Professor Grant McIntyre, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of Edinburgh, said: “At a time when dentistry is under significant pressure, the details of a £350million underspend, representing 10 per cent of the total dental budget for England, is very concerning.
“This shortfall is undoubtedly directly impacting patients and dental teams nationwide.
“The disparity in underspend across different regions exacerbates an already troubling ‘postcode lottery’ in dental care access. It is evident that the current system is not working for patients or dentists, with some practices receiving unjustifiably little support.
“This will not only compromise patient care but also place undue strain on dental professionals, adding to the existing workforce problems that the profession has endured in recent years.
“We must rectify the underlying issues, ensuring suitable working arrangements for professionals and fair access to quality NHS dental care for all patients.”
The Scottish Children’s Services Coalition (SCSC),an alliance of leading providers of specialist care and education to vulnerable children and young people, has raised concerns over an increase in the number of pupils identified with additional support needs (ASN), amounting to over a third of the pupil population.
Set against a backdrop of budgetary cuts and an ongoing lack of support, it has called for increased resourcing to address this growing need, which is also having an impact on surging levels of classroom disruption and violence.
The SCSC has also voiced concerns over a declining number of those with complex needs receiving a co-ordinated support plan (CSP), the only education plans that are legal documents. This is despite a Scottish Government promise that there would be no decline in the numbers of those receiving them.
The figures were released yesterday (12th December) in the Scottish Government’s annual census of pupils and teachers in publicly funded schools.1
These show that the number of pupils with ASN, such as autism, dyslexia and mental health problems in 2023 has reached a record high of 259,036. This represents 36.7% of the pupil population, rising from 131,593 in 2013. 2 This represents almost a doubling (96.8%) in numbers over the past decade.
An increase in demand is however set against a background of spending cuts and a lack of specialist ASN teachers, support staff and the resources needed to support these children and young people.
This is exacerbated by the damaging ongoing impacts of Covid-19 lockdowns and the cost-of-living crisis, which have had a disruptive impact on many of those with ASN, who disproportionately come from the poorest backgrounds. There has also been an increase in those experiencing mental health problems.
The SCSC has also raised concerns over a decline in the number of those receiving a CSP. These are statutory education plans prepared by local authorities to identify and ensure the provision of services for children and young people with complex or multiple ASN.
The only education plans that are legally enforceable documents, CSPs require services such as education, health and social work to work together to give a child or young person the support they need. This provides some guarantees of entitlement to additional resources and legal redress, placing statutory duties on local authorities to review and ensure the provisions contained within it are being met.
Despite a Scottish Government promise that there would be no reduction in the proportion of pupils receiving them since their introduction in 2004, there has been a significant fall in the number of pupils with a CSP. Declining from 3,279 in 2013 3 to 1,318 in 2023 4, this amounts to a drop of 59.8%. and is a reduction from 2.5% to 0.5% of those with ASN.
The coalition has called for an expansion in access to CSPs, with the Scottish Government, local authorities, health and other relevant agencies collaborating more effectively to ensure that those requiring such a legal plan receive one.
This needs to be supported by the necessary resourcing, and increased awareness and understanding of CSPs by families or carers and professionals.
A spokesperson for the SCSC commented: “While more children and young people are being identified as having ASN, this is against the increasingly challenging backdrop of a lack of specialist teachers, support staff and the resources needed to support them.
“This is having an impact in terms of surging levels of school violence we are witnessing. Increased support is critical, especially post the Covid-19 pandemic and the damaging impact this has had on many of our children and young people, exacerbated by the cost-of-living crisis, all of which is hitting the poorest hardest.
“We are also concerned that despite an increase in the numbers of those with ASN we are experiencing a decline in the use of CSPs, which are legally enforceable and designed to support those with the most complex needs.
“The Scottish Government, local authorities, health and other agencies need to work in collaboration with the private and third sectors to provide the necessary resourcing and support to address the needs of children and young people with ASN. They must also work together to ensure that those who are entitled to a CSP receive one.
“With those with ASN drawn disproportionately from poorer neighbourhoods, if we are to genuinely close the educational attainment gap, they must get the care and support they need when they need it.”
Decline in the number of specialist ASN teachers by 546 since 2012
More than doubling in the number of pupils with additional support needs since 2012
The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of specialist care and education to vulnerable children and young people, has called for greater resourcing to support those with additional support needs (ASN).
The call comes as new figures from the Scottish Government’s annual teacher census indicate that while the number of specialist ASN teachers has fallen to a new low, the number of those pupils with ASN has soared to a record high.
