United Nations Convention on the Rights of the Child - concluding observations 2023: SG initial response

6. Basic Health and Wellbeing

6.1 Disabled Children and Young People

No: 40b

UN Concluding Observation

Reduce waiting times and strengthen the system for early detection and intervention, including for children with autism and developmental disorders, in order to facilitate access for children with all types of disabilities to education, health care, social protection and support services.

No: 40c

UN Concluding Observation

Strengthen support for the social integration and individual development of children with disabilities, including by providing capacity-building to professionals working with and for children on the rights and specific needs of children with disabilities, and ensuring their access to personal assistance, rehabilitation and assistive devices.

Relevant section of Scottish Government’s November 2022 Position Statement

• Sections 7.1 – 7.6 - Disability

Progress since November 2022

Early Detection, Intervention, Access to Services

All children in Scotland are entitled to support from the Health Visiting service. The service provides 11 home visits for families between pre-birth and the time a child starts school. This includes three formal child health reviews (13-15 months, 27-30 months, and 4-5 years) at which any developmental concerns can be identified and begin to be addressed and supported. This process helps to ensure that children with disabilities are able to access appropriate support from the earliest stage.

Both the CAMHS Specification and Neurodevelopmental Specification aim to ensure that children and families receive the support and access to services that meet their needs at the earliest opportunity, based on the Getting it right for every child approach. For many children and young people, such support is likely to be community-based, and should be quickly and easily accessible. The CAMHS and Neurodevelopmental Specifications are discussed further at sections 6.7 and 6.8 of this report.

With reference to education, the Education (Additional Support for Learning)(Scotland) Act 2004 (“the 2004 Act”) requires education authorities to identify, provide for, and review the additional support needs of pupils. A formal diagnosis is not needed for a child or young person to receive support, which should be put in place at the earliest possible stage, as soon as a need is identified. This staged intervention model allows support to be reviewed following the results of new assessments, input from specialist staff or diagnosis. Families should be kept informed and have opportunities to input to this process. Other agencies, health (allied health professionals and CAMHS), and social work services can also be asked to help identify needs and provide support under the 2004 Act. The statutory Code of Practice (2017) sets out guidance for authorities and partners on the requirements of the Act on this matter.

The Scottish Government funds Enquire to provide information and advice to parents and carers on additional support for learning. ASN support is also discussed at section 7.2 of this report.

All children can request assistance from Allied Health Professionals (AHPs). Personal assistance can also be accessed as required. In addition, school nurses focus on 10 priority areas deemed most likely to impact on health and wellbeing in later life. Children will also be registered with a local General Medical Practice.

Disability Equality

The Scottish Government is working with Disabled People’s Organisations - Glasgow Disability Alliance, Inclusion Scotland, and Disability Equality Scotland - to develop and implement an Immediate Priorities Plan that delivers actions to help meet the barriers faced by disabled people. The plan will strengthen our ongoing commitment to advancing disability equality and will be a step towards developing a Disability Equality Strategy that will aim to tackle the systemic barriers that affect the daily lives of disabled people and impact on disability poverty.

The Scottish Government has also committed to introduce a new Human Rights Bill in the 2023-24 parliamentary session. The Bill will incorporate into Scots law, within the limits of devolved competence, four international human rights treaties, including the Convention on the Rights of Persons with Disabilities (CRPD). Incorporation of the CRPD will place greater impetus on public bodies to support disabled children and young people in realising their human rights, accessing services, and living with dignity. The Human Rights Bill is discussed at section 1.3.

Learning/Intellectual Disabilities and Autism

In March 2021, the Scottish Government, in partnership with COSLA, published the joint Learning/Intellectual Disability and Autism Towards Transformation Plan. This set out the Scottish Government’s vision to shape supports, services and attitudes to ensure that the human rights of autistic people and people with learning/intellectual disabilities, including children and young people, are respected and protected and that they are empowered to live their lives, the same as everyone else. We have established an innovative new leadership and engagement framework which puts lived experience at the heart of the decision-making process to help drive progress towards implementation of the Towards Transformation Plan.

The Scottish Government will also continue to work on a proposed Learning Disabilities, Autism and Neurodivergence Bill, which will seek to ensure that the rights of autistic people, those with learning disabilities, and neurodivergent people are respected, protected, and championed. We will also consider establishing a Commissioner to champion the rights of these groups. The Scottish Government is working to ensure that the Bill is fully co-designed with people with lived experience, including children and young people, involving from the outset individuals with lived experience through the Lived Experience Advisory Panel, as well as through Disabled People-led Organisations and charities that represent them. The consultation for the Bill launched on 21 December 2023.

British Sign Language

The Scottish Government is committed to making Scotland the best place in the world for British Sign Language (BSL) users to live, work, visit and learn. The BSL National Plan 2023-2029, which was published on 6 November 2023, contains 45 actions across 10 priority areas. Supporting Children, Young People and their Families is one of the 10 priority areas. The Plan was informed by the consultation which took place between July and September 2023. The consultation analysis was published on 1 December 2023.

Family Fund

The Family Fund is the UK’s largest grant-giving charity for disabled children. Grant funding from the Scottish Government has enabled the Family Fund to provide support, advice, and direct grants to families on a low income who are raising disabled or seriously ill children and young people in Scotland. Through the Family Fund grant scheme, each family has choice and control over what grant items they request, based on what they think would best help to meet their own family’s needs and improve their quality of life. In 2022-23, we committed £2.974 million of funding to Family Fund’s Scotland grant programme, which delivered 8,690 grant items to 6,970 families on a low income who are raising a disabled or seriously ill child or young person in Scotland. Social security support for families with disabled children is discussed at section 6.13.

Transitions

We are continuing to take steps to develop Scotland’s first National Transitions to Adulthood Strategy in this Parliamentary term. In March 2023, we formed a new External Strategic Working Group to help support the development and implementation of the Strategy. The Group comprises key strategic representatives of: parent carers; education; skills and employment; third sector; local authorities; health; and social care. The membership aims to reflect the cross-cutting nature of transitions, and the broad and varied life courses disabled young people may encounter and require support with during the transition to young adult life.

On 28 September 2023, we published our Statement of Intent on the Transitions to Adulthood Strategy, which is based on what we have heard through research and engagement to date. The Statement sets out the proposed scope, vision, and priorities for the National Transitions to Adulthood Strategy, which have been co-developed with the Strategic Working Group and disabled young people themselves. This is an important milestone in meeting our commitment. Feedback from the Statement of Intent will be used to develop the Strategy, which we aim to consult on more widely in 2024. The National Transitions to Adulthood Strategy is also discussed at section 2.6.

Employment Support for Disabled People

The Scottish Government is focused on tackling the enduring structural barriers that disabled people face in relation to accessing and progressing in the labour market. The original action plan, A Fairer Scotland for Disabled People: Employment Action Plan (2018), set out the commitment and initial steps the Scottish Government would take to reduce the employment gap between disabled people and the rest of the working age population (the disability employment gap) by at least half by 2038. The Plan focused on three key themes: Young People and Transitions; Supporting Disabled People to Enter and Sustain Employment; and Supporting Employers, see section 7.5 of the Embedding Children’s Rights in Scotland: Position Statement (2022).

A key achievement from the original plan included increased applications to the Independent Living Fund (ILF) Scotland Transitions Fund, which supported young disabled people between the ages of 16 and 25 years with the transition after leaving school or children’s services. Since opening in 2017 and publication of the Position Statement in 2022, the ILF distributed £9.4 million in grants to almost 5,000 young people. Further achievements included delivery of the Young Person’s Guarantee following the pandemic, as well as ensuring support for disabled young people undertaking apprenticeships.^[10]

In December 2022, the Scottish Government published its refreshed Fair Work Action Plan: Becoming a Leading Fair Work Nation by 2025, incorporating the commitment to support more disabled people to enter and sustain fair work, and continuing the ambition to at least halve the disability employment gap. The Fair Work Action Plan takes an intersectional approach, focusing on structural barriers disabled people, women and racialised minorities in particular face in relation to employment, while also considering key issues for young people and transitions.

Next Steps

• We will develop and implement an Immediate Priorities Plan, working with Disabled People’s Organisations.
• We will continue to develop proposals for a Learning Disabilities, Autism and Neurodivergence Bill following the public consultation.
• We will continue to take steps to develop a National Transitions to Adulthood Strategy.
• In relation to young people and employment, the Scottish Government and partners will, through the Fair Work Action Plan, take forward actions which aim to tackle persistent inequalities. We will also continue to develop and deliver our approach to our all-age employability support through No One Left Behind (2018), ensuring those with the greatest barrier to employment, including young people, receive person-centred support to progress into training or work.
• We will publish regular progress reports on the Fair Work Action Plan, and have published an Evidence Plan focusing on how it progresses the deliverables and outcomes from the Plan.

6.2 Access to Paediatric Health Care Services

No: 41a

UN Concluding Observation

Strengthen measures aimed at ensuring the availability of quality, child-sensitive and age-appropriate paediatric primary and specialist health care services to all children, and ensure that children’s perspectives are included in the development and implementation of all health services, health and social care commissioning, and policy and practice reviews;

No: 41c

UN Concluding Observation

Expand health services available to asylum-seeking and migrant children, children without a regular residence status to ensure their access to affordable health and mental health services, including by providing interpretation services and repealing regulations of the National Health Service that prevent such children from accessing health services due to their parents’ immigration or financial status;

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7 – Basic Health and Welfare

Scottish Government Position

All children in Scotland can access the NHS, which is free at the point of use. Scotland’s oversight of child health begins at an early stage through our Child Health Surveillance Programme, which mandates the delivery of a series of routine screenings, health assessments and childhood immunisations. Where a child has a concern identified at a screening or health review, practitioners are expected to provide additional support and/or make a referral into specialised services, which could include secondary paediatric care.

Public Health Scotland (PHS) compile national statistics in relation to the coverage of the Health Visitor first visit, 6-8 week review, and all three child health reviews, and the proportions of children having developmental concerns identified at the child health reviews.

We recognise the importance of young people receiving the right care at the right time in the right place. We are therefore continuing to monitor paediatric service use across the health system to ensure that the Scottish Government can act to support services. Public Health Scotland also publishes information in relation to paediatric secondary care admissions and Accident and Emergency attendances (broken down by age group and Health Board), and diagnoses. ^[11] This can help map trends over time.

We acknowledge the impact long waiting times for NHS treatment can have on children and young people. Our £1 billion NHS Recovery Plan (2021) is supporting an increase in inpatient, day case, and outpatient activity.

