COVID-19 wider impacts

Summary trends

15 June 2023 - outpatient appointments

Data are taken from Scottish Morbidity Record (SMR00) and show weekly outpatient appointments to week ending 25 December 2022, with monthly information shown to 31 December 2022. Further information is available by following the 'Data source and definitions' link on the dashboard.

Initial findings: outpatient appointments

Outpatient appointments fell from the second week of March 2020 onwards: by week ending 19 April 2020, all outpatient appointments had fallen by over two thirds (-68%) compared to the average of the same week in 2018–19 (from an average of 86,774 in 2018–19 to 27,628 in 2020).
This impact was similar across sexes, age groups and deprivation groups. For example, the fall in all appointments was greatest in patients aged 85 and over, dropping by almost three-quarters (-72%), while appointments for patients aged 15–44 dropped by two-thirds (-66%). However, by the week ending 25 December 2022, these figures were 19% lower than the 2018–2019 average for patients aged 85 and over and 18% lower for patients aged 15–44.
There were larger relative falls for surgical (-76%) than medical (-64%) specialties in the early stages of the pandemic. However, by week ending 25 December 2022, medical specialties were around one sixth lower (-18%) than average values for the same week in 2018–19, while surgical specialties were just under one quarter (-23%) lower.
There were larger decreases and a slower recovery in new outpatient appointments than in return outpatient appointments.
Outpatient appointments have generally been recovering from the end of April 2020 onwards but are still not up to pre-pandemic levels. For example, for the week ending 25 December 2022, the total number of appointments remains around 19% below the average of the same week in 2018–19.
There have been large increases in the number of appointments carried out remotely via telephone and videolink. In week ending 25 December 2022, just under one eighth (12%) of all appointments was conducted by telephone, and around 1 in 40 (3%) was by videolink. These modes of clinical interaction were uncommon prior to March 2020 but have consistently made up over one tenth of outpatient activity since then.
The impact of the pandemic on outpatient appointments was similar across ethnic groups: however, interpretation by ethnic group is complicated by the mandating of recording of ethnic group on SMR outpatient (SMR00) returns from 1 February 2021. This is reflected in the fall in the number of appointments with a missing ethnic group, which were 93% lower by December 2022 than the corresponding time in 2018–19. Previously, the 'Missing' ethnic group also included 'Not Known' and 'Refused/Not provided by patient'. From June 2023, the 'Missing' ethnic group category only includes records where the patient's ethnic group was not recorded, and the other two groups are shown separately.
In December 2022, appointments for patients with the 'White Scottish' ethnic group recorded were around 3% lower than the corresponding month in 2018–19. The number of appointments in other ethnic groups varied between 53% higher (‘African') and 1% higher (‘White Other British’). Activity for the ‘Other’ ethnic group was 60% higher than the corresponding month in 2018–19. It is important to note that the trends for ethnic groups with small populations should be interpreted with caution, as they will be subject to greater variability due to small numbers.

Interpreting these figures

Please exercise caution when interpreting these figures, as these data are for management information only. For more information on methodology and data quality, please see the Acute hospital activity and NHS beds publication (quarterly) (external website).

7 September 2022

Monthly hospital admissions by ethnic group

New analysis of hospital admissions by ethnic group has now been added. The COVID-19 pandemic has highlighted the need for ongoing monitoring of health data by ethnicity. Reporting analyses by ethnic group supports efforts to achieve equity in health care provision.
Ethnicity fields were added to Rapid Preliminary Inpatient Data (RAPID) submissions in June 2020 to aid the COVID-19 response. NHS Boards were asked to re-submit admissions data from 1 March 2020 onwards to include ethnicity information.
There was a significant decrease in hospital admissions across all ethnic groups during the lockdowns in Scotland in April 2020 and in the first months of 2021.
It is important to note that the trends for ethnic groups with small populations should be interpreted with caution as they will be subject to greater variability due to small numbers.

Admissions to Golden Jubilee National Hospital

Hospital admissions data for the Golden Jubilee National Hospital is now included. Data for the Golden Jubilee hospital has been submitted to the Rapid Preliminary Inpatient Data (RAPID) collection from June 2020 (with a snapshot of data back to 2018).

23 September 2020 - revision of baseline OOH

An issue with previously published 2018 and 2019 baseline Out of Hours (OOH) data was identified and has now been corrected. OOH figures from January 2018 to 22nd March 2020 had previously referred to numbers of consultations whereas those presented after 23rd March referred to numbers of cases. A correction has been applied to ensure that the full time series is now based on numbers of OOH cases. The impact of this revision is modest and does not materially affect interpretation of the changes observed in post-pandemic activity. At a national level adjusting the baseline data has resulted in a reduction in the baseline OOH figure of approximately 10% (1,600). The post-pandemic reductions in OOH activity previously reported were also over-estimated by around 6% each week, and this has now been corrected. The impact of the data revisions at a sub-national level may vary.

10 June 2020 - excess mortality

Each week National Records for Scotland (NRS) release provisional deaths data and a report (external website) about the numbers of deaths involving COVID-19 in Scotland. NRS report that weekly excess mortality (defined as deaths from any cause in 2020, both COVID-19 and non-COVID-19, compared with the average of the previous five years) peaked at 80% higher in the week ending 12 April, and had reduced to 17% higher by the most recent week (ending 24 May).

PHS are using the NRS data to provide further insight about excess mortality by sex, age group, area deprivation (quintiles of Scottish Index of Multiple Deprivation 2020), as well as at NHS Board and HSCP level. Thet numbers of deaths from any cause increased markedly at all levels of area deprivation from early April 2020. The excess deaths for each SIMD quintile compared with the 2015 to 2019 average was between 72% and 98% in the week ending 19 April, and had reduced to less than 25% for all quintiles by the latest week (ending 24 May).

3 June 2020

From the second week of March 2020 there was an abrupt and steep fall in hospital admissions, attendances at Accident and Emergency (A&E) departments and cases in out of hours services. Use of all of these services fell to around half the average levels seen 2018-19 and has since recovered only slightly. Numbers of NHS 24 111 completed contacts did not change appreciably though the data presented here do not include additional NHS 24 services specific to COVID-19. There was a small fall in attended ambulance incidents. Further analyses are presented in this interactive online tool.

Background

The COVID-19 pandemic has direct impacts on health as a result of illness, hospitalisations and deaths due to COVID-19. However, the pandemic also has wider impacts on health and on health inequalities. Reasons for this may include:

Individuals being reluctant to use health services because they do not want to burden the NHS or are anxious about the risk of infection.
The health service delaying preventative and non-urgent care such as some screening services and planned surgery.
Other indirect effects of interventions to control COVID-19, such as mental or physical consequences of distancing measures.

Public Health Scotland aims to provide information and intelligence on the wider impacts of COVID-19 on health, healthcare and health inequalities that are not directly due to COVID-19.

We have focused initially on using the national datasets that are returned to PHS most quickly, as these allow us to monitor impacts with the minimum delay. The work to date has made use of the following data sources:

The RAPID (rapid and preliminary inpatient data) hospital admissions database.
A&E attendances.
NHS 24 completed contacts.
Out of hours cases.
Scottish Ambulance Service data.

