Wednesday 1 July 2015 SCOTTISH GOVERNMENT Enterprise and Environment Mary Scanlon (Highlands and Islands) (Scottish Conservative and Unionist Party) To ask the Scottish Government what funding it provides to the Scottish Environment Protection Agency to carry out site inspections following onshore energy developments. (S4W-26158) Aileen McLeod: Scottish Environment Protection Agency (SEPA) activities are funded through a combination of grant-in-aid support and charging to recover economic costs of its regulatory actions. These support SEPA’s delivery of its statutory obligations with regard to the delivery of the relevant regulatory requirements.

Murdo Fraser (Mid and Fife) (Scottish Conservative and Unionist Party): To ask the Scottish Government what steps it has taken to ensure that the Scottish Environment Protection Agency is adequately resourced and equipped to determine permit applications and oversee underground coal gasification projects. (S4W-26246) Aileen McLeod: The Scottish Environment Protection Agency (SEPA) is funded by a combination of grant-in-aid received from the Scottish Government and charging income recovered from regulated activities. The Scottish Government regularly monitors SEPA’s performance against its corporate plan targets and assesses resource needs to implement environmental legislation and other objectives as part of this dialogue.

Christine Grahame (Midlothian South, Tweeddale and Lauderdale) (Scottish National Party): To ask the Scottish Government whether it plans to review the Protection of Wild Mammals (Scotland) Act 2002. (S4W-26324) Aileen McLeod: The Scottish Government has no plans at present to review the Protection of Wild Mammals (Scotland) Act 2002. Health and Social Care Bruce Crawford (Stirling) (Scottish National Party): To ask the Scottish Government how many (a) singleton and (b) multiple pregnancies each (i) hospital and (ii) NHS board has dealt with in each of the last 10 years. (S4W-26150) Maureen Watt: The Scottish Government does not hold this data, however, NHS National Services Scotland has provided this data in the following tables: Maternities1 that resulted in singleton births in the last 10 years, by health board of residence2 and hospital of birth3 Financial year ending 31 March i) Hospital of birth by financial year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Aberdeen Maternity Hospital 3951 4070 4064 4417 4577 4705 4877 4783 4931 4984 Aboyne Hospital 35 60 62 81 64 60 77 59 2 0 Arbroath Infirmary 81 83 98 180 168 157 115 115 108 88 Ayrshire Central and Maternity Hospital 3406 3471 3461 1755 0 0 0 0 0 0 Balfour Hospital 96 127 136 140 133 144 128 126 139 143 47 35 52 44 35 39 36 32 37 43 Borders General Hospital 986 993 966 1079 1119 1178 1186 1164 1107 1148 General Hospital 224 205 223 212 254 250 148 160 182 188 2 8 17 16 13 14 20 18 25 16 Financial year ending 31 March 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Chalmers Hospital 38 53 45 76 10 9 3 0 0 0 Crosshouse Hospital 0 0 0 1881 3698 3723 3635 3734 3689 3497 Dalrymple Hospital 75 36 0 0 0 0 0 0 0 0 Dr. Gray's Hospital 848 954 942 998 1103 1143 1147 1031 1038 1048 Dumfries and Galloway Royal Infirmary 1223 1270 1287 1328 1324 1285 1329 1289 1262 1247 Dunoon and District General Hospital 31 33 37 27 35 30 38 33 32 19 Falkirk and District Royal Infirmary 446 0 0 0 0 0 0 0 0 0 Forth Park Maternity Hospital 3063 3243 3266 3443 3619 3726 3682 3667 3689 3429 Forth Valley Royal 0 0 0 0 0 0 0 0 2293 3101 Fraserburgh Hospital 74 59 64 76 69 28 6 45 21 28 Galloway Community Hospital 0 0 0 2 84 93 84 80 83 60 Garrick Hospital 0 39 73 70 7 0 0 0 0 0 Gilbert Bain Memorial Hospital 157 154 128 163 131 143 157 147 141 179 Inverclyde Royal Hospital 536 89 101 86 97 94 110 67 64 44 , Bowmore 1 2 0 0 2 1 2 2 1 1 Isle of Arran War Memorial Hospital 6 7 8 5 1 6 2 3 5 1 Jubilee Hospital, Huntly 26 0 0 0 0 0 0 0 0 0 Kincardine O'Neil War Memorial Hospital 7 0 0 0 0 0 0 0 0 0 Lorne and Islands District General Hospital, Oban 53 33 21 10 15 24 28 38 39 15 Mackinnon Memorial Hospital 7 17 20 13 23 18 27 20 18 19 Mid Argyll Hospital 15 20 13 2 0 0 0 0 0 0 Mid-Argyll Community Hospital 0 0 0 6 17 17 18 15 11 14 Montrose Royal Infirmary 111 124 158 181 202 216 204 172 198 183 New Royal Infirmary of Edinburgh 5763 5609 5821 5953 6478 6595 6292 6546 6706 6437 Ninewells Hospital 2957 3415 3515 3157 3896 3903 3848 3826 3968 3752 Perth Royal Infirmary 1106 398 189 343 303 256 330 367 308 290 Peterhead Cottage Hospital 96 110 117 141 171 173 190 151 148 154 0 0 0 0 0 0 0 1 0 1 Princess Royal Maternity Hospital 5071 5278 4893 5232 5508 5667 5902 6113 6238 5999 1754 1845 1841 1869 1960 2120 2066 2122 2086 2028 Royal Alexandra Hospital 2278 3152 3029 3187 3326 3447 3465 3481 3558 3567 Southern General Hospital 2787 2930 2975 3036 3306 3281 3775 5598 5632 5479 St. John's at Howden, Livingston 2628 2707 2635 2738 2922 2880 2905 2849 2717 2605 Stirling Royal Infirmary 2435 3061 3080 3144 3246 3167 3228 3133 842 0 The Ayr Hospital 1 0 0 0 0 0 0 0 0 0 The Queen Mother's Hospital 3799 3332 3437 3284 3378 3171 2362 0 0 0 Uist and Barra 2 1 0 0 0 0 0 0 0 0 Vale of Leven District General Hospital 45 54 65 73 89 97 113 83 104 95 Victoria Hospital, Rothesay 12 17 16 12 16 13 11 11 6 8 Western Isles Hospital 202 175 175 237 213 201 179 178 206 195 Wishaw General Hospital 4588 4648 4437 4776 4695 4802 4675 4777 4871 4692 Other4 1 4 27 17 3 0 0 0 0 0 Scotland 51070 51921 51494 53490 56310 56876 56400 56036 56505 54797