Transition to Adult Services

The Scottish Government has taken steps to improve transitions in healthcare. For example, the Respiratory Care Action Plan (RCAP) 2021-2026 commits to ensuring that all children transitioning to adult respiratory services go through a dedicated transition service. A transitions sub-group of the Scottish Respiratory Advisory Committee (SRAC) was established in 2022. The Group aims to produce a best practice document for Boards to use to ensure consistency in transition services.

The Diabetes Improvement Plan (2021) also contains a specific commitment to support children and young people to transition well from child to adult services. The Scottish Diabetes Group will establish projects to deliver this commitment in due course. In addition, as part of our National Framework to improve neurology services, we funded NHS Ayrshire & Arran, Cerebral Palsy Scotland, and ARC Housing to develop a neurology specific set of principles for transition across care settings. The National Transitions to Adulthood Strategy for Disabled Young People is discussed at sections 2.6 and 6.1.

Refugee and Asylum-seeking Children

The Scottish Government remains committed to supporting refugees, people seeking asylum and Scotland’s communities through our pioneering and collaborative New Scots: Refugee Integration Strategy approach. The Scottish Government is clear that everyone who is resident in Scotland is entitled to access health care on the same basis. This includes all refugees, people seeking asylum and people whose claim for asylum has been refused. Refugees and people seeking asylum living in Scotland are entitled to: register with a GP; access emergency health services; register with a dentist; and have eye tests. They can also access specialist healthcare, as any other patient can, often through a GP referral. This includes maternity care, mental health services and any other services for specific conditions. The NHS 24 interpreting service is also available for individuals who do not have English as their first language.

Hearing the Views of the Child

It is important that children can have their views heard when accessing any health service. As discussed at section 1.2, the UNCRC Act incorporates the UNCRC into Scots law within the devolved powers of the Scottish Parliament. The Act, once commenced, will place an obligation on public authorities to give due weight to the views of children in accordance with their age and maturity and will ensure that they have the right to receive information (subject to certain restrictions) in a format of their choice. Steps taken to support public authorities to further embed children’s rights across service delivery are discussed at section 1.11.

In addition, each Health Board appoints a Child Health Commissioner to promote the specific needs of children in respect of the planning and delivery of healthcare. This can include promoting children’s rights, including the right to be heard, and the importance of transitions into adult services.

Next Steps

• We will continue to monitor paediatric service use across the health system.

6.3 Health Inequalities

No: 41b

UN Concluding Observation

Develop a strategy to address health inequalities, including the underlying causes, and in particular in respect of children in disadvantaged situations including children with disabilities, children belonging to ethnic minorities, socioeconomically disadvantaged children, children living in rural areas and transgender children.

Relevant section of Scottish Government’s November 2022 Position Statement

• Chapter 7 – Basic Health and Welfare

Progress since November 2022

The Scottish Government remains firmly committed to addressing health inequalities and its underlying causes. We know that deprivation is a significant driver of excess mortality and so reducing poverty and inequality sits at the heart of our investment across portfolios. In 2022-23, we invested £3 billion across a range of programmes targeted at low-income households, with £1.25 billion directly benefitting children. We increased the Scottish Child Payment to £25 per eligible child per week, an increase of 150% in less than a year, and expanded the payment to all eligible children under the age of 16 (see section 6.13 of this report).

We are also continuing to take forward initiatives to promote and support the life chances of all our children and young people, including through the Baby Box, which supports parents during the first few months of their child’s life; the Family Nurse Partnership (FNP), which supports young first time parents; and measures to promote and support good nutrition amongst children, including the expansion of free school meals. These are discussed further in Chapter 7 of the Embedding Children’s Rights in Scotland: Position Statement (2022).

All children in Scotland are entitled to the support of a Health Visitor from pre-birth to the time when a child starts school. Health Visitors should offer a minimum of 11 home visits during that period as a way of monitoring and supporting the child’s health and development, and the wider family’s wellbeing. The universal provision of the Health Visiting service can help to ensure that health inequalities are minimised by pursuing prevention and early intervention. In cases where a Health Visitor identifies a need for additional support, referrals can be made to more specialised health services.

Health Visitors also provide additional support to children in disadvantaged situations. Those in most need can receive additional support. Health Boards are also directed to deploy more Health Visitors to areas of socioeconomic deprivation. This allows Health Visitors more capacity to help those most in need. In addition, Health Visitors are required to enquire about family finances and money worries at periodic points throughout the pathway, to allow them to assess need and signpost families to appropriate support services.

The Scottish Government monitors the extent to which the Health Visiting Service is reaching children and families in disadvantaged circumstances. Public Health Scotland’s annual statistics on Health Visitor coverage provide a breakdown of coverage by deprivation.

Racialised Health Inequalities in Health and Social Care

The Scottish Government acknowledges there are health inequalities between minority ethnic and majority white groups, as well as between different minority ethnic groups. The picture is complex and understanding of the scale and nature of the problem in Scotland is limited by lack of good quality data.

We have established a senior Steering Group on Racialised Health Inequalities in Health and Social Care to oversee implementation of the health and care specific recommendations of the Expert Reference Group on Covid-19 and Ethnicity. Working with senior leaders across the health system, the aim is to improve access, experience and outcomes within health and social care for minority ethnic communities in Scotland, taking an anti-racism approach. Priorities include the development of robust plans for addressing racism in the workplace, increasing diversity at all levels of the health workforce, improving access to and experience of key services including mental health, maternal and infant health, cardiovascular disease, and type 2 diabetes prevention, and improving race and ethnicity data to inform action to address inequalities and to measure progress.

This work builds on the Scottish Government’s Data Strategy for Health and Social Care (February 2023), which commits to improving the quality and consistency of protected characteristics data, including race and ethnicity data, to ensure that equitable care is provided for everyone in Scotland requiring it.

A range of health related actions were progressed through the Scottish Government and COSLA’s Gypsy/Travellers Action Plan (2019-21), with the aim of improving health outcomes for Gypsy/Traveller communities. This included funding for the Minority Ethnic Carers of People Project (MECOPP) Community Health Matters Programme. A key component of the programme has been to recruit and train Community Health Workers from Gypsy/Traveller communities, whose role is to provide information and support on a wide range of health and social care issues to Gypsy/Traveller communities in a number of Health Board areas. Work to identify a sustainable future model for ensuring that learning and best practice can be shared and mainstreamed is ongoing. A new Gypsy/Traveller Action Plan is expected to be published after the spring of 2024, the development of which will provide an opportunity to review key actions that can be taken to improve access to and experience of health services for the community.

Care and Wellbeing Portfolio

Reducing inequalities is one of the key aims of the Care and Wellbeing Portfolio (CWP), the main strategic reform vehicle across Health and Social Care within the Scottish Government. Established in 2022, the CWP brings together key reforms into a single coherent Portfolio, which seeks to improve population health and wellbeing, reduce inequalities, and achieve health and care system sustainability. A CWP Portfolio Board, comprised of a wide array of stakeholders, provides oversight and strategic direction on delivery.

As part of this, we are working closely with key stakeholders, including Public Health Scotland, to develop and implement a systematic approach to enable us to embed consideration of health inequalities across government. This work will align with other similar approaches being taken across government and will help to promote a more robust approach to assessing the impact of our policies. We will also continue to work with our partners to understand what is needed at a national and regional level to support local, preventative action to drive improvements in health, and thus embed health considerations within wider policy making.

Next Steps

Health Visitors

• The Scottish Government has committed to supporting Health Visitors to access additional professional development opportunities in respect of financial inclusion, to help them conduct discussions with families around money worries and household finances. Any families disclosing concerns around money worries can then be further supported by the Health Visitors and/or referred on to a specialist service.

Family Nurse Partnership (FNP)

• The Scottish Government has committed to extending the Family Nurse Partnership incrementally by offering to first time mothers aged 20 and under, and then 21 and under by the end of 2024, and care-experienced first-time mothers aged 25 and under by the end of 2025. This will support up to 500 extra families per year by 2025.

Racialised Health Inequalities in Health and Social Care

• We will continue to work to implement the health and care specific recommendations of the Expert Reference Group on Covid-19 and Ethnicity.
• We will also work with senior leaders across the health system to develop a framework for action for improving healthcare access, experience, and outcomes, taking an anti-racism approach.

Care and Wellbeing Portfolio

• We are actively contributing to Keeping The Promise through our work to support the scoping of a pre-birth to three transformation programme led by Education and Justice colleagues.
• Our ‘Getting it right for everyone’ pathfinders also provide an opportunity for us to work together in localities in a shared way to support families who are at risk of poverty. This includes the development of a family support model with services built around families, including employability support, drug and alcohol, and community mental health services.
• We are supporting health and social care bodies to operate as effective anchor institutions as part of the wider community wealth building agenda. Health Boards are developing plans focused on maximising local economic contributions through improving access to good work and good income, which will target the six priority family groups described in the Tackling Child Poverty Delivery Plan; supporting local businesses via supportive procurement practices; and widening community access to land and assets.
• We are also expanding how we monitor and improve our contribution to early years and child poverty by adding additional data indicators to the Care and Wellbeing dashboard, including Antenatal Booking, Perinatal Mortality Rate, Child Material Deprivation, Infant Mortality, Healthy Birthweight, Breastfeeding at 6-8 Weeks Child Development, Immunisation Rates, Unintentional Injuries, and Healthy Weight at primary 1.

6.4 Support for Transgender and Gender-questioning Children and Young People

No: 41d

UN Concluding Observation

Urgently address the long waiting times faced by transgender and gender-questioning children in accessing specialized health services, improve the quality of such services, and ensure that their views are taken into account in all decisions affecting their treatment;

Relevant section of Scottish Government’s November 2022 Position Statement

• N/A

Progress since November 2022

The Scottish Government fully recognises the need to provide the best possible clinical care for young people experiencing gender incongruence or gender dysphoria.

As part of our ongoing commitment to improve access to gender identity healthcare in Scotland, since December 2022, we have invested over £2.8 million to support improvement work, with over £2 million of that allocated directly to NHS Health Boards with gender identity clinics. This includes over £896,000 allocated directly to NHS Greater Glasgow and Clyde to support both their adult gender identity service and the only gender service for young people in Scotland - the Gender Dysphoria for Young People Service. NHS Greater Glasgow and Clyde are using this funding to expand existing service capacity, recruit to their multidisciplinary team and contact those on the waiting list to identify unmet needs. Service pressures are being reviewed by the Health Board and nationally.