Between 2012 and 2022 the number of ASN teachers (publicly funded primary, secondary, special and centrally employed) has fallen from 3,389 to 2,843, a decrease of 546 teachers, representing a cut of 16.1 per cent.1
This fall is against the background of an increase of 104.8 per cent increase between 2012 and 2022 in the number of pupils identified with ASN, from 118,011 to 241,639, amounting to 123,628 individuals. This includes those with mental health problems, learning disability, autism and dyslexia, and currentlyrepresenting more than a third of all pupils (34.2 per cent).2
Against a background of spending cuts and reduction in specialist support, the SCSC has called for greater resourcing from both the Scottish Government and local authorities to ensure that those with ASN, who are disproportionately drawn from poorer neighbourhoods, are getting the care and support that they need.
The coalition has also raised concerns about the effectiveness of a presumption of mainstreaming, meaning that all pupils are educated in a mainstream educational environment unless exceptional circumstances apply, without the necessary support.
A spokesperson for the SCSC commented: “It is vital that those with ASN get the care and support they need.
“This is also key if we are to genuinely close the educational attainment gap as we know that those with ASN are disproportionately drawn from poorer neighbourhoods. With cuts in support, including in the number of specialist teachers, it is going to be extremely challenging to reduce the current inequalities faced by those with ASN.
“While we also support the presumption of mainstreaming, which means that all children and young people are educated in a mainstream educational environment unless exceptional circumstances apply, it is clearly difficult to see how this is functioning properly given the fall in specialist support and increase in the number of those with ASN.
“The Scottish Government and local authorities need to work together to provide the necessary resourcing to address the needs of those children and young people with ASN, who represent some of the most vulnerable individuals in our society.”
Responding to the latest annual Scottish Stroke Figures, the Stroke Association has expressed concern that people in Scotland are much more likely to have a stroke than those in the rest of the UK.
The latest data from Public Health Scotland suggests that the incidence rate for stroke (adjusted for age and sex) has decreased by just 2.4% since 2012/13.
John Watson, Associate Director for the Stroke Association, said: “Stroke rates in Scotland are a third higher than for the UK as a whole. We need to see much faster progress if we are to reduce the devastating personal cost of stroke and bring Scotland more in line with its neighbours.
“Worryingly, this report shows that stroke incidence amongst men has actually increased slightly. And those in the most deprived areas are almost twice as likely to be discharged from hospital with a stroke, a gap that has widened in the last year.
“However, there is good news in the report too. Stroke mortality rates continue to decline, indicating that the standard of care and treatment provided by Scotland’s stroke community is helping deliver better outcomes for stroke patients. But even here, there is still much to do.
“We need to see concerted action to address Scotland’s unacceptably high stroke numbers. The Stroke Association is urging greater awareness of and action on atrial fibrillation, a form of irregular heartbeat that greatly increases stroke risk.
“Tens of thousands of people in Scotland are unaware that they have this condition so we urge everyone to check their pulse at home. If it doesn’t feel regular, then go and speak to your GP practice and they can advise on the range of treatments that can dramatically reduce stroke risk.”
The Scottish Children’s Services Coalition (SCSC),an alliance of leading providers of specialist care and education to vulnerable children and young people, has raised concerns over a sharp decline in the number of legally-binding education support plans for those with complex or multiple additional support needs (ASN).
So-called co-ordinated support plans (CSPs), prepared by local authorities, are the only education plans that are legal documents.
This provides some guarantees of entitlement to additional resources and legal redress, placing statutory duties on local authorities to review and ensure the provisions contained within it are being met.
Despite a Scottish Government promise that there would be no reduction in the proportion of pupils receiving them since their introduction in 2004, there has been a significant fall in the number of pupils with a CSP, from 3,448 in 2012 1 to 1,420 in 2021 2, amounting to a drop of 58.9%. This is a reduction from 2.9% to 0.6% of those with ASN, amounting to 0.2% of the pupil population.
A concern raised by the coalition is that councils are reluctant to issue CSPs due to the legal protections they afford, against the backdrop of a lack of resources to support these, with non-statutory alternatives often being offered in their place.
This sharp fall in the number of CSPs is against a background of a dramatic increase in the number of pupils with ASN, such as autism, dyslexia and mental health problems which in 2021 has reached a record high of 232,753.
Of this total 58.0% cent are boys. This represents 33.0% of the pupil population, rising from 118,011 in 2012, and is a near doubling (97.2%) in numbers from that year.
The coalition has called for an expansion in access to CSPs, ensuring that those requiring it receive the care and support they are entitled to, and to revise the relevant statutory guidance, with the necessary resourcing to support this.
A spokesperson for SCSC commented: “We are deeply concerned that there has been a decline in the use of CSPs, which are designed to support those with the most complex needs. This is despite a Scottish Government assurance that they would not decline and a dramatic increase in the numbers of those with ASN.