Initial findings: hospital admissions

Hospital admissions fell sharply from the second week of March, reaching levels nearly 50% below those expected on the basis of admissions during 2018-19.
There has been some recovery since late April, but numbers of admissions remain around 35% below the 2018-19 average.
Similar patterns are seen by sex and by deprivation, but falls were larger for children under 14 years and smaller for those aged 85 years and over.
There were larger relative falls for surgical than medical specialties.
There were much larger falls in planned admissions (around 65%) than in emergency admissions (around 40%).
There were particularly large falls (around 60%) for emergency paediatric admissions.
The pattern was broadly similar across NHS Boards; the low level of recorded admissions in NHS Forth Valley is likely to be due to data quality problems.

Initial findings: unscheduled care

Other data sources showed changes with similar time patterns to those seen for hospital admissions. There were larger falls (nearly 60%) for A&E attendances, with similar patterns by age, sex and deprivation.
NHS 24 111 completed contacts rose substantially for working age adults, but fell to around 50% of previous levels for children under 15 years of age, with little sign of recovery to previous levels. However it is important to note that while these figures include some contacts related to COVID-19, they do not include additional services set up to respond directly to COVID-19. Compared to previous years, percentage falls in completed contacts were smaller among those living in more deprived areas.
Compared to earlier years there were large percentage falls (around 55% overall) in cases in out of hours services, especially for children, where the fall was around 70%.
There were more modest falls in attended ambulance incidents (around 15% overall) though the fall was much larger for children (around 50%). These figures include incidents related to COVID-19.

Interpreting these figures

These analyses are based on a selected range of data sources that are available to describe changes in health service use in Scotland during the COVID-19 pandemic. Hospital admissions, attendances at A&E departments, contacts with the NHS 24 111 completed contacts and cases in out of hours services all fell to around half the average levels seen 2018-19 and have since recovered only modestly. There was a smaller fall in attended ambulance incidents and no appreciable change in NHS 24 111 completed contacts. These falls are likely to reflect a range of factors, including public anxiety about using NHS services, changes in the delivery of NHS services in response to rising numbers of COVID-19 hospital admissions and actions to defer planned activity in order to be prepared for expected COVID-19 related demand. The changes preceded by around a week the introduction of social distancing measures. The impact was particularly large for children under 14 years, with larger percentage falls in hospital admissions, NHS 24 111 completed contacts, out of hours cases and ambulance incidents. As expected, the falls in hospital admissions were larger for planned than for emergency admissions and larger for surgical than medical admissions. There was little evidence from these data sources that social inequalities in the use of these services increased during this period.

Future work

Work is under way to broaden the range of data sources available – within the next few weeks we expect to publish information on health visitor checks, perinatal mortality, excess mortality (in collaboration with NRS), prescribing and cardiovascular presentations.

Cardiovascular

5 May 2022

Cardiovascular hospital admissions and excess mortality

Data now available for cardiovascular hospital admissions and excess mortality. Information is available by quarter for diagnosis Heart Attack, Heart Failure and Stroke.

16 December 2020

Cardiovascular GP out of hour cases

For GP out of hours services there was a sharp fall of around 30% in cases for cardiovascular problems that started in early March 2020, some weeks prior to the introduction of ‘lockdown’ measures in Scotland. Contact numbers did not return to previous levels until early April, and during April, May and June were around 20% above the average for 2018-19. Trends were similar by age group and deprivation.

Cardiovascular Scottish Ambulance Service incidents

For Scottish Ambulance Service incidents, there was a sharp initial fall of around 40% in cardiovascular related incidents that started in early April 2020, shortly after the introduction of lockdown restrictions. This continued until mid-July. The fall in incidents was greatest in the most deprived groups.

17 June 2020

Prescribing

Information on prescriptions issued for cardiovascular medicines through General Practice has been included for the first time on 17th June 2020. These data indicate that:

The number of prescriptions for cardiovascular medicines overall rose sharply in the third week of March, increasing by approximately 35% when compared to the average for the same time period in 2018 and 2019.
When examining specific groups of cardiovascular medicines routinely prescribed in primary care a similar pattern is seen:
- The number of prescriptions rose sharply in March and peaked in the third week.
- The number of prescriptions in April was below that expected from the 2018/2019 average and is likely a consequence of early ordering of repeat supplies in March.
- By the end of May, the numbers of prescriptions were returning to normal levels.

Cardiovascular A&E attendances

Information on cardiovascular attendances at Accident & Emergency Departments is presented in this tool. This data is based on coding available in the Accident & Emergency Datamart (managed by Public Health Scotland). Note that, due to limitations in diagnosis recording in the A&E datamart, the data are incomplete for a number of NHS Boards. Thus, the figures reported for cardiovascular-related attendances offer only a very approximate indication of attendances. Additionally, some NHS Boards have moved to a new recording standard which has not been fully consolidated in the A&E datamart as yet. As a result, figures for 2020, even prior to the introduction of lockdown measures, appear somewhat lower when compared to previous years.

Overall there was a sharp drop in cardiovascular attendances at Accident and Emergency Departments starting in early March 2020. Attendances were around 60% lower compared to the 2018-2019 average. Levels rose again by the end of May, but remain around 30% below the 2018-19 average.
This drop in cardiovascular attendances was consistent across both males andfemales, in younger and older patients and across deprivation quintiles.

Cardiac procedures

Information on cardiac procedures has been obtained from two of the four cardiac care centres in Scotland (Royal Infirmary of Edinburgh and Golden Jubilee National Hospital). Data on the number of procedures was collected for:

coronary angiography (an investigation to evaluate whether there is any narrowing of the arteries supplying the heart);
cardiac devices, including pacemakers to treat rhythm problems of the heart and
percutaneous coronary interventions, cardiac procedures to treat narrowing of the arteries supplying the heart.

The major observations are as follows:

Overall, the number of coronary angiographies dropped from early March 2020. A significant proportion of these procedures are elective and these activities are likely to have been reduced in late March 2020.
The change in percutaneous coronary interventions has been less pronounced. A significant proportion of coronary interventions occur in a context of patients suffering a heart attack. A proportion of coronary interventions are also planned and elective in nature.
The number of device procedures has been lower than expected since the end of March 2020.

Cancer in Scotland in 2019 to 2022

Note: as the information provided in this dashboard is updated, it will both add more recent data and may also change historical data. This commentary includes reference to pathological specimens reported to the week ending 31 December 2022, which were available for inclusion in the analysis when the data were extracted on 30 May 2023.

Background

COVID-19 has had a wide impact on cancer in Scotland since it led to widespread social disruption from the end of March 2020. Some parts of this are better understood than others. For example, cancer screening programmes were paused and urgent referrals for suspected cancer fell substantially. The effects on patients being less likely to seek help, delays in investigations and treatment, or changes in usual treatment, are less clear. We explored how many patients had their cancers confirmed pathologically from 2020 onwards compared with how many there were in 2019, as a proxy measure of changes in cancer incidence.

What these data do and do not show

The numbers in this dashboard are individuals from whom a pathology sample found cancer in 2019 onwards in Scotland. Each individual was counted once the first time they appeared from 1 January; any subsequent samples for the same individual were not counted (except when reporting cancer type-specific numbers, where an individual could contribute to more than one cancer type).

In most cases, these indicate a new diagnosis (incidence) of cancer but in some cases they are follow-up samples of cancers that were diagnosed previously.