Wider work is also underway to consider how best to sustainably provide young people’s gender services in NHS Scotland in the longer term by exploring national commissioning. This is part of a wider programme of work to improve access to, and delivery of, gender identity healthcare in Scotland.

The NHS Gender Identity Services: Strategic Action Framework 2022-2024 (2021) describes how we are working to improve access to, and delivery of, NHS gender identity services. A National Gender Identity Healthcare Reference Group was established in 2022 to oversee implementation of the Framework’s actions. The Group includes NHS Board representation, LGBTI organisations, including those representing LGBT young people, clinicians, academics, and people with lived experience of using gender identity healthcare.

The Scottish Government continues to closely engage with people who have lived experience of accessing gender identity healthcare in work to improve services. This includes young people and organisations representing them. As part of this, the Scottish Government has funded a Lived Experience Coordinator role hosted in the third sector. The post holder’s role is to engage with trans/non-binary people across Scotland who have lived experience of accessing or waiting to access gender identity services and to ensure their voices inform the work of the National Gender Identity Healthcare Reference Group.

Next Steps

• Work is underway to expand existing service capacity, recruit to the multidisciplinary team and contact those on the waiting list for the Young People’s Service to identify unmet needs.
• Work will also continue to consider how best to sustainably provide young people’s gender services in NHS Scotland in the longer term by exploring national commissioning of young people’s gender services.

6.5 Child Nutrition

No: 41e(i)

UN Concluding Observation

Strengthen measures to address child malnutrition, food insecurity and growing trends in overweight and obesity, including by: (i) ensuring all children’s access to nutritious foods and reducing their reliance on food banks, regardless of their or their parents’ migration status.

No: 41e(ii)

UN Concluding Observation

Expanding the free school meals programme to all children in disadvantaged situations, including children whose parents receive Universal Credit;

No: 41e(iii)

UN Concluding Observation

Addressing the root causes of food insecurity including poverty;

No: 41e(iv), (v)

UN Concluding Observation

Providing nutrition services in schools and communities; and promoting healthy lifestyles and physical activity.

Relevant section of Scottish Government’s November 2022 Position Statement

• Sections 7.13 – 7.19 – Child Nutrition
• Section 7.29 – Child Poverty

Progress since November 2022

Child Healthy Weight

The Scottish Government’s aim to halve childhood obesity by 2030, and significantly reduce diet-related health inequalities, is deliberately ambitious. It is a public health priority to ensure that Scotland is a place where children eat well, have a healthy weight and are physically active. We remain committed to taking forward the wide range of action set out in our Diet and Healthy Weight Delivery Plan (2018) to achieve this. Our actions emphasise prevention to ensure children have the best start in life, and include, among other things:

• Continuing to take forward our Out of Home Action Plan (2021), which supports people and business to provide access to healthier options.
• Maintaining support for convenience stores through the Healthy Living Programme, which predominantly focuses on stores in areas of higher deprivation, to make healthier food and drink more accessible. ^[12]
• Helping smaller businesses reformulate common products to make them healthier through the Reformulation for Health Programme; and
• Funding regional community food networks, such as Edinburgh Community Food, supporting them to increase access to affordable, healthier food to members of their local community, and promote the health benefits of nutrition and physical activity.

In addition to this, we have continued to fund Health Boards to deliver weight management services for children and young people, in line with our national standards for delivery of tier 2 and tier 3 weight management services, and have provided £2.3 million to Health Boards in 2023-24. In addition to core funding, since 2020-21, we have provided over £2.4 million to health boards and local partners for projects to encourage healthy eating and physical activity in families and communities at risk of diet-related health inequalities. This work has included: specialised training for practitioners; increasing physical activity; and support for those experiencing food insecurity.

A Whole Systems Approach to childhood obesity remains the strongest evidence-based route to improving levels of healthy weight in children. As an action from our 2018 Diet and Healthy Weight Delivery Plan, the Scottish Government supported pilots of whole systems approaches to improving diet and healthy weight in eight local authority areas, focusing specifically on childhood obesity and health inequalities. The Public Health Scotland evaluation of the pilots was published in December 2022 and is informing next steps.

Malnutrition

We have established a working group, including representatives from health, social care and the third sector, to provide recommendations for the development of policy for the early detection, prevention and monitoring of malnutrition and dehydration.

Energy Drinks

In 2019, the Scottish Government consulted on whether there is sufficient evidence to support mandatory measures on the sale of energy drinks, which contain high levels of caffeine, to children and young people. Our consultation analysis report and evidence brief were published on 30 May 2023. Having carefully considered the consultation responses and current evidence base, we will not pursue mandatory measures to restrict the sale of energy drinks to children and young people at this time. We continue to support voluntary measures to restrict the sale of energy drinks to children and will keep under review how these could be strengthened. We will also continue to ensure that children and young people have high quality education on the nature and importance of a balanced diet through the Curriculum for Excellence.

Nutrition in Schools and Health Promotion

We remain committed to the expansion of free school meals to include children in primaries 6 and 7. The next phase of expansion will be to provide a free school meal for all primary 6 and 7 pupils from families in receipt of the Scottish Child Payment. In 2022-23, we provided local authorities with £30 million of capital to invest in the infrastructure required to support the expansion of free school meals. In 2023, 231,957 free school lunches were provided to children and young people. This represents an increase from the previous high of 215,053 free lunches provided in 2022.

Our School Food and Drink Regulations are designed to ensure school meals contain an appropriate amount of energy and key nutrients to support the healthy growth and development of our children and young people. Our food and drink standards ensure there is a limit on the amount of salt, sugar, fat, and saturated fat contained in food and drink that is offered at any time during the school day, including mealtimes. Compliance with our Regulations continues to be monitored by Education Scotland’s Health and Nutrition Inspectors.

In 2023, 99% of primary schools were reported to be meeting our target of providing two hours of physical education (PE) to pupils each week. In 2023, 95% of secondary schools were reported to be meeting our target of providing two 50‑minute periods of PE to pupils each week (for pupils in secondaries 1 to 4). Other measures to support and promote the physical activity of children and young people are discussed at section 7.8 of this report.

Best Start Foods

Best Start Foods provides pregnant women and families with children under the age of three, who receive certain benefits under a certain amount, with a minimum of £4.95 a week via a pre-payment card to purchase healthy foods. Although we do not have a statutory duty to uprate Best Start Foods, in April 2023, the Scottish Government increased payments in line with inflation by 10.1%. This increase is in recognition of the difficulties being faced by many due to the increased cost of living.

Food Insecurity

Scotland is the first nation in the UK to publish a Plan, grounded in human rights, that works towards ending the need for food banks. Our Cash-First Plan (June 2023) outlines the nine collaborative actions we will take over the next three years to improve response to crisis so that fewer people need to turn to emergency food parcels. This includes a new £1.8 million Programme to improve urgent access to cash in a crisis, maintaining the value of our £41 million Scottish Welfare Fund, and continuing to invest in dignified community-led responses to food insecurity.

Our actions include targeted work to ensure timely access to appropriate nutrition for families with infants. Following initial scoping work in spring 2023, we established a Short Life Working Group with local and national partners to support the development of emergency routes to cash first solutions and infant formula where needed.

Among the UNCRC requirements being incorporated into Scots law by the UNCRC Act is the right to the highest attainable standard of health, including through the provision of adequate nutritious food. The Human Rights Bill will incorporate the International Covenant on Economic, Social and Cultural Rights (ICESCR), which includes a right to adequate food as part of the overall right to an adequate standard of living, into Scots law, within the limits of devolved competence. The duties under the UNCRC Act will commence on 16 July 2024 and the Human Rights Bill will be introduced to the Scottish Parliament during the 2023-24 parliamentary session.

Next Steps

Healthy Weight and Malnutrition

• We will continue to deliver the actions in our Diet and Healthy Weight Delivery Plan.
• Our new Eating Out Eating Well Framework, which is designed to help outlets provide healthier food choices, is due to be piloted in early 2024. This initiative aims to support people and business to make access to healthier choices easier, such as developing a Code of Practice for children’s menus.
• The evaluation of our Diet and Healthy Weight whole systems approach pilots is informing our next phase of developing resources to support national roll-out.
• We are also focusing on transforming the food environment because this is more likely to be effective in improving diet and reducing health inequalities than only encouraging behaviour change. We are committed to legislating to restrict the promotion of less healthy food and drink where these are sold to the public. We are actively engaging with key stakeholders as part of an extensive and inclusive consultation process on the detail of proposed regulations.
• We will develop policy for the early detection, prevention and monitoring of malnutrition and dehydration. A working group is currently developing draft recommendations.
• With regard to energy drinks, we will consider further research to inform consideration of potential legislation in the future, including in relation to consumption patterns and the impact of current voluntary actions.

Free School Meals

• We are working with local authorities to better understand the infrastructure required to deliver our commitment to expand free school meals in primary schools.

Best Start Foods

• We are delivering on our commitment to increase eligibility for Best Start Foods to all in receipt of Universal Credit and will go further on this by removing the income thresholds for all qualifying benefits from February 2024, supporting an additional 20,000 people.
• We do not have a statutory duty to uprate Best Start Foods. Despite this, we will again, subject to Parliamentary approval, increase Best Start Foods from April 2024 by 6.7% in line with the Consumer Prices Index (CPI) rate of inflation at September 2023.

Food Insecurity

• Our new £1.8 million Cash-First Programme will provide funding and practical assistance to up to eight area-based Partnerships to improve urgent access to cash in a crisis alongside wider support. By 31 March 2026, the Cash-First Programme will have concluded, generating evidence that can be shared to inform future policy and practice to help reduce the need for emergency food parcels. In 2023-24, we are also providing:
  • A further £623,000 to the British Red Cross to deliver crisis grants and wrap around support to people at risk of destitution, including those who may have No Recourse to Public Funds.
  • £290,000 for an expanded crisis response pilot with nine local advice bureaux in the Citizens Advice Scotland network, using shopping cards and cash grants to meet immediate needs.
  • £155,000 to support the Dignity Peer Network and marginalised groups to develop dignified responses to food insecurity.

6.6 Breastfeeding and Infant Nutrition

No: 41f (i)-(iii)

UN Concluding Observation

Continue its efforts to promote breastfeeding, including by: (i) strengthening support for mothers, including through flexible working arrangements; (ii) fully implementing the International Code of Marketing of Breast-milk Substitutes and strengthening relevant legislation; (iii) raising awareness of the importance of breastfeeding among families and the general public.