ii) Health board of residence by financial year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Ayrshire and Arran 3521 3540 3551 3711 3766 3803 3673 3784 3729 3542 Borders 970 983 939 1022 1044 1075 1050 1048 985 1008 Dumfries and Galloway 1290 1348 1355 1405 1411 1374 1417 1373 1346 1305 Fife 3534 3661 3650 3797 4035 4108 4055 4049 4068 3804 Forth Valley 2909 3065 3051 3146 3253 3191 3210 3125 3101 3004 ii) Health board of residence by financial year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Grampian 5002 5221 5214 5689 5923 6046 6209 5996 6011 6082 Greater Glasgow and Clyde 12506 12801 12540 12773 13657 13684 13705 13479 13725 13442 2726 2809 2812 2826 2922 3144 3003 3012 3023 2894 Lanarkshire 5879 5988 5687 6140 6089 6139 6021 6020 6076 5837 Lothian 8146 8067 8231 8473 9192 9255 8956 9127 9226 8913 Orkney 149 178 180 200 192 199 185 185 197 198 Shetland 220 224 222 258 211 245 275 239 240 276 Tayside 3852 3723 3699 3617 4240 4209 4196 4167 4266 3980 Western Isles 238 211 214 271 242 237 214 204 245 232 Scotland5 51070 51921 51494 53490 56310 56876 56400 56036 56505 54797 1 - Excludes home births and births at non-NHS hospitals. 2 - Health board 2006 boundaries 3 - Over the 10 year period some hospitals have closed, transferred services or are new-builds, and therefore may not be represented every year. 4 - Other includes a small number of cases where a birth occurs at home or en route to hospital and then a subsequent admission to hospital occurs. In general, SMR02 excludes home births. 5 - Scotland data includes births where NHS board of residence is unknown or outside Scotland. Includes live and still births IR2015-01223/S4W26150 Source: SMR02