Cancer is often diagnosed initially through clinical examination (including radiology) followed by pathological confirmation. However, not all cancers are diagnosed by pathology: some are better diagnosed through other methods (e.g. blood tests) and for some, the tumour is inaccessible for tissue sampling. On average, around 80% of cancers have pathological confirmation, though this varies by the type of cancer.

There is generally a 2-3 month time lag between the pathology sample being reported on by the laboratory and the complete data being received and processed by the Scottish Cancer Registry; as such the data shown in the dashboard are for pathological samples taken for patients to 31 December 2022.

Any observed differences in numbers of pathologically confirmed cancers from 2020 onwards, compared to 2019, could be due to changes in:

patients seeking or obtaining an initial medical consultation
availability of cancer screening
availability of diagnostic services
treatment (particularly surgery, which may provide the pathology sample)
completeness of pathology data
true changes in cancer occurrence (incidence)

Since the definitive 2020 cancer incidence data were published in June 2022, and 2021 incidence published in April 2023, quality assurance work is being carried out to validate the pathology dashboard figures.

Overall trends in pathologically confirmed cancers

In 2020, numbers were similar to 2019 until towards the end of March. After the first national lockdown, the numbers fell by about 40% of those seen in comparable weeks in 2019. Numbers then rose from late April 2020. Overall, the weekly numbers of patients with pathologically confirmed cancers were close to those before the pandemic by the end of September 2020. It should be noted that there were important variations in patterns between types of cancer.

In 2021 and 2022, overall numbers remained fairly close to those seen in 2019 but they varied considerably by cancer type and there were some notably higher and lower than expected numbers (see relevant updates).

3 August 2023 - Pathology data updated to 31 December 2022 (extracted 30/05/2023)

In 2022, the total number of individuals with a pathological diagnosis of cancer (Excl.C44) was slightly higher than in 2019 (33,765 and 32,809 in 2022 and 2019 respectively, a difference of approximately 2.9%). This is consistent with a trend in cancer incidence seen for many decades in Scotland driven by an increasing size of older population despite falling risks of cancer occurring (overall).

For this update, we review patterns in the most common types of cancer during 2022 as well as updating the results for the calendar year 2021.

2022 data

Among the most common cancer types, in 2022 and 2019, respectively:

Lung cancer: 2,257 versus 2,815 pathological diagnoses. This indicates a continued deficit (-20%) which was also seen through 2021.
Breast cancer (females only): 5,535 versus 5,310 pathological diagnoses. This indicates an increase in diagnoses of 4% after the return to typical numbers of diagnoses in 2021.
Prostate cancer: 4,903 versus 3,146 pathological diagnoses. This indicates a further increase in diagnoses of 56%, a continuation of the increase seen in 2021.
Colorectal (bowel) cancer: 4,165 versus 4,009 pathological diagnoses. This indicates an increase of 4% after the return to typical numbers of diagnoses in 2021.
Liver and intrahepatic bile ducts: 406 versus 320 pathological diagnoses. This indicates an increase of 27%, a continued increase in diagnoses also seen in 2021.
Oesophagus: 1,155 versus 1,004 pathological diagnoses. This indicates an increase of 15% and a continuation of the increase in diagnoses seen in 2021.
Cervical: 351 versus 371 pathological diagnoses. This indicates a decrease of 5% and a return to typical number of diagnoses in 2022 after the increase in diagnoses seen in 2021.

These results show a mixture of some continued under-diagnoses and some “catching-up” with the under-diagnoses seen earlier in the pandemic. Where pathologically-confirmed cancers can be compared to the gold standard for cancer incidence, the Scottish Cancer Registry, there are sometimes large differences that require further explanation beyond under-diagnosis and “catching-up”.

Revisions of 2021 data

As pathology data are continually updated, a revision of diagnoses comparisons in 2021 and 2019 in this latest extract is given below:

Lung cancer: 2,318 versus 2,815 pathological diagnoses; a decrease of 497 individuals, or 18% lower.
Breast cancer (females only): 5,338 versus 5,310 pathological diagnoses; an increase of 28 individuals, or less than 1% higher.
Prostate cancer: 3,677 versus 3,146 pathological diagnoses; an increase of 531 individuals, or 17% higher.
Colorectal (bowel) cancer: 4,062 versus 4,009 pathological diagnoses; an increase of 53 individuals, or 1% higher.
Liver and intrahepatic bile ducts: 379 versus 320 pathological diagnoses; an increase of 59 individuals, or 18% higher.
Oesophagus: 1,188 versus 1,004 pathological diagnoses; an increase of 184 individuals, or 18% higher.
Cervical: 360 versus 371 pathological diagnoses; a decrease of 11 individuals, or 3% lower.

Comparison with the 2021 cancer incidence publication is now possible. While the historical comparisons used for this dashboard (numbers in 2019) differ from those used in the cancer incidence publication (projections based on 10-year trends from 2010-19), it is notable that cancer registrations showed little change in 2021 for all cancers, lung and prostate and a decrease in liver cancers in males. However, the pathology dashboard shows large decreases in lung, and increases in prostate and liver cancer specimens. Further information validating the dashboard against the Scottish Cancer Registry will be published at a later date.

A new chart comparing 2019 quarterly totals to the same quarters in 2020 and 2021 shows that after initial falls in diagnoses, there was some recovery or catching-up in the cumulative figures, repeating 2019 figures over two years for comparison with the 2020-2021 period:

All excl. NMSC: 32,700 (2021) and 28,293 (2020) compared with 32,809 in 2019. That is, down 4,625 in total by December 2021. No overall reduction in the number of “missing” patients although it is important to look at each cancer type to understand what has happened.
Lung: 2,318 (2021) and 2,252 (2020) compared with 2,815 in 2019. That is, 1,060 down in total by December 2021. So the continued under-diagnosis in 2021 added to the total “missing”.
Colorectal: 4,062 (2021) and 3,194 (2020) compared with 4,009 in 2019. That is, 762 down in total by December 2021.
Breast (females only): 5,338 (2021) and 4,518 (2020) compared with 5,310 in 2019. That is, down 764 in total by December 2021.
Cervical: 360 (2021) and 308 (2020) compared with 371 in 2019. That is, down 74 in total by December 2021.
Prostate: 3,677 (2021) and 2,614 (2020) compared with 3,146 in 2019. That is, down only 1 patient in total by December 2021 – suggesting that those missing in 2020 were largely identified in 2021 and there is little ongoing deficit.

New information on age and socio-economic deprivation has been added to the dashboard, reviewing the annual data to the end of December 2022 compared to 2019:

Age

For all cancers except non-melanoma skin cancers, the proportionate fall in cumulative pathologically confirmed cancers by December 2022 were much smaller than at the end of 2021, and there was less difference between age groups. The reduction in breast and colorectal cancer diagnoses, which were both affected by pauses in the screening programmes for people aged 50-69, were smaller by December 2022 than December 2021. For example, for breast cancer, pathological cancer diagnoses in those aged 50-69 showed a shortfall of 3.3% in those of screening age (50-69) by the end of Q4 2022, compared to a shortfall of 1.6% for those under 50. For colorectal cancers, numbers in 50-69 years olds showed a shortfall of 5.3% by the end of Q4 2022; however, the equivalent numbers in under 50s had shown less improvement, a shortfall of 10.2%.