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.7 – Breastfeeding and Infant Nutrition

Progress since November 2022

The Embedding Children’s Rights in Scotland: Position Statement (2022) provides information on the steps taken by the Scottish Government to support and promote breastfeeding across Scotland, including funding support. We have provided a further £2 million additional funding in 2023-24 to Health Boards and other partners to support, promote and protect breastfeeding. The additional investment is being used to fund breastfeeding projects and initiatives. Particular emphasis has been given to the quality improvement aspects of these projects, with an aim to boost their sustainability.

There is also ongoing development of focused support for mothers returning to work after maternity leave. This will encourage employers to make space and allowances for mothers to hand express throughout the day, if desired, in privacy and comfort, without discrimination. This is initially being taken forward in NHS settings with guidance for managers on their workplace policies for staff that may be breastfeeding after returning to work. Activity will then continue to spread and scale this work into other sectors.

We are working to change the breastfeeding culture in Scotland via the national Breastfeeding Friendly Scotland scheme. The scheme is aimed at supporting women to feel confident when breastfeeding out and about and is a way that communities and businesses can show they welcome and support breastfeeding. The scheme is free and joining is open to any organisation or business in Scotland. Further Scottish Government investment in this scheme comes in the form of support for NHS Health Boards to provide resources and marketing materials they can use to support and promote the scheme. NHS Boards can order the scheme’s marketing materials via the Scottish Government policy team and Public Health Scotland. These can be used to promote the scheme and it’s benefits in the local Board area.

To support the early learning and childcare part of the scheme, national training modules have been developed in conjunction with NHS Education for Scotland (NES). The packages are hosted on the NES training platform. These will be used by early years practitioners to help further embed breastfeeding friendly principles within a younger age group. The training modules will include advice on limiting the imagery of babies with bottles and access to bottle-feeding dolls or toys.

The annual Scottish Breastfeeding Week was held in June 2023, with co-ordinated events around the country in conjunction with NHS Health Boards and third sector partners. These events celebrated both local and national achievements and were promoted via social media activity on Scottish Government communication channels.

The UNICEF Baby Friendly Initiative (BFI) is a world-wide programme which provides a practical and effective way for health services to improve the care provided for all mothers and babies. In Scotland, the BFI develops best practice standards for health professionals and services to support women to successfully establish breastfeeding or safer formula feeding if that is their choice. BFI also provides tools and an assessment process to enable services to implement and maintain best practice. The BFI is a key driver of improved care for mothers and babies and Scotland is celebrating the most progress in the UK in achieving the Baby Friendly Initiative best practice standards. Since 2018:

• 100% of Scottish Maternity units are fully accredited;
• 100% of Health and Social Care partnerships are fully accredited; with
• 100% of our community services accredited with the Achieving Sustainability award;
• 100% of the eight pre-registration Midwifery and Health Visiting university programmes are fully accredited; and
• 69% (9 out of 13) of Scottish neonatal service providers are fully accredited, with the other neonatal units progressing towards this.

The Scottish Government provides funding to UNICEF UK for a Baby Friendly Initiative professional lead post for Scotland (PLS). The PLS provides expertise, guidance, training and support to maternity units, neonatal and community facilities approaching accreditation and to those already accredited, with a particular focus on the implementation of the new BFI standards. The PLS also contributes to the work of the Scottish Government in matters relating to breastfeeding policy and development of future workplans. The Scottish Government also funds UNICEF to deliver training for healthcare staff and BFI accreditation assessments in maternity hospitals, neonatal units, community settings and universities that provide midwife and health visitor courses in Scotland.

As discussed at section 7.7 of the Embedding Children’s Rights in Scotland: Position Statement (2022), whilst Scotland does not have the legal powers to implement the whole of the WHO Code, the Foods for Specific Groups (Infant Formula and Follow-on Formula)(Scotland) Regulations 2020 incorporates some of the Code into Scots law. There are also strict promotional and commercial practice rules laid out in the Regulations and in guidance that restrict the advertising and promotion of infant formula and additional labelling requirements that apply to both infant formula and follow-on formula. This is monitored by Food Standards Scotland. Embedding the Code forms part of the Baby Friendly Initiative (BFI) standards, and is a requirement for all NHS health professionals to adhere to.

There is also regular work on a four-nation basis to consider the potential for strengthening existing WHO code legislation.

Next Steps

• Development of national training modules in conjunction with NHS Education Scotland. These are hosted on TURAS (the NES training system).
• Work is ongoing on the development of a breastfeeding peer support strategy/framework. A Peer Support Advisory Group is in place to determine this strategy/framework. This group is still in its early stages with meaningful outcomes expected by the end of 2024-25.
• We will continue to Chair and support a range of advisory groups around maternal and infant nutrition, including Peer Support, Breastfeeding Friendly Scotland, and Maternal and Infant Nutrition leads/representatives from NHS.
• Continued NHS adherence through BFI accreditation. Working on a four-nation basis to consider the potential for strengthening existing legislation.
• Breastfeeding Friendly Scotland schemes (Local Authority, Schools etc) continue to be developed with expected national scale and spread to follow.
• The national breastfeeding statistics were released on 7 November 2023. The publication of these statistics will be followed by policy analysis and co-ordinated work with stakeholders.

6.7 Community-Based Mental Health and Wellbeing Support

No: 43c

UN Concluding Observation

Develop or strengthen strategies, with sufficient resources, for ensuring the availability of community-based therapeutic mental health services and programmes for children of all ages, and for providing comprehensive mental health promotion, screening for mental health issues and early intervention services in schools;

No: 43e

UN Concluding Observation

Develop adequately funded mental health services that are tailored to the specific needs of lesbian, gay, bisexual, transgender and intersex children, migrant children, children with disabilities and “young carers”, including through sufficient investments in specialist services

No: 43g

UN Concluding Observation

Strengthen measures to address the underlying causes of poor mental health, eating disorders and other self-harming behaviours among children, and invest in preventive measures

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.22 – Community-based Mental Health and Wellbeing Support
• Section 7.24 – Mental Health Support for Specific Groups of Children & Young People
• Section 7.25 – Suicide Prevention

Progress since November 2022

In June 2023, the Scottish Government published the new Mental Health and Wellbeing Strategy. This highlights the mental health needs of certain groups of people including women and girls, disabled people, LGBTI people, and those from minority ethnic groups. The Strategy is evidence-based, informed by lived experience, and underpinned by equality and human rights.

The accompanying Mental Health and Wellbeing Delivery Plan 2023-2025 and Mental Health and Wellbeing: Workforce Action Plan were published jointly with COSLA in November 2023. The Delivery Plan sets out a range of actions which we will take to promote mental wellbeing and tackle the underlying causes of poor mental health and distress, which can contribute to self-harm and suicide across the Scottish population, including amongst children and young people. The Workforce Action Plan ensures that the commitments in the Strategy and Delivery Plan are underpinned by a resilient and sustainable workforce who feel valued and supported to promote better mental health and wellbeing outcomes. Equality Impact Assessments for the actions contained within these plans have also been published.

The Community Mental Health and Wellbeing Supports and Services Framework (2021) supports the delivery of community-based mental health services for children and young people aged 5-24 (26 if care experienced), their families and carers. The Framework was produced in partnership with COSLA following extensive consultation with stakeholders, including children and young people. The Scottish Government has provided local authorities with £15 million per annum in 2021-22, 2022-23 and 2023-24 to fund these services.

The Framework states that there should be targeted provision for specific groups of children and young people, including LGBTI+, young parents and carers, and children and young people with learning disabilities or complex needs. This has resulted in a number of local authorities providing support specifically for these groups. Supports and services are expected to be equitably accessible to all children and young people. More than 300 community-based supports are now in place across the country, with services operating in every local authority area. These are focused on prevention and early intervention and include mentoring services, art-based therapies, digital services, whole-family supports, counselling services and supports involving sport or physical activity. Local authorities have advised that more than 58,000 people used the supports and services in the first half of 2023.

Mental Health and Wellbeing Support in Education

The Scottish Government is continuing to provide £16 million to local authorities per year to ensure that all secondary schools in Scotland have access to counselling services. The aims and principles for the delivery of access to counsellors through schools set out that the counselling service should be available for children aged 10 and over, meaning that the service will also be available for primary and special schools that are linked to a secondary school. Local authorities have confirmed that counselling services are in place across Scotland. Between January and June 2022, 14,508 pupils accessed school counselling, with 13,150 pupils accessing these services between July and December 2022.

School counselling is enhancing the work that schools already do to support children and young people to learn about mental wellbeing as part of Health and Wellbeing in Curriculum for Excellence. The Whole School Approach: Framework, published in 2021, provides practical measures that a school and a local authority can use to support children and young people’s mental health and wellbeing. A professional Learning Resource (2021) also provides school staff with the knowledge and understanding to support children and young people’s mental health and promote positive mental wellbeing.

Over the past four academic years (2019-20 – 2022-23), the Scottish Government has successfully invested over £16 million to help introduce more than 80 extra counsellors in colleges and universities and, in Academic Year 23-24, provided an additional, one-off, investment of £3.21 million to help institutions transition to a more sustainable means of providing mental health support for students. The Scottish Government also supports the NUS Scotland Think Positive initiative and has confirmed funding for Financial Year 2023-24.

Following the publication of its Mental Health and Wellbeing Strategy in the summer of 2023 and accompanying Delivery Plan in the autumn of 2023, the Scottish Government will consult on a draft Student Mental Health Action Plan in February and early March 2024.

Mental Health Support for Specific Groups of Children and Young People

The Scottish Government is taking forward a range of actions to support specific groups of children and young people including those with neurodevelopmental support needs, and with reference to eating disorders, self-harm, and suicide.

The National Neurodevelopmental Specification for Children and Young People: Principles and Standards of Care (2021) (ND Specification), sets out seven standards for service providers to ensure that children and young people who have neurodevelopmental profiles with support needs, receive further support than is currently available. These children and young people are often referred to CAMHS but do not always meet the mental health criteria described in the National CAMHS Service Specification.

To support national implementation, we have funded five Tests of Change to take forward various aspects of the ND specification. These are taking place in Grampian, East Lothian, Highland, Fife and Forth Valley. We are working to collate and share learning from these Tests of Change, including through a national sharing event, which was held in September 2023. This work is informing next steps around implementation of the ND specification and will support wider roll-out across other areas in Scotland.