Maternities1 that resulted in multiple births in the last 10 years, by health board of residence2 and hospital of birth3 Financial year ending 31 March i) Hospital of birth by financial year 2005 2006 2007 2008 2009 2010 2011 2012 2013 Aberdeen Maternity Hospital 80 63 87 94 74 88 83 80 89 84 Ayrshire Central and Maternity Hospital 51 63 55 20 0 0 0 0 0 0 Balfour Hospital 1 0 0 0 0 0 0 0 0 0 Borders General Hospital 9 26 13 16 13 12 18 14 22 13 Caithness General Hospital 0 0 0 0 0 0 0 1 1 1 Crosshouse Hospital 0 0 0 33 62 49 55 59 45 55 Dr. Gray's Hospital 10 2 8 4 12 14 7 10 12 9 Dumfries and Galloway Royal Infirmary 16 18 16 24 22 13 25 14 18 24 Falkirk and District Royal Infirmary 7 0 0 0 0 0 0 0 0 0 Forth Park Maternity Hospital 43 47 49 44 53 72 70 54 44 57 Forth Valley Royal 0 0 0 0 0 0 0 0 34 38 Garrick Hospital 0 0 1 0 0 0 0 0 0 0 Inverclyde Royal Hospital 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Lorne and Islands District General Hospital, Oban 0 1 0 0 0 0 0 0 0 0 New Royal Infirmary of Edinburgh 107 108 106 101 124 121 115 120 114 93 Ninewells Hospital 79 34 36 47 80 81 95 67 75 71 Perth Royal Infirmary 0 0 1 5 2 0 0 0 0 0 Princess Royal Maternity Hospital 97 87 88 90 104 98 107 128 95 101 Raigmore Hospital 35 25 25 31 31 38 26 38 38 27 Royal Alexandra Hospital 35 48 62 45 44 52 58 63 51 53 Southern General Hospital 36 38 50 45 65 43 60 103 82 83 St. John's at Howden, Livingston 34 27 30 41 46 36 50 37 35 18 Stirling Royal Infirmary 32 37 54 41 40 61 60 49 9 0 The Queen Mother's Hospital 77 57 55 72 51 40 34 0 0 0 Western Isles Hospital 3 2 3 3 4 3 3 3 0 3 Wishaw General Hospital 66 72 62 70 86 79 68 83 65 68 Scotland 821 755 801 826 913 901 934 923 829 798 1 - Excludes home births and births at non-NHS hospitals. 2 - Health board 2006 boundaries 3 - Over the 10 year period some hospitals have closed, transferred services or are new-builds, and therefore may not be represented every year. 4 - Other includes a small number of cases where a birth occurs at home or en route to hospital and then a subsequent admission to hospital occurs. In general, SMR02 excludes home births. 5 - Scotland data includes births where NHS board of residence is unknown or outside Scotland. Includes live and still births IR2015-01223/S4W26150 Source: SMR02 Background Notes – Recommended not for publication- please discuss with Information Services Division (ISD) before publishing. Data are sourced from the Scottish Morbidity Record 02 (SMR02) submitted by maternity hospitals to ISD. There is no legal requirement to submit SMR02 data to ISD. Live and still births are included on SMR02.