Socio-economic deprivation

For deprivation, the least and most deprived quintiles are highlighted in colour. For all cancers except non-melanomas skin cancers, these showed the largest decreases in diagnoses remained among people from the most deprived areas, showing a shortfall of 12.0% by the end of Q4 2022. The least deprived were down 6.4% by the same period.

14 December 2022 - Pathology data updated to 24 May 2022 (extracted 31/08/2022)

In 2022 (weeks ending 5 January to 24 May), there was little difference in the total number of individuals with a pathological diagnosis of cancer (Excl.C44) compared with those in 2019 over the same dates (14,872 and 14,639 in 2022 and 2019 respectively, a difference of approximately 1.6%). It should be noted that there are usually fewer cancer diagnoses in late December and early January because of seasonal holidays, so the interpretation of results from the first few months of 2022 should be made with caution.

For this update, we review patterns in the most common types of cancer for early 2022 as well as updating the results for the calendar year 2021.

Early 2022 data

Among the most common cancer types, comparing January to week ending 24 May in 2022 and 2019, respectively:

Lung cancer: 926 versus 1,140 pathological diagnoses. This indicates a continued deficit (-19%) which was also seen through 2021.
Breast cancer (females only): 2,625 versus 2,458 pathological diagnoses. This indicates an increase in diagnoses of 7% after the return to typical numbers of diagnoses in 2021.
Prostate cancer: 1,934 versus 1,365 pathological diagnoses. This indicates a further increase in diagnoses of 42%, a continuation of the increase seen in 2021.
Colorectal (bowel) cancer: 1,835 versus 1,779 pathological diagnoses. This indicates an increase of 3% after the return to typical numbers of diagnoses in 2021.
Liver and intrahepatic bile ducts: 170 versus 124 pathological diagnoses. This indicates an increase of 37%, a continued increase in diagnoses also seen in 2021.
Oesophagus: 509 versus 422 pathological diagnoses. This indicates an increase of 21% and a continuation of the increase in diagnoses seen in 2021.
Cervical: 137 versus 145 pathological diagnoses. This indicates a decrease of 6% and a return to typical number of diagnoses in 2022 after the increase in diagnoses seen in 2021.

These early results therefore show a mixture of some continued under-diagnoses and some “catching-up” with the under-diagnoses seen earlier in the pandemic.

Revisions of 2021 data

As pathology data are continually updated, a revision of the January to week ending 27 December in 2021 and 2019, in this latest extract is given below:

Lung cancer: 2,324 versus 2,833 pathological diagnoses; a decrease of 509 individuals, or 17.9% lower.
Breast cancer (females only): 5,321 versus 5,315 pathological diagnoses; an increase of 6 individuals, or less than 1% higher.
Prostate cancer: 3,651 versus 3,143 pathological diagnoses; an increase of 508 individuals, or 16.2% higher.
Colorectal (bowel) cancer: 4,072 versus 4,041 pathological diagnoses; an increase of 31 individuals, or less than 1% higher.
Liver and intrahepatic bile ducts: 380 versus 330 pathological diagnoses; an increase of 50 individuals, or 15.2% higher.
Oesophagus: 1,184 versus 1,006 pathological diagnoses; an increase of 178 individuals, or 17.7% higher.
Cervical: 358 versus 371 pathological diagnoses; a decrease of 13 individuals, or 3.5% lower.

All excl. NMSC: 33,162 (2021) and 28,783 (2020) compared with 33,345 in 2019. That is, down 4,745 in total by December 2021. No overall reduction in the number of “missing” patients although it is important to look at each cancer type to understand what has happened.
Lung: 2,324 (2021) and 2,263 (2020) compared with 2,833 in 2019. That is, 1,079 down in total by December 2021. So the continued under-diagnosis in 2021 added to the total “missing”.
Colorectal: 4,072 (2021) and 3,216 (2020) compared with 4,041 in 2019. That is, 794 down in total by December 2021.
Breast (females only): 5,321 (2021) and 4,529 (2020) compared with 5,315 in 2019. That is, down 780 in total by December 2021.
Cervical: 358 (2021) and 309 (2020) compared with 371 in 2019. That is, down 75 in total by December 2021.
Prostate: 3,651 (2021) and 2,614 (2020) compared with 3,143 in 2019. That is, down only 21 patients in total by December 2021 – suggesting that those missing in 2020 were largely identified in 2021 and there is little ongoing deficit.

New information on age and socio-economic deprivation has been added to the dashboard, reviewing the annual data to the end of December 2021 compared to 2019:

Age

For all cancers except non-melanoma skin cancers, the proportionate fall in cumulative pathologically confirmed cancers by December 2021 were much smaller than at the end of 2020, and there was less difference between age groups. The reduction in breast and colorectal cancer diagnoses, which were both affected by pauses in the screening programmes for people aged 50-69, were smaller by December 2021 than December 2020. For example, for breast cancer, pathological cancer diagnoses in those aged 50-69 showed a shortfall of 7.0% in those of screening age (50-69) by the end of Q4 2021, compared to a shortfall of 1.9% for those under 50. For colorectal cancers, numbers in 50-69 years olds showed a shortfall of 10.5% by the end of Q4 2021; however, the total falls in under 50s had shown less improvement, a shortfall of 18.0%.

Socio-economic deprivation

3 August 2022 - Pathology data updated to 2 February 2022 (extracted 02/06/2022)

In 2022 (weeks ending 5 January to 2 February), there was little difference in the total number of individuals with a pathological diagnosis of cancer (Excl.C44) compared with those in 2019 over the same dates (4046 and 3986 in 2022 and 2019 respectively, a difference of approximately 1.5%). It should be noted that there are usually fewer cancer diagnoses in late December and early January because of seasonal holidays, so the interpretation of results from the first few weeks of 2022 should be made with caution.

For this update, we review patterns in the most common types of cancer for early 2022 as well as updating the results for the calendar year 2021.

Early 2022 data

Among the most common cancer types, comparing January to week ending 2 February in 2022 and 2019, respectively:

Lung cancer: 230 versus 274 pathological diagnoses. This indicates a continued deficit (-16%) which was also seen through 2021
Breast cancer (females only): 804 versus 739 pathological diagnoses. This indicates an increase in diagnoses of 9% after the return to typical numbers of diagnoses in 2021.
Prostate cancer: 476 versus 350 pathological diagnoses. This indicates a further increase in diagnoses of 36%, a continuation of the increase seen in 2021.
Colorectal (bowel) cancer: 538 versus 486 pathological diagnoses. This indicates an increase of 11% after the return to typical number of diagnoses in 2021.
Liver and intrahepatic bile ducts: 38 versus 29 pathological diagnoses. This indicates an increase of 31%, a continued increase in diagnoses also seen in 2021.
Oesophagus: 112 versus 104 pathological diagnoses. This indicates an increase of 8% and a continuation of the increase in diagnoses seen in 2021.

These early results therefore show a mixture of some continued under-diagnoses and some “catching-up” with the under-diagnoses seen earlier in the pandemic.