The National Review of Eating Disorder Services was commissioned by the Scottish Government in 2020 and published its final report and recommendations in March 2021. We have made good progress responding to the short term recommendations made by the Review. This has included: establishing an Eating Disorder Lived Experience Panel to ensure the voices of those impacted by an eating disorder are central to our policy development and delivery of the Review’s recommendations; developing a National Specification for the Care and Treatment of Eating Disorders in Scotland; and appointing a Chair for the National Network for Eating Disorders to support us in delivering the remaining long-term recommendations.

The Scottish Government is committed to supporting people to access the right care at the right time. That is why we have allocated £55.5 million to Health Boards in 2023-24 to improve the quality and delivery of mental health and psychological services for all, including eating disorder services. We have also provided Beat, the UK’s largest Eating Disorder charity, with over £600,000 in 2023-24 to provide a range of support services for those impacted by an eating disorder.

In partnership with COSLA, we have developed our first dedicated Self-Harm Strategy and Action Plan (November 2023). The Strategy commits to building self-harm information, advice, and support into work already underway to support children and young people’s mental health. The Strategy and Action Plan were developed with people with lived experience, including children and young people, and those who support them.

In tandem with the development of the Strategy, we committed funding of £1.5 million between 2021 and 2024, to support a national webchat service offering people help out-of-hours. The webchat service is part of the Self-Harm Network Scotland, run by Penumbra, which also provides up to date, reliable and accessible advice for anyone affected by self-harm, including children and young people. It also offers free training sessions, either in person or online. We have committed a further £1.5 million for 2024-26 to continue this support.

Our 10 year suicide prevention Strategy, Creating Hope Together (2022) includes a commitment to prevent suicidal behaviour in children and young people. Work is currently underway to drive forward the year one priorities. These include building more understanding of suicide risk and behaviour amongst young people and using that to improve responses, and focusing on improving safety at key locations of concern. The views and needs of young people will be considered within the Strategy through input from our Youth Advisory Group.

Next Steps

Mental Health and Wellbeing Strategy

• With our key partners, we will take forward the Mental Health and Wellbeing Delivery Plan 2023-2025 and Workforce Action Plan.

Community-based Supports

• We are continuing to fund community-based mental health services in 2023-24 by providing local authorities with a further £15 million. Through the Mental Health and Wellbeing Delivery Plan 2023-2025, we are committed to continuing to fund local authorities to provide these supports during the life of the Delivery Plan, and also to reviewing the Community Mental Health and Wellbeing Supports and Services Framework (2021) in conjunction with COSLA.

Eating Disorders

• We are continuing to deliver the recommendations from the National Review of Eating Disorder Services. This includes:
• continuing to provide funding to Beat, the UK’s eating disorder charity, to deliver a range of self-help and peer support groups; and
• establishing the National Eating Disorder Network in 2024 which will support us to deliver on the remaining long-term recommendations.

publishing a National Specification for the Care and Treatment of Eating Disorders in Scotland. This was out for consultation until 9 February 2024 and analysis of the consultation results will help us finalise the National Specification;

Self-harm Strategy

• We will begin to implement our first Self-Harm Action Plan (November 2023). The main focuses of the Plan include: deepening knowledge and compassionate understanding of self-harm; building support and services across Scotland, whilst tackling stigma and discrimination; and improving and sharing data and evidence.

Suicide Prevention

• We are currently delivering our year one priorities under the new suicide prevention Strategy and action plan.

6.8 Child and Adolescent Mental Health Services

No: 43a(i) – (iii)

UN Concluding Observation

Urgently reform the Mental Health Act, in line with previous commitments and the policy position set out in the 2021 White Paper, and ensure that it:

• Explicitly prohibits the detention or placement in adult psychiatric units or police stations of children with mental health issues, learning disabilities and autism;
• Guarantees children’s right to be heard in decisions regarding their mental health care, to access therapeutic mental health services and to receive support from Independent Mental Health Advocates;
• Establishes standards for determining the duration of inpatient mental health care and for appropriate follow-up, with a view to preventing unnecessary and prolonged stays in inpatient mental health care.

No: 43d

UN Concluding Observation

Urgently address the long waiting times for accessing mental health services, without stigma; and ensure that the number of qualified medical professionals, including child psychologists and psychiatrists, is sufficient to meet children’s mental health needs in a timely manner and close to where they live;

No: 43f

UN Concluding Observation

Address the overrepresentation of children belonging to minority groups, children with autism and children with learning disabilities in inpatient mental health care;

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.21 – Child and Adolescent Mental Health Services

Progress since November 2022

Improving mental health remains a priority for the Scottish Government and, whilst we recognise the ongoing pressures facing the NHS, long waits are unacceptable. We remain committed to supporting all Boards to meet the standard that 90% of patients start treatment within 18 weeks of referral.

It is positive to see significant and sustained improvements in Child and Adolescent Mental Health Services (CAMHS) waiting times over the last year. 13 out of 14 CAMHS Services have now effectively eliminated their long waits (where 3% or fewer of all waits are over one year). This has been made possible by the hard work of our CAMHS workforce, which has more than doubled (+128.9 %) under this Government (since 2007) to the current all-time high of 1,372.2 whole time equivalent posts.

We are seeing continued positive signs of improvement across the whole waiting list:

• The overall CAMHS waiting list decreased by 36% in the previous year (from 8,385 in September 2022 to 5,344 in September 2023).
• Children waiting over 18 weeks decreased by 69% in the previous year (from 3,493 in September 2022 to 1,073 in September 2023).
• Children waiting over 52 weeks decreased by 88% in the previous year (from 1,252 in September 2022 to 147 in September 2023).

Services are continuing to respond well to high demand for CAMHS, with statistics showing one in two children and young people referred to CAMHS now start treatment within 10 weeks.

There has been significant progress made to improve CAMHS services and implement the recommendations of the Children and Young People’s Mental Health and Wellbeing Taskforce (2019). Most notably, our National CAMHS Service Specification, which was published in 2020, sets out the levels of service that children, young people and families can expect from CAMHS across Scotland. This includes a requirement that services must offer a first appointment to all children and young people who meet the CAMHS Scotland referral criteria. This first appointment, unless in unscheduled or urgent care, should be as soon as possible and no later than four weeks.

In-Patient and Specialist CAMHS Care

The Scottish Government expects children and young people who need inpatient mental health care to be looked after in age-appropriate facilities. However, there may be occasions when it is not possible for a young person to be admitted to a specialist child and adolescent bed, for example, a crisis admission out of hours where there are concerns for the young person’s safety, or where a specialist facility might be a considerable distance from family support which may aid recovery.

Children and young people accessing CAMHS will normally be treated in the community with only a very small number (approximately 1%) requiring treatment in an inpatient facility. In 2020, in response to Action 19 in the Mental Health Strategy 2017-2027, the Scottish Government published a protocol for admissions to non-specialist wards for young people with mental health problems. This set out standards and guidance to support admissions of under 18s to adult wards. The guidance notes that ‘whenever possible young people should be admitted to an age‑appropriate environment’.

Following recommendations made in previous Mental Welfare Commission reports, the Scottish Government commissioned a national review of existing provision for young people under 18 years who had needs and risks that required intensive psychiatric care. This review published its findings in June 2021 and recommended purpose-built regional units adjacent to existing inpatient services. In September 2021, we provided £1.65 million to NHS Boards to support the development of regional Intensive Psychiatric Care Units for young people.

The National Secure Adolescent Inpatient Service (NSAIS), known as Foxgrove, will be the first medium secure mental health inpatient service for children and young people in Scotland. It is expected to open in March 2024. Foxgrove will provide services for children and young people aged between 12 and 18 years who are subject to measures for compulsory care and treatment; have a mental disorder; present a significant risk to themselves or other people and require a medium secure level of security in order to meet their needs.

In September 2021, we provided £700,000 to NHS Boards to support the establishment of regional CAMHS services for children and young people with learning disabilities, forensic needs and those who are in secure care and prison. We have established a Forensic/Secure Care advisory group in order to provide expert guidance to the Scottish Government about mental health needs of the following groups of children (aged under 18 years): in secure accommodation, or ‘on the edges of’ secure care; or in custody; or who present high risk to others; or are involved in serious offending. This advice will inform development of NHS community Forensic/Secure Care Outreach CAMHS across Scotland.

We do not think it is the case that there is overrepresentation of children belonging to minority groups, children with autism and children with learning disabilities in inpatient mental health care in Scotland. Both the CAMHS and Neurodevelopmental Specifications aim to ensure that children and families receive the support and access to services that meet their needs at the earliest opportunity, based on the Getting it right for every child approach. For many children and young people, such support is likely to be community-based, and should be quickly and easily accessible. The Neurodevelopmental Specification is discussed further at section 6.7.

In 2021, we allocated £500,000 to NHS Greater Glasgow and Clyde to take forward, on behalf of the National e-Health Director Group, a programme of improvement of CAMHS patient management systems. The programme aims to improve provision of CAMHS and Children and Young People’s Neurodevelopmental services, infrastructure, applications, and a data improvement programme.

The Scottish Government is also taking forward a Mental Health and Capacity Reform Programme. This will look at options to update and modernise our mental health and capacity legislation to enhance protection of human rights. Alongside efforts to strengthen the law, the programme will drive action across mental health services to improve how we put human rights into practice.

Next Steps

• Recognising that performance varies across Health Boards, we continue to provide targeted, tailored support towards those Boards with the longest waits and poorest performance. We have asked Boards to submit trajectories up to March 2024 for performance against the CAMHS standard, and for clearing long waits. This will include an indication of when they predict they will meet the CAMHS standard if they are not already doing so.
• Further support will be provided through regular enhanced support meetings involving our professional advisors to those Boards not on track to meet the standard.
• We are continuing to fund CAMHS improvement work, including the reduction in waiting lists through the Outcomes Framework. We have allocated £48.6 million of supplementary funding so far to Boards this year via the Mental Health Outcomes Framework to improve the quality and delivery of mental health services for all. This is in addition to £36.7 million allocated to Health Boards via the Outcomes Framework in 2022-23; and to the total package of core funding that Health Boards receive.
• Work is ongoing to support NHS Boards to establish regional Intensive Psychiatric Care Units for young people.