“By not providing this statutory support, many of those vulnerable individuals are being failed and not getting the support they are entitled to, which is of particular significance given the impact of Covid-19. The Scottish Government, local authorities and other agencies need to collaborate to ensure that those requiring a CSP receive it, with the necessary resourcing to support this.
“With those with ASN drawn disproportionately from poorer neighbourhoods, if we are to genuinely close the educational attainment gap they must get the care and support they need, when they need it.”
‘the reality is that the NHS is really struggling’
Responding to the latest set of performance figures released by NHS England for July 2021, President of the Royal College of Emergency Medicine, Dr Katherine Henderson, said: “The NHS has been running hot for months now and these figures show we are nearly at boiling point.
“We are worried that the public think that things are getting back to normal on the virtual eve of a further reduction in restrictions, and messages from the centre that says things are OK are disingenuous – the reality is that the health service is really struggling.
“Four-hour performance has sunk to its lowest ever level, we have levels of 12 hour waits we would usually associate with winter, and July saw the second highest ever number of attendances across emergency care units. Yet there is no sign of rescue ahead of winter. Despite our calls for action, crowding is back with us and is compromising patient care.”
there were 1,431,499 attendances at major Emergency Departments – the second highest on record
67.7% of patients waited less than four hours from arrival to admission, transfer, or discharge in Type 1 EDs – the lowest percentage on record
the number of patients waiting more than four hours after a decision to admit them stood at 89,768 – this is a 30% increase compared to June 2021 (66,619) and is the third highest ever
the number of patients waiting more than 12 hours after a decision to admit them stood at 2,215 – by far the highest July figure on record (second highest is 451 from July 2019).
Dr Henderson said: “The NHS was in a pretty dreadful state going into the pandemic – we were seeing record waits across the board, due to insufficient resourcing – but the sheer determination of an overstretched workforce, combined with a ‘whatever it takes’ approach, got us through.
“The problems that were with us before the pandemic have not gone away. Not only do they remain but are now much worse due to the impact of Covid, as these figures make crystal clear.
“The ambulance service saw thehighest ever number of ambulance callouts for life threatening conditions in July, and we saw ‘trolley waits’ in hospitals go up by 30% on the previous month. This means there have been delays offloading ambulances and patients have experienced long waits to be seen and moved to a bed if they need admission.
“Emergency Departments are very, very busy.
“There has also been a steady rise in Covid presentations and even though numbers are still low all the infection risk concerns remain in hospitals, further depleting capacity. Staff have had no let up and are worried about what the winter will be like if this is where we are in the summer.
“Demand is driven by multiple factors – difficulties accessing primary care, complications of chronic conditions, new presentations of significant illness and waiting list patients with on-going symptoms and no sign of getting their care sorted any time soon.
“NHSE recommends patients to access help via 111 but unless the system is responsive and clinically supported and other options available that advice too often defaults to go to the Emergency Department. Local health systems must ensure adequate urgent care facilities for their communities, letting Emergency Department have capacity to treat the seriously ill and injured.
“The other side of this is problems with supply – we do not have enough staff, beds, or equipment. There is still no plan for social care, which has a huge impact on the NHS. These have been issues for some time, but on top of this is the growing waiting list for elective care, staff absence due to a combination of leave and necessary self-isolation, and an even lower bed capacity due to infection prevention control measures.
“We fear for what winter may hold; we know it will be worse than now but a heavy flu season, another potential Covid surge and an understandable desire not to cancel elective care this winter could cripple us and put patient safety at risk.
“NHS Trusts must do all that they can to wring out every drop of capacity ahead of winter and the Department of Health and Social Care must extend ‘discharge to assess’, which made a significant difference freeing up beds during the pandemic. There has been a sustained rise in the number of patients experience long stays in hospital, and this funding is critical to freeing beds and maintaining flow in hospitals.
“We also need clarity in terms of performance – we are currently in a performance vacuum with Trusts uncertain about what they need to focus on. Implementing some of the metrics proposed by the Clinical Review of Standards is vital ahead of winter. We need to operationalise the metric of a maximum of a 12 hour stay from point of arrival. This will be a small step to reducing exit block, and allow timely ambulance offloads.
“While the NHS rollout of the vaccine has been an incredible success, parliament must not take its eyes off the ball regarding the state of the NHS. This autumn’s spending review – one which has not been put out to consultation – is an opportunity for the government to further signal it’s ‘peace time’ commitment to NHS funding and help prevent the NHS from boiling over this winter.”
The situation in Scotland is also giving cause for alarm. Lothian MSP, Miles Briggs is ‘very concerned’ A&E waiting times aren’t showing signs of improvement.
Miles Briggs MSP said: “NHS Lothian is in desperate need of an injection of funds to alleviate pressure on services.
“Years of chronic underfunding and a global pandemic has left staff on their knees, struggling to meet the increased numbers of patients attending A&E.