Revisions of 2021 data

As pathology data are continually updated, a revision of the January to week ending 27 December in 2021 and 2019, in this latest extract is given below:

Lung cancer: 2,324 versus 2,833 pathological diagnoses; a decrease of 509 individuals, or 17.9% lower.
Breast cancer (females only): 5,322 versus 5,315 pathological diagnoses; a decrease of 7 individuals, or less than 1% lower
Prostate cancer: 3,651 versus 3,143 pathological diagnoses; an increase of 508 individuals, or 16.2% higher.
Colorectal (bowel) cancer: 4,071 versus 4,041 pathological diagnoses; an increase of 30 individuals, or less than 1% higher.
Liver and intrahepatic bile ducts: 380 versus 330 pathological diagnoses; an increase of 50 individuals, or 15.2% higher.
Oesophagus: 1184 versus 1006 pathological diagnoses; an increase of 178 individuals, or 17.7% higher.

All excl. NMSC: 33162 (2021) and 28784 (2020) compared with 33345 in 2019. That is, down 4744 in total by December 2021. No overall reduction in the number of “missing” patients although it is important to look at each cancer type to understand what has happened.
Lung: 2324 (2021) and 2263 (2020) compared with 2833 in 2019. That is, 1079 down in total by December 2021. So the continued under-diagnosis in 2021 added to the total “missing”.
Colorectal: 4071 (2021) and 3216 (2020) compared with 4041 in 2019. That is, 795 down in total by December 2021.
Breast (females only): 5322 (2021) and 4529 (2020) compared with 5315 in 2019. That is, down 779 in total by December 2021.
Cervical: 358 (2021) and 309 (2020) compared with 371 in 2019. That is, down 75 in total by December 2021.
Prostate: 3651 (2021) and 2614 (2020) compared with 3143 in 2019. That is, down only 21 patients in total by December 2021 – suggesting that those missing in 2020 were largely identified in 2021 and there is little ongoing deficit.

New information on age and socio-economic deprivation has been added to the dashboard, reviewing the annual data to the end of December 2021 compared to 2019:

Age

For all cancers except non-melanoma skin cancers, the proportionate fall in cumulative pathologically confirmed cancers by December 2021 were much smaller than at the end of 2020, and there was less difference between age groups. The reduction in breast and colorectal cancer diagnoses, which were both affected by pauses in the screening programmes for people aged 50-69, were smaller by December 2021 than December 2020. For example, for breast cancer, pathological cancer diagnoses in those aged 50-69 showed a shortfall of 8.9% in those of screening age (50-69) by the end of Q4 2021, compared to a shortfall of 1.7% for those under 50. For colorectal cancers, numbers in 50-69 years olds showed a shortfall of 10.5% by the end of Q4 2021; however, the total falls in under 50s had shown less improvement, a shortfall of 18.0%.

Socio-economic deprivation

15 June 2022 - Pathology data updated to 31 December 2021 (extracted 20/04/2022)

In 2021 (weeks ending 5 January to 27 December), there was little difference in the total number of individuals with a pathological diagnosis of cancer (Excl. C44) compared with those in 2019 (33086 and 33345 in 2021 and 2019 respectively, a difference of approximately 0.8%). However, within cancer sites, some were higher and some lower than expected in 2021 compared with 2019.

Among the most common cancer types, comparing January to week ending 27 December in 2021 and 2019, respectively:

Lung cancer: 2,319 versus 2,833 pathological diagnoses; a decrease of 583 individuals, or 20.6% lower.
Breast cancer (females only): 5,314 versus 5,315 pathological diagnoses; a decrease of 1 individual, or less than 1% lower
Prostate cancer: 3,646 versus 3,143 pathological diagnoses; an increase of 503 individuals, or 16% higher.
Colorectal (bowel) cancer: 4,057 versus 4,041 pathological diagnoses; an increase of 16 individuals, or 0.4% higher.
Liver and intrahepatic bile ducts: 379 versus 330 pathological diagnoses; an increase of 49 individuals, or 14.8% higher.
Oesophagus: 1182 versus 1006 pathological diagnoses; an increase of 176 individuals, or 17.5% higher.

All excl. NMSC: 33086 (2021) and 28481 (2020) compared wi33345 in 2019. That is, down 5123 in total by December 2021. No overall reduction in the number of “missing” patients although it is important to look at each cancer type to understand what has happened.
Lung: 2319 (2021) and 2250 (2020) compared wi2833 in 2019. That is, 1097 down in total by December 2021. So the continued under-diagnosis in 2021 added to the total “missing”.
Colorectal: 4057 (2021) and 3187 (2020) compared wi4041 in 2019. That is, 838 down in total by December 2021.
Breast (females only): 5314 (2021) and 4488 (2020) compared wi5295 in 2019. That is, down 788 in total by December 2021.
Cervical: 307 (2021) and 357 (2020) compared wi371 in 2019. That is, down 78 in total by December 2021.
Prostate: 2587 (2021) and 3646 (2020) compared wi3143 in 2019. That is, down only 53 patients in total by December 2021 – suggesting that those missing in 2020 were largely identified in 2021 and there is little ongoing deficit.

New information on age and socio-economic deprivation has been added to the dashboard, reviewing the annual data to the end of December 2021 compared to 2019:

Age

For all cancers except non-melanoma skin cancers, the proportionate fall in pathologically confirmed cancers by December 2021 were much smaller than at the end of 2020, and there was less difference between age groups. The reduction in breast and colorectal cancer diagnoses, which were both affected by pauses in the screening programmes for people aged 50-69, were smaller by December 2021 than December 2020. For example, for breast cancer, pathological cancer diagnoses in those aged 50-69 showed a shortfall of 9.1% in those of screening age (50-69) by the end of Q4 2021, compared to a shortfall of 1.6% for those under 50. For colorectal cancers, numbers in 50-69 years olds showed a shortfall of 11.2% by the end of Q4 2021; however, the total falls in under 50s had shown less improvement, a shortfall of 17.2%.

Socio-economic deprivation

For deprivation, the least and most deprived quintiles are highlighted in colour. For all cancers except non-melanomas skin cancers, these showed the largest decreases in diagnoses remained among people from the most deprived areas, showing a shortfall of 12.9% by the end of Q4 2021.The least deprived were down 6% by the same period.

22 September 2021 - Pathology data updated to 14 June 2021 (extracted 19/8/2021)

In the first half of 2021 (weeks ending 05 January to 14 June), there was little difference in the total number of individuals with a pathological diagnosis of cancer compared with those in 2019 (16455 and 16569 in 2021 and 2019, respectively, a difference of less than 1%). However, within cancer sites, some were higher and some lower than expected in 2021 compared wi2019.

Among the most common cancer types, comparing January to week ending 14 June in 2021 and 2019:

Lung cancer: 1,102 versus 1,328 pathological diagnoses; a decrease of 226 individuals, or 17% lower.
Breast cancer (females): 2,658 versus 2,774 pathological diagnoses; a decrease of 116 individuals, or 4% lower.
Prostate cancer: 1,581 versus 1,544 pathological diagnoses; an increase of 37 individuals, or 2% higher.
Colorectal (bowel) cancer: 1,958 versus 2,011 pathological diagnoses; a decrease of 53 individuals, or 3% lower.
Liver and intrahepatic bile ducts: 166 versus 147 pathological diagnoses; an increase of 19 individuals, or 11% higher.
Oesophagus: 579 versus 473 pathological diagnoses; an increase of 106 individuals, or 22% higher.

A new quarterly chart of cumulative numbers shows that after initial falls in diagnoses, there was some recovery or catching-up. For all cancers except non-melanoma skin cancers, there had been a drop to -14% of 2019 numbers by the end of Quarter 3 (Q3) but this increased to -12% by the end of 2020. A similar pattern of maximum fall by the end of Q3 with a small recovery by the end of Q4 was seen for the commonest cancers – lung, breast, colorectal, and prostate.