6.9 Adolescent Health

No: 44a

UN Concluding Observation

Ensure access for adolescent girls to age-appropriate family planning services, affordable contraceptives and safe abortion and post-abortion care services, with a view to ensuring that no adolescent girl has to travel to other jurisdictions of the State party to access reproductive health care

No: 44b

UN Concluding Observation

Integrate comprehensive, age-appropriate and evidence-based education on sexual and reproductive health into mandatory school curricula at all levels of education and into teacher training, and ensure that it includes education on sexual diversity, sexual and reproductive health rights, responsible sexual behaviour and violence prevention, without the possibility for faith-based schools or parents to opt out of such education;

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 8.8 – Curriculum for Excellence

Access to Abortion and Contraception

Abortion is legal in Scotland and is available free of charge from NHS Scotland for all women and girls, including those aged under 16. Abortion care and related support, including interpreters where needed, can be accessed through local NHS Health Boards. Patients can choose for their treatment to remain confidential, regardless of age.

All mainland Health Boards in Scotland are now offering abortions within Scotland to at least 20 weeks gestation. Where Health Boards are unable to offer treatment up to 24 weeks gestation locally, they must work to provide an appropriate and person-centred care pathway for patients to receive treatment, with the majority of these services being provided in England. The Scottish Government is working with NHS Boards to explore all options for the delivery of a service up to 24 weeks gestation within Scotland. This follows a letter sent to NHS Board Chief Executives in June 2022, asking that girls under 16 years old are supported to access abortion services locally where possible.

Provision of contraceptives are offered free of charge from a range of services including specific young people services in Scotland. We continue to work through the Sexual Health and Blood Borne Virus Action Plan: 2023 to 2026 and Women's Health Plan (2021) to ensure that all women have access to contraceptive information and services in a timely manner suitable for their needs.

Relationships, Sexual Health, and Parenthood (RSHP) Education

The Scottish Government has consulted on draft revised statutory teaching guidance on Relationships, Sexual Health and Parenthood (RSHP) education in Scottish schools. The consultation closed in November 2023. The revised guidance contains additional guidance for schools to ensure children and young people learn about consent, as well as safe and healthy relationships to help promote responsible behaviour and tackle violence against women and girls.

In order to support young people’s engagement in the consultation, Young Scot, and the Scottish Youth Parliament (SYP) conducted an engagement project to gather young people’s views. The SYP and Young Scot facilitated face-to-face sessions with representative groups of young people and ran a survey to seek their views on the revised guidance. This engagement ran in tandem with the public consultation and will be reflected in the final version of the teaching guidance published in 2024.

It should be noted that we do not take a prescriptive approach to the curriculum in Scotland, and it is very much up to individual schools and local authorities what approaches they use and external partnerships they build to help them deliver relevant and engaging learning. We expect teachers to use their professional judgement, experience and understanding of their pupils to respond sensitively to complex and challenging issues.

Next Steps

Access to Abortion and Contraception

• A short life working group has been established to explore all options for the delivery of a later stage abortion service in Scotland.
• The 2023-26 Sexual Health and Blood Borne Virus Action Plan includes young people as a priority. Access to contraceptive information and services remains a key focus within this plan for people of all ages, including young women.

RSHP Education

• The Scottish Government will analyse responses to the public consultation on the statutory Relationships, Sexual Health and Parenthood (RSHP) teaching guidance and will consider possible amendments to the draft guidance in tandem with the outcome of engagement with young people. It is hoped that the revised statutory guidance will be formally published and available for use by teachers in 2024.

6.10 Use of Drugs, Alcohol and Tobacco

No: 44c

UN Concluding Observations

Strengthen measures to provide adolescents with information on preventing substance abuse, including of tobacco and alcohol, and to ensure the early identification and adequate referral of adolescents requiring treatment;

No: 44d

UN Concluding Observations

Ensure the availability of accessible, community-based drug dependence treatment services for adolescents, and ensure their complementarity with mental health services as relevant.

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.27 – Drug and Alcohol Use
• Section 7.28 – Smoking

Progress since November 2022

Drug Use

Work is underway to improve the availability, accessibility and quality of drug treatment services across Scotland via our National Mission to reduce drug-related deaths.^[13] This includes work to: implement the Medication-Assisted Treatment (MAT) Standards (2021), which set best practice for supporting people who use drugs; expand access to residential rehabilitation; and improve mental health support for people who use drugs.

In early 2023, we announced that Healthcare Improvement Scotland would work with every Health Board across Scotland to ensure that they have a protocol in place which sets out how mental health and substance use services should work together to support people with co-occurring conditions. This work is currently underway.

We have been working with a multi-agency expert working group to develop guidance on the treatment and support for young people experiencing harms from drug use. In June 2023, we commenced an engagement process with young people to ensure that their needs are at the centre of this work.

Alcohol

Our Alcohol Framework (2018) sets out the Scottish Government’s priorities for preventing alcohol-related harm. This includes a strong focus on protecting children and young people from alcohol-related harm and putting their voices at the centre of our proposals.

Restricting alcohol advertising and promotion is one of the World Health Organisation’s “three best buys” to reduce alcohol-related harms. In 2022, the Scottish Government carried out a written consultation on potential restrictions to alcohol advertising and promotion to protect vulnerable groups, including children and young people and those in recovery. Alcohol marketing is seen by, and appealing to, large volumes of children and young people in Scotland. International evidence shows that seeing alcohol marketing is associated with an increased likelihood that children and young people will start to drink alcohol or, if they already drink alcohol, drink more. This is harmful to them in both the short and long term.

As part of developing the consultation, we commissioned a co-design project with young people in Scotland. We followed this up with further work to directly engage young people and encourage them to respond to the consultation.

Children and young people were also consulted as part of the evaluation and review of Minimum Unit Pricing. This work was undertaken in summer 2023 through a dedicated focus group. The results were used to inform the final Report on the operation and effect of Minimum Unit Price, which was laid in Parliament in September 2023.

Tobacco and Nicotine

Our Tobacco and Vaping Framework – Roadmap to 2034, which was published in November 2023, aims to protect children born since 2013 from tobacco, so that when they begin to turn 21 (from 2034) they will be, and remain, tobacco-free. Our Framework lays out a roadmap as to how we will reach our goal of a tobacco-free Scotland by 2034. The plan has been developed collaboratively with stakeholders, including the Children’s Parliament and Young Scot, and we will continue to engage with them as we move through the first implementation plan, which ends in November 2025.

The Scottish Government is also part of the UK-wide smoke free generation consultation, which contains proposals which would prevent tobacco being legally sold to anyone born after 1 January 2009. That same consultation also contains proposals which aim to reduce the visibility and attractiveness of vapes to children and young people. The Scottish Government’s Programme for Government (2023) also stated our commitment to take action to reduce vaping among non-smokers and young people and to tackle the environmental impact of single-use vapes, including consulting on a proposal to ban their sale and other appropriate measures.

Next Steps

Drug Use

• The work to develop joint working protocols with mental health and substance use services will continue over the next two years, with all Health Boards in Scotland to have an agreed protocol that is publicly available.
• We hope to publish the guidance on young people experiencing harms from substance use in early 2024.

Alcohol

• We have published an independent analysis report of the responses to the restricting alcohol advertising and promotions consultation, which includes the findings from Children in Scotland’s engagement work and report based on a series of focus groups and other engagement activities involving children and young people. These will inform the potential content and scope of any policy proposals and our consideration of appropriate next steps with this work. We will hold further talks with public health stakeholders and the alcohol industry this year to discuss ways of limiting children and young people’s exposure to alcohol promotions.

Tobacco

• We will progress actions included within the first Implementation Plan (to November 2025) for the Tobacco and Vaping Framework.
• We will continue to work with the UK Government on their smoke free generation consultation on further restrictions on vapes and increasing the age of sale of tobacco.

6.11 Climate and Environment

No: 45a

UN Concluding Observations

Reduce greenhouse gas emissions in line with its national and international commitments;

No: 45b

UN Concluding Observations

Adopt legislation on air quality and urgently take measures to ensure children’s environmental health, including by improving air quality in urban areas, preventing children’s exposure to environmental toxins and high levels of lead;

No: 45d

UN Concluding Observations

Strengthen climate change mitigation and adaptation measures to storms and hurricanes.

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.40 – Environment
• Section 7.41 – Climate Change

Progress since November 2022

Climate Change

Scotland has its own distinct framework of statutory climate change targets set under the Climate Change (Scotland) Act 2009 (2009 Act). This legislation includes targets for Scotland to reach net-zero greenhouse gas emissions by 2045. Statutory annual and interim emissions reduction targets are set for every year until net zero, including an ambitious interim target for 2030 of a 75% emissions reduction relative to a 1990-95 baseline. Progress towards these targets also contributes to achievement of UK-wide targets.

The Scottish Greenhouse Gas Statistics 2021, published in June 2023, show that Scotland’s emissions are already down by around 50% since the baseline, half-way to net zero. The data shows continued underlying progress in reducing emissions across many key sectors of our economy, such as energy supply and industry.

We are currently developing the next full Climate Change Plan, which will set out our pathway to meeting our emissions reduction targets to 2040 and will publish the Plan by March 2025. The Plan will be supported by new sectoral Just Transition Plans and will reflect our ongoing commitment to a fair transition for all. The Plan will also set out the costs and benefits of the policies it contains, as well as how these will affect different sectors of the Scottish economy and different regions in Scotland.

We are also continuing to deliver on the outcomes set out in the Second Scottish Climate Change Adaptation Programme (2019). In May 2023, we published the fourth progress report on delivery of the climate change adaptation programme in line with the requirements set out in the 2009 Act. In response to recommendations from the independent advisory body, the Climate Change Committee, we also published an interim response to climate risks in August 2023, as part of the development of the next five-year statutory adaptation programme.

Measures to Improve Air Quality

Cleaner Air for Scotland 2 - Towards a Better Place for Everyone (2021), sets out the air quality policy framework for Scotland to 2026 and is accompanied by the Cleaner Air for Scotland 2 Delivery Plan (2021) containing around 80 actions intended to deliver further air quality improvements. Actions include: introducing Low Emission Zones in Scotland's four biggest cities, which was completed in May 2022; development of a public engagement framework around air quality; and a code of good practice to reduce pollution from agricultural activity. The Cleaner Air for Scotland 2 annual Progress Report 2022-23 was published in September 2023.

In 2022, for the first time outside of Covid-19 lockdown periods, all air quality objectives were met at each of the c.100 sites in the Scottish monitoring network. Monitoring and actions to improve air quality continue however, to ensure that this progress is maintained.

