of people with lived experience of trauma. The framework lays out the essential and core knowledge and skills required by all tiers of the Scottish workforce to ensure that the needs of children and adults who are affected by trauma are recognised, understood and responded to in a way which recognises individual strengths, acknowledges rights and ensures timely access to effective care, support and interventions for those who need it.