New information on age and socio-economic deprivation has been added to the dashboard, reviewing the annual data to the end of December in 2020 compared to 2019:

Age

For all cancers except non-melanoma skin cancers, the largest proportionate fall in pathologically confirmed cancers were among those aged 50-69 years and the smallest falls were in those under 50 years. This difference is more clearly seen in breast and colorectal cancers, which were both affected by pauses in the screening programmes for people aged 50-70 and 50-74, respectively. For example, for breast cancer, there was little difference in pathological cancer diagnoses in those aged under 50; and a maximum fall of -24% in those of screening age (50-69) by the end of Q3, with some recovery (to -19%) by the end of the year. For colorectal cancers, numbers in 50-69 years olds fell -20% by the end of Q3 with little recovery by the end of the year; while the total annual falls in under 50s and 70 and over were -17% and -14%, respectively.

Socio-economic deprivation

For deprivation, the least and most deprived quintiles are highlighted in colour. For all cancers except non-melanomas skin cancers, these showed the largest decreases in diagnoses were among people from the most deprived areas (a maximum fall of -18% by the end of Q3).The smallest was among the least deprived (-11% by Q3). There was a greater recovery in the most deprived and some narrowing of the deprivation gap by the end of the year. Nevertheless, the end-of-year differences in numbers of diagnoses were -9% among the least deprived and -14% in the most deprived. This general pattern – that reductions in diagnoses were greater among people from more deprived areas – were seen across cancer types. In lung cancer, the most deprived experienced a -24% reduction in diagnoses by the end of 2020 compared with -12% in the least deprived. For breast cancer in women, the deprivation gap was wider: a fall of -20% in women from the most deprived quintile compared with a fall of -6% from those from the least deprived quintile. For colorectal cancer, the pattern across socio-economic groups was a little less clear, although the reduction in diagnoses was smallest for those in the least deprived quintile (-11%) and greater for those in the most deprived quintile (-20%), but the greatest was for those in the second most deprived quintile (-25%). For prostate cancer, the greatest reduction in diagnoses by the end of the year was -23% for those in the most deprived areas; -15% for those in the least deprived areas; and smallest for those in the middle quintile (-12%).

29 July 2021 - Pathology data updated to 26 February 2021 (extracted 20/5/2021)

By the end of 2020 (week ending 27 December), the total number of individuals in Scotland with a pathological confirmation of cancer (excluding non-melanoma skin cancers) in Scotland was 28,474 in 2020 and 33,343 in 2019, an absolute difference of 4,869 individuals (an overall cumulative difference of -14.6% ). That is to say, more than 4,800 fewer patients in Scotland had a pathologically confirmed cancer diagnosis by the 27 of December 2020 than would have been expected.

By December 2020, weekly numbers of pathological cancer diagnoses had risen from an initial drop of 40% at the start of the pandemic to around 3% lower than in the previous year. This meant that the gap was continuing to increase but by a small amount. In the first two months of 2021 (to week ending 21 February), the total number of individuals with a pathologically confirmed cancer (excluding non-melanoma skin cancers) was 5,922, compared with 5,844 in 2020 (before the impact of the pandemic). This suggests that the overall rate of cancer diagnoses in Scotland has returned to levels that are similar to, or higher than, pre-pandemic ones. For some cancer types, numbers of diagnoses in 2021 are higher than previously and for others, lower.

Among the most common cancer types:

Lung cancer: The cumulative difference between 2019 and 2020 was 584 individuals ( -20.6% ). In 2021, the cumulative difference to 21 February 2021 compared with the same week in 2020 was 40 fewer individuals ( -9.6% ).
Breast cancer: The cumulative difference between 2019 and 2020 was 849 individuals ( -15.8% ). In 2021, the cumulative difference to 21 February 2021 compared with the same week in 2020 was 17 more individuals ( 1.6% ).
Prostate cancer: The cumulative difference between 2019 and 2020 was 556 individuals ( -17.7% ). In 2021, the cumulative difference to 21 February 2021 compared with the same week in 2020 was 6 fewer individuals ( -1.1% ).
Colorectal cancer: The cumulative difference between 2019 and 2020 was 851 individuals ( -21.1% ). In 2021, the cumulative difference to 21 February 2021 compared with the same week in 2020 was 31 fewer individuals ( -4.2% ).
Malignant melanoma of the skin: The cumulative difference between 2019 and 2020 was 338 individuals ( -20.2% ). In 2021, the cumulative difference to 21 February 2021 compared with the same week in 2020 was 32 fewer individuals ( -12.8% ).

10 March 2021 - Pathology data updated to 29 November 2020 (extracted 22/2/2021)

By the week ending 29 November 2020, the total number of individuals in Scotland with a pathological confirmation of cancer (excluding non-melanoma skin cancers) in Scotland was 40,343 in 2019 and 33,341 in 2020, an absolute difference of 7,002 individuals (-17%). That is to say, just over 7,000 fewer patients in Scotland had a pathologically confirmed cancer diagnosis by the end of November 2020 than would have been expected.

After the initial fall by 40% of 2019 figures in late March, weekly numbers of pathological cancer diagnoses increased to around 10% lower than the previous year's numbers by 29 November 2020. While the total (cumulative) difference in cancer diagnoses between 2020 and 2019 was therefore not increasing as much as at the beginning of the pandemic, the gap was continuing to widen rather than close. However, for some types of cancer by the autumn of 2020, weekly pathological cancer diagnoses were the same or higher than in 2019.

Among the most common cancer types, by 29 November 2020:

Lung cancers: weekly numbers had risen such that in two weeks (ending 18 October and 15 November) they were higher than in corresponding weeks in 2019. However, they were typically around 20% lower than in 2019 in October and November. The cumulative difference from the start of the year was 726 individuals (-23%).
Breast cancer (female only): weekly numbers had risen such that in one week (ending 22 November) they were higher than in the corresponding week of 2019 for the first time since March. The cumulative difference from the start of the year was 1615 individuals(-21%).
Prostate cancers (male only): weekly numbers had risen such that in three weeks (ending 11 and 25 October, and 8 November) they were higher than in corresponding weeks of 2019. The cumulative difference from the start of the year was 590 individuals (-19%).
Colorectal cancer: weekly numbers rose to around 10% lower than in corresponding weeks of 2019. At no point did they exceed the previous year's. The cumulative difference from the start of the year was 1064 individuals (-23%).
Non-melanoma skin cancer: from late March 2020, weekly numbers fell more steeply initially (to -80% of the 2019 figures) than other cancers but in six weeks (in July, September, October and November), they were higher than in corresponding weeks of 2019. The cumulative difference from the start of the year was 5223 individuals (-27%).

23 December 2020 - Pathology data updated to 30 August 2020 (extracted 27/11/2020)

By the week ending 30 August 2020, the total number of individuals in Scotland with a pathologically confirmed cancer (excluding non-melanoma skin cancers) in Scotland was 23,375 in 2020 and 29,364 in 2019, an absolute difference of 5,989 individuals (and an overall cumulative difference of 26%). That is to say, just under 6,000 fewer patients in Scotland had a pathologically confirmed cancer diagnosis by the end of August 2020 than would have been expected.