“SNP Ministers must take responsibility for allowing the situation to get to this point and immediately fund NHS Lothian properly to start getting services back to normal.”
The UK Government has declined to give evidence to the Scottish Parliament on its UK Internal Market Bill.
The UK Government says it regrets that Secretary of State for Business, Energy and Industrial Strategy, Alok Sharma MP (above) will not be able to appear before Holyrood’s Finance and Constitution Committee on account of the “tight legislative timeline” for the Bill that is currently going through Westminster.
Finance & Constitution Committee Convener Bruce Crawford MSP says he is ‘dismayed’ by the declined invitation.
The UK Government acknowledges “all aspects” of the Internal Market Bill will require the legislative consent of the Scottish Parliament.
Finance & Constitution Committee Convener Bruce Crawford MSP said:“The UK Internal Market Bill will affect many people’s lives and livelihoods in Scotland. It will also have a profound impact on the devolution settlement and on the powers of the Scottish Parliament.
“The UK Government already recognises and accepts that all aspects of this Bill require the legislative consent of the Scottish Parliament.
“I am genuinely dismayed, therefore, that the Secretary of State for Business will not make time to give evidence to our committee, as we consider whether or not to recommend that consent be given to this UK Bill.
“Our report to the Scottish Parliament will not have the benefit of direct evidence from the UK Government and that is a matter of regret, as is the discourtesy that colleagues will infer from the UK Government’s response.”
Mr Crawford added: “Under my convenership, this committee has always set out to engage constructively with the UK Government. Indeed, we will hear from Mr Hands on the Trade Bill next week.
“It is implausible why a UK Minister is available for the relatively limited impact on devolution of that Bill, while not being available for the Internal Market Bill which has a potentially huge impact on the people of Scotland.”
The text of the email from Mr Sharma’s office is below.
The declined request cites the Bill’s “tight legislative timeline”, which was set by the UK Government.
Full text of email dated 15 September 2020:
Hi (Name of Clerk to Committee),
Apologies for the delay and thank you for your invitation for the SoS to give evidence to the committee. Given the tight legislative timeline for the Bill, it is with regret that the SoS will be unable to attend this committee session. We look forward to the findings of the Committee’s engagement on the UK internal market Bill.
Thanks, (Name of Private Secretary) Office of Secretary of State for Business, Energy and Industrial Strategy, Alok Sharma MP
More on the Committee’s scrutiny of the Internal Market Bill can be found here.
Finance Ministers’ “deep concern” over UK Internal Market Bill
Spending proposals would “reverse devolution”.
Finance Ministers from Scotland, Wales and Northern Ireland have met to discuss a range of fiscal matters and voiced their collective concerns about the financial implications the UK Internal Market Bill will have on devolved governments.
Kate Forbes, Rebecca Evans and Conor Murphy expressed their joint concerns on the spending powers set out in the Bill which override the existing devolution settlement.
The powers enable the UK Government to undertake spending in devolved areas, including for replacement of EU funding, without any engagement with the devolved nations.
Finance Ministers also voiced concerns about what this could mean for future consequential funding arrangements.
Scotland’s Finance Secretary, Kate Forbes said: “It is entirely unacceptable that – with no prior notice – the UK Government has written provisions into the Bill that presume Whitehall control over the delivery of replacements for the EU funding programme in Scotland – a programme that Scottish Ministers have delivered successfully for decades.
“This Bill would also allow the UK Government to dictate how money is spent in devolved areas without the consent of Scottish Ministers. It puts at risk funding for a whole host of capital programmes – schools, hospitals and infrastructure. It reverses the devolution process and we will oppose any attempt to bypass the Scottish Parliament and Government, which are elected by the people of Scotland.
“Not only is it in contravention of the devolution settlement, but it has the potential to create confusion, duplication and unnecessary additional bureaucracy at a time when economic recovery is paramount.”
Welsh Finance Minister Rebecca Evans said: “I am deeply concerned that the Bill gives UK Ministers, for the first time since devolution, powers to fund activity in areas which are clearly devolved to Wales.
“In Wales funding decisions are taken in partnership with local communities, to ensure that they reflect the needs of the people in Wales. The powers set out in the Bill completely undermine devolution and will see decisions currently taken in Wales, clawed back by the UK Government.”
Finance Minister for Northern Ireland, Conor Murphy said: “The Internal Market Bill will give the British Government wide ranging powers to make funding decisions in devolved areas.
“This is greatly concerning and could have huge implications for the Good Friday Agreement. The British Government should not interfere in funding matters which are currently the responsibility of the Devolved Administrations.
“It is also imperative that they provide details on the scope of the Shared Prosperity Fund. This will be a vital source of replacement funding for devolved areas and the lack of meaningful engagement to date is extremely disappointing.”