Bruce Crawford (Stirling) (Scottish National Party): To ask the Scottish Government how many complaints regarding maternity care involving (a) a singleton or (b) multiple pregnancy in Scotland (i) Healthcare Improvement Scotland, (ii) the General Medical Council, (iii) the Nursing and Midwifery Council and (iv) each hospital has received in each of the last 10 years. (S4W-26152) Maureen Watt: Healthcare Improvement Scotland has received one complaint regarding maternity care in the last 10 years. It was regarding a singleton pregnancy in 2014. The Scottish Government does not hold the information to answer parts (ii) and (iii). The Scottish Government cannot supply the number of complaints broken down by singleton or multiple pregnancy or by hospital, however NHS National Services Scotland has provided information on the number of complaints by NHS boards for the last 10 years. Number of complaints1 received for Hospital and Community Health Services2 by NHS Board and Maternity Service Area: 2004/05 to 2013/14 NHS Board Area Number of complaints by Maternity Service Area 2004- 2005- 2006- 2007- 2008- 2009- 2010-11 2011-12 2012-13 2013-14 05 06 07 08 09 10 Scotland 128 148 195 177 217 209 241 219 199 199 Argyll and Clyde3 6 2 Ayrshire and 11 6 6 7 2 21 16 13 14 14 Arran Borders 2 5 3 4 1 1 - 2 2 1 Dumfries and 5 10 8 12 4 7 4 5 5 10 Galloway Fife 0 1 4 10 14 10 17 7 7 1 Forth Valley 7 11 5 2 18 19 10 4 7 16 Grampian 28 34 38 28 26 32 40 60 68 71 Greater 19 13 Glasgow3 Greater Glasgow 20 22 49 47 70 68 33 18 and Clyde3 Highland3 16 11 3 4 10 5 10 15 11 15 Lanarkshire 11 6 26 6 15 2 - - 3 1 Lothian 21 39 69 56 50 46 54 41 32 31 Orkney 0 0 0 0 0 - 1 1 1 1 Shetland 0 1 0 1 0 1 1 - 3 - Tayside 1 8 12 24 27 17 16 1 11 19 Western Isles 1 1 1 1 1 1 2 2 2 1 Source: Information Services Division (ISD Scotland) NHSScotland complaints: Data provided from NHS boards and compiled by ISD Scotland. Data as at July 2014 and may be subject to change in future reporting. 1 In the NHS complaints procedure, a complaint is defined as 'an expression of dissatisfaction requiring a response'. Citizen's Charter Complaints Task Force. The number of complaints includes complaints still open i.e. complaints which have not yet been completed within the reporting period but excludes complaints withdrawn i.e. not taken forward, consent not received, and complaints which have been transferred to another NHS board, division, service or national support organisation. 2 Hospital and Community Health Services only (excludes complaints relating to family health services, special NHS boards and national and support organisations). 3 Argyll and Clyde: Following the dissolution of Argyll and Clyde health board in April 2006, the number of complaints for Argyll and for Clyde regions are now shown under Highland and Greater Glasgow and Clyde respectively. ‘-‘ denotes zero i.e. nil data/records.

Bruce Crawford (Stirling) (Scottish National Party): To ask the Scottish Government how many multiple pregnancy-related patient safety incidents have been reported in each (a) hospital and (b) NHS board in each of the last 10 years and what the cause was in each case. (S4W-26153) Maureen Watt: The Scottish Government does not hold information on multiple pregnancy related patient safety incidents at hospital or NHS board level. We expect that all NHS health boards in Scotland have in place effective systems to support review of and learning from patient safety incidents locally to ensure women and babies have safe and effective care. The Maternity and Children’s Quality Improvement Collaborative established by the Scottish Government in 2013 aims to reduce avoidable harm in maternity, neonatal and paediatric care by 30% by 2015, as defined by reference to specific criteria. It is already making significant progress in improving services and keeping safety at the top of the agenda. The Scottish Perinatal Infant Mortality and Morbidity Report 2012 outlines on page 12 the outcomes for registered twin pregnancies: http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal__child/reproductive_ health/spimmr_2012.aspx The Maternal, Newborn and Infant Clinical Outcome Review Programme published the first of a series of reports aimed at learning lessons to inform maternity care in December 2014, and its perinatal audit in June 2015. The Scottish Government has established an expert group to consider these reports and make recommendations for actions for Scotland.

Bruce Crawford (Stirling) (Scottish National Party): To ask the Scottish Government what steps it is taking to support (a) research into (i) still births and (ii) neonatal deaths and (b) the dissemination of clinical best practice in relation to multiple pregnancies. (S4W-26154) Maureen Watt: (a) Research: The Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorate supports and promotes high quality research aimed at improving the quality and cost-effectiveness of services offered by NHSScotland and securing lasting improvements to the health of the people of Scotland. CSO invests directly in research projects through its response mode funding system, which relies on high quality research applications being made by the research community with proposals funded on the basis of scientific excellence. This system covers research across a very broad range of areas of health and would include consideration of research proposals into stillbirth and neonatal death. Proposals to CSO funded fellowship schemes could also include research in these areas. In addition, CSO contributes financially to National Institute for Health Research (NIHR) research programmes in order that researchers based in Scotland can lead applications to these health research programmes, and again applications to these programmes could include research proposals in these areas. CSO Response Mode Grant Funding: The CSO grant funding initiatives financial support for 31 research projects has been provided since June 2009 in areas of maternal, fetal and/or neonatal health. Funding of £2.9 million has so far been provided in relation to these projects. The CSO has funded stillbirth research being led by the University of Edinburgh; AFFIRM (Can Promoting Awareness Fetal movements and Focussing Interventions Reduce Fetal Mortality), which is a stepped wedge cluster randomised trial. Sands, Tommy’s and SiMBA have also contributed to the study which is aimed at reducing stillbirth rates. The Scottish Government has also given Sands £25,000 to be allocated to their UK-wide Research Fund for 2015/16. National Institute for Health Research (NIHR) Research Programme Funding The estimated 2015-2016 contribution to the NIHR Research programmes is £10.1 million. There are currently eight projects led by Scottish institutions with a current total cost of £10.5 million. Reproductive Health & Childbirth Specialty Group: The funding provided in 2015-2016 is £22,000.