After the initial fall by 40% of 2019 figures in late March, weekly numbers increased to just under 20% of the previous year's numbers by 30 August 2020. While the total (cumulative) difference in cancer diagnoses between 2020 and 2019 was therefore not increasing as much as at the beginning of the pandemic, it was still increasing, and there continued to be 20% fewer confirmed cases of cancer in 2020 than in 2019.

Among the most common cancer types, by 30 August:

Lung cancers: weekly numbers were down a quarter of the previous year's (-25%) taking the cumulative difference from the start of the year to 577 individuals.
Breast cancer (female only): weekly numbers were down over a quarter of the previous year's (-27%) taking the cumulative difference from the start of the year to 1320 individuals.
Prostate cancers (male only): weekly numbers were down nearly 40% of the previous year's (-39%) taking the cumulative difference from the start of the year to 482 individuals.
Colorectal cancer: weekly numbers were down over a quarter of the previous year's (-27%) taking the cumulative difference from the start of the year to 950 individuals.
Non-melanoma skin cancer: from late March 2020, weekly numbers fell more steeply initially (to -80% of the 2019 figures) than other cancers but by the end of August, they were down by 18% of the previous year's. The cumulative difference from the start of the year was 4,312 individuals.

18 November 2020 - Pathology data updated to 21 June 2020 (extracted 16/9/2020)

By the week ending 21 June 2020, the total number of individuals with a pathologically confirmed cancer (excluding non-melanoma skin cancers) was 16,899 in 2020 and 20,962 in 2019, an absolute difference of 4,063 individuals (and an overall cumulative difference of 19%). That is to say, around 4,000 fewer patients in Scotland had a pathologically confirmed cancer diagnosis by the end of June 2020 than would have been expected.

Cancer sites: (note individuals can be counted in more than one cancer site for those who happen to have more than one type of cancer)

Lung cancer numbers fell sharply by about 40% of 2019 levels after lockdown, with no evidence of return to expected numbers by the end of June 2020. There was a total of 376 fewer individuals in 2020 by w/e 21/06/2020, a cumulative fall of 23%.
Breast cancer numbers in women fell by about 40% of 2019 levels after lockdown, with no evidence of return to expected numbers by the end of June 2020. The difference was -799 individuals by w/e 21/06/2020, a cumulative difference of 20% lower. Part of this fall in numbers will be due to the National Breast Screening Programme being paused in March, with no new invitations sent out to eligible women between March and August.
Colorectal cancers numbers initially fell by about 60% of the 2019 numbers immediately after lockdown, and although there was evidence of recovery towards the expected numbers, there were still a quarter fewer patients having pathologically confirmed colorectal cancers each week. Overall, there had been a total of 677 fewer individuals, or 27% cumulatively lower by w/e 21/06/2020. It is known that there have been, and continue to be delays in patients accessing colonoscopies which may explain some of the greater percentage drop for confirmed colorectal cancers. Additionally, the National Bowel Screening Programme was also paused in March, which will account for some of the fall in numbers.
Prostate cancer numbers fell with no evidence of return to expected numbers by the end of June 2020. There were 279 fewer men confirmed by w/e 21/06/2020, a fall of 17%
Oesophageal cancer numbers fell by over 50% immediately after lockdown, but there is evidence that these have returned to expected levels by the end of June. Cumulatively, there remains 69 fewer individuals by week ending 21/06/20.
Cancers of the stomach also fell sharply after lockdown, although there have been some signs of recovery to the expected numbers by 21/06/20, with 70 fewer patients cumulatively with a pathologically confirmed stomach cancer.
Initially there was not a sudden fall just after lockdown, however, the expected numbers each week started to diverge in May and there were 111 fewer patients with malignant melanoma of the skin confirmed pathologically by w/e 21 June in 2020 compared to 2019.
Haematological cancers are not often diagnosed on the basis of a pathological sample and therefore any differences observed are likely to be random variation. Other sources of information are needed to better understand the incidence of these types of cancer.
Brain tumour numbers fell. By w/e 21st June there were 53 fewer individuals in 2020 compared with 2019, a cumulative fall of 29%. However, it is important to note that a pathological sample is often not the basis of making a diagnosis of a brain tumour and therefore other sources of information are needed to better understand their incidence.

Additionally, although not generally reported in the totals for all cancers, there was a fall in the numbers of patients with pathologically confirmed non-melanoma skin cancer. Immediately after lockdown the numbers fell by about 80% of 2019 numbers, and although there was some return to expected numbers by the end of June 2020, there were still about 40% fewer cases each week. In total, there had been 3508 fewer patients by w/e 21/6/2020, a cumulative drop of 35%.

Data Source (external website)

Cancer waiting times and cancer first treatments

This dashboard gives information about cancer waiting times and first treatments. Instead of giving the proportions of patients who achieve the 31-day and 62-day targets (which remain available), it provides the times that different proportions of cancer patients wait for treatment for those patients who receive a confirmed cancer diagnosis. For example, in July 2022, half of all cancer patients urgently referred with a suspicion of cancer received their first treatment within 48 days, or just under 7 weeks (62-day target). And half of all cancer patients received their first treatment 3-5 days after the decision was made to treat them (31-day target).

There was a big drop in numbers following the beginning of the pandemic and the impact was larger on urgent suspected cancer referrals partly because screening and primary care were disrupted. Both took about a year to fully return to their pre-pandemic levels, with the recovery in 31-day numbers being later because there is a lag between referrals increasing and then decisions being made to treat patients.

In the first months of the pandemic, in particular, there were shifts in the first treatment that patients received, with less surgery, less chemotherapy, and more radiotherapy being given. These choices were influenced by the need to reduce the demand for intensive care beds and to minimise immune-suppressing treatments that might make patients more vulnerable to COVID-19.

Background

In October 2008, the Scottish Government published Better Cancer Care - An Action Plan. The statement in the Action Plan formed the basis for the current standards of cancer waiting times where 95% of all eligible patients should wait no longer than 31 or 62 days for cancer treatment. A 5% tolerance level is applied to these standards (i.e., 95% meeting the waiting time standard rather than 100%), as for some patients, it may not be clinically appropriate for treatment to begin within the standard's time. This dashboard focuses on the two current cancer waiting times standards: 31 days and 62 days.

All the waiting times reported in this dashboard are adjusted waiting times. As part of a patient’s treatment pathway there can be delays out with the NHS Board’s control, and in these cases waiting times adjustments can be made to discount periods of patient unavailability and medical suspensions. These adjustments can be made in cases where the patient did not attend an appointment, cancelled an appointment, deferred an appointment, or was suffering from a short-term illness. There are other patient-induced suspensions and medical suspensions which may be applied.

It is important to note that data in both the Cancer Waiting Times Tab and the Cancer First Treatments Tab is for patients with a confirmed case of cancer and so caution should be taken when comparing these data to other datasets.

What is the difference between the 31 and 62 day waiting times standards?

62-day standard from receipt of urgent suspicion of cancer (USoC) referral to start of first treatment for newly diagnosed primary cancers. The waiting time standard for these patients is that no patient should wait longer than 62 days to start their first treatment for a newly diagnosed cancer following USoC referral. This applies to:

Patients urgently referred with a suspicion of cancer by a primary care clinician or general dental physician
Screened positive patients referred through a national cancer screening programme
Direct referral to hospital where the signs and symptoms are consistent with the cancer diagnosed as per the Scottish Referral Guidelines e.g., self-referral to A&E

31-day standard from decision to treat to start of first treatment for newly diagnosed primary cancers (whatever their route of referral). The standard is that these patients should wait no longer than 31 days for the start of their treatment following the decision to treat.