Since EU exit, a complex suite of chemicals regulation implements measures to control risks to the environment and people, including the most vulnerable groups in society. This framework, inherited from the EU, is the main means of ensuring chemicals’ safety but some national measures also exist that complement this. The UK Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) regulation ensures chemicals are used safely in consumer products and prevents risks during their use. This extends to ensuring people are not exposed to harmful levels of chemicals via their environment. The Scottish Government works with the UK Government and Welsh Government to prioritise chemical issues that need to be considered and addressed through UK REACH via an annual work programme.

Low Emission Transport

The Scottish Government is committed to building on the investment in active travel of recent years and announced record funding of £220 million in its draft budget proposal for 2024-25 to contribute to active travel investment, accelerating progress towards our ambitions for an active nation and reducing car kilometres. We have already delivered around 415 miles of walking and cycling paths in our towns and cities, of which around 270 miles is completely new infrastructure, and around 290 active travel infrastructure projects are already in train nationally within the Places for Everyone scheme.

In addition, the launch of the National Bus Travel Concession Scheme for Young Persons (Scotland) in January 2022 makes free bus travel available to all residents of Scotland aged under 22. The Scheme aims to encourage Scotland’s younger generations to use low-emission and lower carbon public transport, with a view to embedding that behaviour from a young age. By end September 2023, there were 688,000 cardholders and over 91 million journeys had been made through the Scheme. This is making a real difference to the lives of young people and their families by helping to cut costs for essential, every day and leisure travel.

Next Steps

Climate Change

• The Scottish Government will publish the next full Climate Change Plan by March 2025.
• In line with legislative requirements, the Scottish Ministers will lay a third National Climate Adaptation Plan in the Scottish Parliament in autumn 2024. This will respond to the climate risks and opportunities set out in the UK Climate Change Risk Assessment 2022. The public consultation for this plan will take place in early 2024.
• In spring 2024, the Scottish Government will consult on a national Flood Resilience Strategy (FRS). The FRS will set out what we need to do to enable Scotland’s places to become more resilient to warmer, wetter winters and increased instances of storms and flash flooding.

Air Quality

• We will continue to take forward actions in Cleaner Air for Scotland 2.

6.12 Participation in Climate Change Policy

45c

UN Concluding Observations

Ensure that national policies and programmes on addressing environmental protection, climate change and disaster risk management are developed and implemented in accordance with the principles of the Convention and take into account children’s needs and views;

45e

UN Concluding Observations

Promote, with the active participation of schools, children’s awareness of and preparedness for climate change and natural disasters, and strengthen awareness-raising among children on relevant climate legislation and their right to a clean environment and the enjoyment of the highest attainable standard of health;

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.42 – Participation in Climate Change Policy

Progress since November 2022

Scotland’s Public Engagement Strategy for Climate Change (2021-2026) commits to developing a new approach to ensuring a genuine role in climate policy processes for young people so their views are heeded and can influence policy design. As part of our Open Government commitment on climate change, the Scottish Government has developed a stakeholder network to support engagement and participation in climate change policy delivery. Several young people focused organisations are part of this network and, to date, have influenced its set-up and government climate policy development. In 2023, our engagement on the next Climate Change Plan and the next three Just Transition Plans has included children and young people representative organisations and young people aged over 18.

Climate Change Education in Schools

The Scottish Government published a refreshed and strengthened Learning for Sustainability (LfS) Action Plan in June 2023, in direct response to requests from youth-led campaign groups. The refreshed Plan was informed by research undertaken by the Children’s Parliament and the University of Dundee.

We are currently funding the Climate Action Schools programme delivered by Keep Scotland Beautiful. The programme delivers climate education in schools for children and young people from nursery age to adulthood and helps to engage children and young people on Scotland’s net zero transition and the ongoing implementation of the refreshed LfS Action Plan.

The Scottish Government has been funding the Scottish Credit Qualifications Framework (SCQF) Partnership to work with programme owners to further develop the LfS related qualifications and awards available for learners in the SCQF Partnership database. This includes qualifications on all LfS themes, including climate change and environmental issues. Phase 1 of this work took place in 2022‑23 with eight funded projects.

The Scottish Government also funded NatureScot to develop the Nature Discovery Map Scotland in 2022-23. This project aims to develop a mapping tool that supports education settings to engage with nature around them to understand the biodiversity and eco-systems of their area and the importance of sustainability and climate adaptation. The pilot of this project was successfully completed in June 2023 and further development is now underway.

Next Steps

• Further climate policy engagement is in development and should provide opportunities to engage with children and young people, for example, through representative organisations.
• The Scottish Government is funding the Children’s Parliament and the Scottish Youth Parliament to establish children and young people leadership groups to work alongside the LfS Leadership Group to ensure ongoing engagement with learners on the implementation of the refreshed LfS Action Plan. These Groups are now in place.
• Keep Scotland Beautiful will continue to deliver the Climate Action Schools programme 2023-2024. This will help strengthen awareness-raising amongst children and young people in schools on climate change and environmental issues.
• The Scottish Government is currently funding the SCQF Partnership for a Phase 2 of the work to develop LfS related qualifications and awards available for learners.

6.13 Tackling Child Poverty

No: 46a

UN Concluding Observation

Develop or strengthen existing policies, with clear targets, measurable indicators and robust monitoring and accountability mechanisms, to end child poverty and ensure that all children have an adequate standard of living, including by increasing social benefits to reflect the rising costs of living and abolishing the two-child limit and benefit cap for social security benefits;

No: 46d

UN Concluding Observation

Ensure that measures to combat poverty comply with a child rights-based approach and include a particular focus on children in disadvantaged situations, especially children of single parents, children with disabilities, Roma, Gypsy and Traveller children and children belonging to other minority groups, asylum-seeking and refugee children, children in large families, and children leaving care.

No: 40a

UN Concluding Observation

Assess the impact of welfare changes on children with disabilities and their families, and increase social welfare payments accordingly to ensure that policies do not have a discriminatory effect on them and that such payments are sufficient in ensuring their right to an adequate standard of living.

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.29 – Child Poverty
• Section 7.32 – 7.36 – Social Security Support

Progress since November 2022

Tackling Child Poverty

Tackling poverty and protecting people from harm is one of three critical and interdependent missions for the Scottish Government, as set out in the First Minister’s Policy Prospectus, published April 2023 – alongside our focus on the economy and strengthening public services. As noted in the Embedding Children’s Rights in Scotland: Position Statement (2022), the Child Poverty (Scotland) Act 2017 (“the 2017 Act”) set in statute ambitious income-based targets to significantly reduce child poverty by 2030-31, with interim targets to be met in 2023-24.

The 2017 Act also established a robust framework for action and to monitor progress. Under the Act, Scottish Ministers are required to publish Tackling Child Poverty Delivery Plans, outlining actions to drive progress towards the child poverty targets, and to publish annual reports on progress made towards meeting the child poverty targets and in implementing the relevant Delivery Plan.

The first Tackling Child Poverty Delivery Plan, Every Child, Every Chance (2018) identified six priority family types where children are at greatest risk of living in poverty: lone parent families, minority ethnic families, families with a disabled adult or child, families with young mothers aged under 25, families with a child under one and larger families (three or more children). Our second Tackling Child Poverty Delivery Plan, Best Start, Bright Futures (2022), remains firmly focused on ensuring that policies and services meet the needs of these families in particular. Almost 90% of all children in poverty in Scotland live within these six priority family types and we have built our knowledge and understanding of the barriers that these families face in moving out of poverty.

Our most recent annual Progress Report on Tackling Child Poverty (June 2023), highlights that 40 of the 101 actions set out in ‘Best Start, Bright Futures’, are either complete or delivering at scale with a further 39 in progress. The report also shows that in 2022-23, we invested an estimated £3 billion across a range of programmes targeted at low income households, with an estimated £1.25 billion directly benefitting children. Key action taken over the reporting period included:

• Delivering the planned expansion and further increase in the value of our Scottish Child Payment from 14 November 2022, which is estimated to lift 50,000 children out of relative poverty in 2023-24.
• Delivering our Five Family Payments: Scottish Child Payment, Best Start Foods and the three Best Start Grants, which could be worth around £10,000 by the time an eligible child turns six and over £20,000 by the time an eligible child is 16.
• Investing around £84 million in Discretionary Housing Payments (DHPs) to support people with housing costs and mitigate the UK Government’s bedroom tax, including making £2.6 million available to mitigate the UK Government’s Benefit Cap as fully as is possible within the scope of devolved powers.
• Introducing legislation to freeze rents in the private and social rented sector and increase protections for tenants in response to the cost of living crisis.
• Doubling investment in our Fuel Insecurity Fund to £20 million in 2022-23, with investment to be tripled to £30 million in 2023-24.
• Doubling the final Bridging Payment made to low income families with school age children to £260 per child, benefitting 143,000 children in December 2022. Bridging Payments were introduced to provide support to these families ahead of the full roll-out of the Scottish Child Payment on 14 November 2022 and provided almost £170 million in direct financial support over two years.

Alongside the annual progress report, the Scottish Government published modelling (June 2023), estimating that 90,000 fewer children will live in relative and absolute poverty in 2023-24 as a result of Scottish Government policies, with poverty levels 9% points lower that they would have otherwise been.

Social Security

The Scottish Government has introduced a number of social security benefits which seek to support low income families, including those with a disabled child.

The eligibility criteria for the Scottish Child Payment (SCP) is based upon receipt of a qualifying benefit based upon a low income. In November 2022, SCP was increased from £20 to £25 per eligible child per week and extended to families with eligible children aged 6-15 years. SCP expenditure in 2023-24, the first full year of full roll-out, is forecast to be £405 million. An Interim Evaluation of the SCP (2022) indicated that the payments were having a number of positive impacts on families, including those with a disabled child.

Child Winter Heating Payment (CWHP), formerly Child Winter Heating Assistance, helps mitigate the additional heating costs that households of the most severely disabled children and young people face in the winter months. Eligibility for CWHP was extended from winter 2022 onwards to also be paid to young people up to the age of 19 who are in receipt of the enhanced rate of the daily living component of Adult Disability Payment.

CWHP has provided assistance to 26,555 children and young people for winter 2022-2023, with payments totalling £5.7 million. As of March 2023, the total value of Child Winter Heating payments issued since November 2020 was £13.4 million. The payment will be uprated by 6.7% to £251.50 for 2024-25. The CWHP Evaluation Report, published in August 2022, highlighted that CWHP has largely met its short-term goals and has made some progress towards its medium-term goals. The report will continue to inform future developments of the policy area.