(b) Clinical best practice in relation to multiple pregnancies. Evidence based advice on the care of women with multiple pregnancies is set out in the following: -The National Institute for Health and Care Excellence clinical guidelines Multiple Pregnancies – The management of twin and triplet pregnancies in the antenatal period. In line with these guidelines, we would expect clinical care for women with twin and triplet pregnancies to be provided by a nominated multidisciplinary team consisting of a core team, including named specialist obstetricians, who have experience and knowledge of managing twin and triplet pregnancies; and The Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives, Royal College of Anaesthetists and Royal College of Paediatrics and Child Health report on Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour (2007). This report sets out the essential minimum staffing standards required to support women in labour and provide safe care for them and their babies.

Bruce Crawford (Stirling) (Scottish National Party): To ask the Scottish Government whether its review of delivering best quality care for mothers and babies will look at the care received by families who have a (a) high risk and (b) multiple pregnancy. (S4W-26155) Maureen Watt: The Scottish Government’s review of maternity and neonatal care aims to examine choice, quality and safety of maternity and neonatal services in light of current evidence and practice, in consultation with the workforce, NHS boards and service users and make recommendations for a Scottish model of care that contributes to the government's aims of patient centred care which provides the right care for every woman and baby every time and giving all children the best start in life.

Jim Hume (South Scotland) (Scottish Liberal Democrats): To ask the Scottish Government, further to the answer to question S4F-02890 by Nicola Sturgeon on 18 June 2015 (Official Report, c.20), what action it is taking to raise awareness of the dangers of diabetes among (a) the general public and (b) people at increased risk of developing the condition. (S4W-26233) Maureen Watt: We want to ensure that people with diabetes are diagnosed as soon as possible and supported to manage their condition to minimise the risk of complications. This is reflected in our Diabetes Improvement Plan, published in November 2014, which includes the prevention and early detection of diabetes as one of its main priorities. The plan contains a specific action to develop and implement an appropriate framework for assessing the risk of diabetes for people currently undiagnosed to support early identification, diagnosis and treatment of diabetes. This framework will facilitate targeted lifestyle advice for those at highest risk and will be developed in line with the current evidence base including Scottish Intercollegiate Guideline Network guidelines 115 and 116. This work will complement our wider health strategy to address the underlying risk factors associated with diabetes by reducing obesity, encouraging healthy eating and promote healthier living across Scotland.

Christine Grahame (Midlothian South, Tweeddale and Lauderdale) (Scottish National Party): To ask the Scottish Government what its position is on expanding the use of the “Solitaire” stent in people who have had an ischaemic stroke. (S4W-26237) Maureen Watt: New treatments which may increase positive outcomes for people who have suffered an ischaemic stroke are to be welcomed. Trials in clot retrieval are important in order to build a strong evidence base to ascertain whether this treatment is safe and effective. We remain committed to exploring the options for this treatment, starting with looking at the trial evidence and the outcome of the assessment which we recently funded.

Richard Simpson (Mid Scotland and Fife) (Scottish Labour): To ask the Scottish Government how many young women per 10,000 HPV vaccinations have required referral for specialist assessment following vaccination. (S4W-26271) Maureen Watt: The information requested is not held centrally. However, as with all vaccines and medicines the Medicines and Healthcare products Regulatory Agency (MHRA) monitors and provides advice on the safety of the HPV vaccine in the UK. Since the introduction of the HPV vaccine in 2008 it has been used in millions of girls across the UK and around the world, and the MHRA continue to advise that the vaccine has a very good safety profile. The MHRA keeps the HPV vaccine under close and continual review and would take regulatory action if new evidence emerged which called into question the safety of the HPV vaccine or any other vaccine currently in use.