The Scottish Government’s Winter Heating Payment (WHP), which replaced the UK Government’s Cold Weather Payment, was launched in February 2023. WHP provides additional support to low income households who have a greater need for heat, including households with disabled children, acknowledging that it is harder for them to meet the costs of heating their homes during the winter months. By providing a reliable payment each winter, it ensures that every person identified as requiring that additional support will receive it. In winter 2022-2023, we paid WHP to 394,135 people, a total investment of £19.7 million. For winter 2024-25, WHP will be uprated by 6.7% to £58.75, a forecast investment of over £24 million. Based on the data available, official estimations suggest that there were around 84,000 WHPs paid out in winter 2022-23 to families responsible for a disabled child or a child under five.^[14]

Child Disability Payment, the Scottish replacement for Disability Living Allowance for Children, helps cover the extra costs of caring for a disabled or terminally ill child or young person. Since July 2021, Child Disability Payment has paid out £399.9 million to families with disabled children. As of September 2023, it is estimated that over 71,000 children and young people were receiving this disability benefit.

We began transferring the awards of approximately 47,300 children and young people from Disability Living Allowance to Child Disability Payment in October 2021. Social Security Scotland has now completed the transfer process for over 99% of children and young people who were in receipt of Disability Living Allowance for children in Scotland. Over 80% of people surveyed in the Child Disability Payment Client Survey 2022 reported that Child Disability Payment helped to make a difference to their lives.

October 2022 saw inflation reach record levels and in April 2023, the Scottish Government uprated all devolved Scottish benefits by 10.1% - in line with the annual rate of the September 2022 Consumer Prices Index (CPI), at a cost of around £430 million (except for Scottish Child Payment which was uprated early, see above). Since then, inflation has started to slow and on 19 December 2023, the Scottish Government announced that all Scottish benefits would be uprated by 6.7%, the annual rate of the September 2023 CPI, in April 2024. This uprating includes benefits where uprating is a statutory requirement, as well as those where uprating is discretionary, in recognition of the difficulties being faced by many due to the continued increases to the cost of living.

Benefit Take-up

Income via social security benefits is a key driver in tackling poverty in Scotland and strengthening support for families. Ensuring that individuals access all of the social security benefits to which they are entitled is therefore a fundamental priority for the Scottish Government. The Social Security (Scotland) Act 2018 (2018 Act) establishes a legal duty for the Scottish Ministers to promote the take-up of benefits within the Scottish social security system. The second Benefit Take-Up Strategy was published in October 2021.

Reserved Benefits

The Scottish Government does not have the powers to change the two-child limit policy at source while Universal Credit and Child Tax Credits remain reserved to the UK Parliament. Since January 2023, the Scottish Government has been mitigating the benefit cap as fully as possible within devolved powers through Discretionary Housing Payments (DHPs).

Next Steps

Tackling Child Poverty

• As set out in our annual Progress Report on Tackling Child Poverty, in 2023-24, we will continue to focus on strengthening the support available to families in order to mitigate the ongoing cost of living crisis and break the cycle of child poverty in Scotland. This includes:
• Launching Carer Support Payment in pilot areas from November 2023, expanding to more areas from spring 2024, to be available nationally by autumn 2024.
• Continuing to implement Whole Family Wellbeing Funding, driving whole system change to deliver a long-term shift towards earlier, preventative intervention.
• Delivering the actions set out in the refreshed Fair Work Action Plan which will be supported by evidence and data as per the associated Evidence Plan published January 2024.
• Working with business leaders to agree a set of actions that business can take to support the transition to a wellbeing economy within the frame of the New Deal for Business.
• Building on emerging evidence to support targeted scale up and sharing of learning around place-based transformation.
• Early Learning and Childcare is discussed at section 5.1 of this report.

Supporting families by introducing regulations that remove income thresholds and so increase eligibility for Best Start Foods to around an additional 20,000 people from February 2024.

Social Security

• The Scottish Government also introduced the Social Security (Amendment) (Scotland) Bill on 31 October 2023. The Bill aims to improve the Scottish system of social security and includes a number of different provisions, including the ability to create regulations for childhood assistance. Scottish Ministers intend to use this power in due course to modify the legislative footing on which the Scottish Child Payment (SCP) is based. This will allow the Scottish Government to make regulations for SCP as a standalone payment, in line with other forms of assistance delivered by Scottish Ministers.

Whilst Scottish Ministers envisage SCP eligibility maintaining a close link to reserved benefits, this new approach will allow Scottish Ministers additional flexibility. This would offer scope to better align the payment more closely with other forms of assistance delivered by Scottish Ministers, such as the Best Start Grants and Best Start Foods.

Benefit Support

• We will continue to monitor the impact of Child Winter Heating Payment through management information and will continue to consider improvements going forward.
• Winter Heating Payment will be subject to evaluation and review. This will help to drive continuous improvement in accordance with the Social Security Charter’s guiding principles.
• The Disability Assistance (Miscellaneous Amendment) (Scotland) Regulations 2023 further improve the journey from Child Disability Payment to Adult Disability Payment, including enabling payment cycles to be maintained and other minor consequential amendments. These came into force on 20 November 2023.
• As described in the Evaluation Strategy for devolved disability benefits (2021), a series of evaluations, drawing on the experiences of individuals, staff and stakeholders, are planned to help us identify next steps. We have commenced work to evaluate the Child Disability Payment to Adult Disability Payment journey.
• We will commission a further evaluation on our five family payments (Scottish Child Payment, Best Start Foods and the three Best Start Grants) to report in 2025.

6.14 Homelessness

No: 46b

UN Concluding Observations

Address the root causes of homelessness among children, strengthen measures to phase out temporary and “contingency” accommodation schemes, and significantly increase the availability of adequate and long-term social housing for families in need, with a view to ensuring that all children have access to affordable quality housing

No: 46c

UN Concluding Observations

Ensure that the best interests of the child are given primary consideration in all eviction matters, that evictions are not targeted at families belonging to minority groups and that any evictions are always subject to adequate alternatives;

Relevant section of Scottish Government’s November 2022 Position Statement

• Section 7.37 - Homelessness
• Section 7.38 – Preventing Homelessness for Young People
• Section 7.39 – Access to Housing

Progress since November 2022

Temporary Accommodation

While there will always be a need for temporary accommodation, as people do not necessarily know that they are going to become homeless, the Scottish Government is committed to reducing the number of households, including those with children, in temporary accommodation and the length of time households spend there. We are committed to acting on the recommendations of the expert Temporary Accommodation Task and Finish Group (March 2023). In our response (July 2023), we confirmed that we will:

• Invest at least £60 million from the Affordable Housing Supply Programme in 2023-24 to support a National Acquisition Programme to enable local authorities and registered social landlords to acquire properties of the right types and in the right places for use as high quality, affordable, permanent homes.
• Maintain momentum in the Affordable Housing Supply Programme (see below).
• Ask social landlords to increase allocations to homeless households.
• Support councils to develop targeted plans with an additional £2 million in 2023-24.

In the longer term, preventing homelessness before it happens and taking a rapid rehousing approach when homelessness does occur is the best way to limit the number of people in temporary accommodation. Proposals for new prevention of homelessness duties to be taken forward through housing legislation, as outlined in the Scottish Government’s Programme for Government (September 2023), will aim to ensure responsibility to prevent homelessness is a shared public responsibility and that action to prevent homelessness starts much earlier.

Sections 7.37 and 7.38 of the Embedding Children’s Rights in Scotland: Position Statement (2022) provide further information on steps taken by the Scottish Government to prevent homelessness, including amongst young people. Discretionary Housing Payments are discussed at section 6.13 of this report.

Support for Tenants

Since November 2022, we have extended our important emergency measures under the Cost of Living (Tenant Protection)(Scotland) Act 2022 to help stabilise in-tenancy rents in the private rented sector and temporarily increase eviction protections in the private, social rented and student accommodation sectors. In September 2023, Parliament approved regulations to extend these important emergency measures for a further and final six month period to 31 March 2024. On 24 January 2024, regulations were laid to temporarily modify the existing rent adjudication process for one year. Subject to the approval of the Scottish Parliament, these measures are intended to protect tenants concerned about rent increases following the ending of the emergency measures.

We are continuing to progress further reform of the private and social rented sectors as consulted on in our A New Deal for Tenants: Draft Rented Sector Strategy Consultation (2021). Some of the measures under consideration include additional protections during the evictions process and reforming how civil damages for unlawful eviction are calculated in both the private rented and social rented sectors. These build on changes introduced under the Coronavirus (Recovery and Reform)(Scotland) Act 2022, which brought the private rented sector in line with the social rented sector by introducing pre-action protocols for those with rent arrears and discretion for the First-tier Tribunal for Scotland (Housing and Property Chamber), ensuring that the reasonableness of an eviction is taken into account based on the circumstances of the case. These changes are intended to support all tenants facing eviction, including families with children.

Affordable Housing Supply

From 23 March 2022 to 30 September 2023, 15,765 homes were delivered towards the 110,000 affordable homes target, of which 12,188 (77%) are homes for social rent.

An estimated 3,530 households with children have been helped into affordable housing in the year to September 2023 and keeping social rents lower than market rents benefits approximately 140,000 children in poverty each year.

Furthermore, investing at least £60 million from the £752 million Affordable Housing Supply Programme in 2023-24 in a national acquisition programme to increase the supply of social and affordable homes may also offer local authorities the opportunity to increase the number of larger family properties in their portfolio to help reduce the number of children in temporary accommodation.

Next Steps

• Scottish Ministers have agreed with COSLA leaders that funding of £2 million will be allocated to 15 local authorities with above average percentage increases in the number of households in temporary accommodation from 2021-22 to 2022-23. This resource should be used by local authorities to maximise the use of existing housing stock, including large scale flipping of tenancies, effective void management, greater allocations of social homes to homeless households and bringing empty homes back into use to increase the supply of available affordable housing.
• Our Programme for Government (September 2023) reaffirms our intention to introduce a Housing Bill to deliver a New Deal for Tenants. This includes the introduction of long-term rent controls for the private rented sector, creating new tenants’ rights and introducing new duties aimed at the prevention of homelessness. The exact timing and content of the Bill are still to be confirmed.
• Inflationary pressures, Brexit impacts and wider market conditions have triggered rising construction costs and workforce challenges. This has significantly impacted our ability to progress our 110,000 homes target. We will bring forward a review of the target from 2026-27 to 2024, focusing on the timeline. In parallel, we are also accelerating work with the financial community in Scotland and elsewhere to boost private sector investment in Scotland year on year and help deliver more affordable homes.