Who do the standards apply to?

The cancer waiting times standards are applicable to adult (over 16 years of age at date of diagnosis) NHS Scotland patients with a newly diagnosed primary cancer. Performance is monitored on the following cancer types: Breast, Cervical, Colorectal, Head & Neck, Lung, Lymphoma, Ovarian, Melanoma, Upper Gastrointestinal (Hepatopancreatobiliary and Oesophagogastric), and Urological (Prostate, Bladder,Other)

Key definitions:

USoC referrals: Patients referred through 1) Referral from a National Cancer Screening Programme, 2) Primary care clinician or GDP urgent referral with suspicion of cancer or 3) Direct referral to hospital (self, GP or NHS24 referral to A&E or other).

Non-urgent referrals: Patients referred through 1) GP/GDP referral other or 2) Other routes

Date of decision to treat: Following MDT discussion, the date on which the treatment plan was agreed between the patient and the clinician (or delegate) responsible for first treatment, is the date of decision to treat. Where there are two possible dates, the earliest date applies.

Date of first treatment: This is the date of first cancer treatment.

Eligible referral (62-day): Urgent referral submitted with a suspicion of cancer by a GP or GDP, or direct referral to hospital (self, GP, or NHS 24 referral to A&E or other), or referral from a National Cancer Screening Programme, excluding patients who had a clinically complex pathway, who died before treatment or refused treatment.

Eligible referral (31-day): All referrals (urgent and non-urgent) submitted from all sources (regardless of route of referral), excluding patients who had a clinically complex pathway, who died before treatment or refused treatment.

Median wait: The middle value of (Referral to Treatment days for 62-day standard or date of Decision to Treat to Treatment days for 31-day standard), with half of patients waiting less than that time, and half waiting more than that time. Medians are only calculated when there are three or more eligible patients.

Referral A request to a care professional, team, service or organisation to provide appropriate care to a patient/client. A referral may be made by a person, team, service or organisation on behalf of a patient/client, or a patient/client may refer him/herself.

Systemic Anti-Cancer Therapy

8 March 2023

An update to the SACT (Chemotherapy) monthly patients page to "SACT (Chemotherapy) monthly and annual activity". Monthly data now cover the period from 2014 to the present, showing both the number of patients and the number of appointments. The new annual activity cover the period from 2014 to the present, also showing the number of patients and the number of appointments. Please note that the dashboard will continue to be updated weekly on the Wednesday, but the commentary will only be updated in the case of updates to the dashboard.

Injuries

Unintentional injuries and assaults - extracted 31 January 2022

Background

The response to the COVID-19 pandemic has had the potential to influence both the occurrence of unintentional injuries and assaults, and how people receive care after such events. Within this dashboard information is presented on the number of such events resulting in an admission to hospital each month from January 2020, along with data from 2018-2018 for comparison. Data on unintentional injuries is split by type (road traffic accidents, poisonings, falls and other), and all data can be explored by age, sex, deprivation (SIMD) and location of event, as well as at Scotland, Health Board and Health and Social Care Partnership (HSCP) level.

The data shown here include events where it is not possible to determine intent from the hospital records, but do not include those that were documented to be self-harm. Many unintentional injuries result do not result in hospital admission, but are treated by the individual, GPs, at Accident and Emergency departments or by a child's parent or carer, and are therefore not represented in this information. Changes in the number of admissions for injury do not necessarily mean changes in the number of injury events, but may also reflect changes in how injuries are cared for, for example, more people may seek to treat themselves, or may have been less likely to be admitted for less severe injuries at particular times.

Description of key findings for months in the period January 2020 to June 2021, compared with average admissions for the same months in 2018-2019

There was a substantial fall in the number of admissions for unintentional injury in April 2020, with around one-third fewer admissions compared with the average for the same period in 2018-2019. In the subsequent months, numbers gradually increased, and by August 2020 were at a similar level to previous years. There was a further, smaller fall in admissions in November 2020, but since then the overall number has been similar to that seen in 2018-19.

The most substantial reduction in April 2020 was seen in children and young people aged 5-24 years, among whom admissions were between a half and two-thirds lower than previous years. This reduction was particularly notable in admissions for falls, which constitute the largest proportion of unintentional injuries. Among adults there was a notable increase in admissions in January 2021, which was contributed to largely by an increase in the number of admissions for falls among those aged 25-64 years.

Admissions due to injury following a road-traffic accident have been lower each month from April 2020 to May 2021, compared to 2018-2019, with the exceptions of August 2020 and March 2021, when levels were similar. The number of admissions for poisoning has been similar to previous years throughout this period, with the exception of June 2020, when they were 18% higher. In that month the largest number of admissions was among those aged 25-64 years, although the largest proportional increase on previous years was seen in those aged 5-11 years. The number of admissions for assault was lower than in previous years in March to May 2020, and again from October 2020 to February 2021, at other points the number were similar.

Across all unintentional injuries and assaults, the largest number of admissions were among people living in the most deprived fifth of areas in Scotland, according to the Scottish Index of Multiple Deprivation (SIMD 1). However, the percentage change in admissions compared with previous years was similar across deprivation groups, or a mixed picture, with the exception of the increase in falls observed in January 2021, when the largest increase (52%) was seen in those living in the least deprived areas.

The overall number of admissions per month was similar between men and women up to November 2020. The fall in admissions in April 2020 was more substantial among men (-39%) than women (-26%). From December 2020 there has been a larger number of admissions among women, and these have been similar to or higher than previous years, most notably in January 2021, when they were 19% higher among women, which was largely attributable to an increase in falls. For men there was a change in the number of admissions for poisoning in May and June 2020, when they were around 20% higher than previous years.

Across the period from May 2020 to June 2021 there was around a 10% to 25% increase in admissions due to injuries occurring in the home, and a reduction in admissions for injuries in other and undisclosed locations, compared with 2018-2019.

Mental health

15 June 2022

Information on the number of patients starting a new treatment course for selected mental health medicines (those commonly used for depression, anxiety or insomnia) through General Practice was included for the first time in the COVID Wider Impacts Dashboard on 30 September 2020. This data does not include hospital prescribing. These data indicate:

The number of patients starting new treatment with the selected medicines fell by almost 40% between the week ending 22nd March, 2020 and the week ending 5th April, 2020 compared with the previous two years' average for the same period. This period corresponds with the first national lockdown in response to COVID-19 in Scotland. Since then, the total numbers have been gradually increasing but have generally remained below the 2018-2019 baseline levels to April 2022.
Looking at the selected medicines in separate groups, the number of new treatment courses for depression returned to expected in July 2020, whilst new treatment courses for insomnia and anxiety continued to remain below the 2018-2019 baseline to May 2022.
Observed downward spikes in the trend seen around the Christmas Periods in late December/early January reflect low overall activity in those periods, most likely due to reduced access over the holiday periods.

30 September 2020

Unscheduled care

Information on the number of contacts for mental health problems with accident and emergency (A&E) and with primary care out of hours (OOH) services was included for the first time on 30 September 2020.

Compared to the pattern seen in previous years, there was a sharp fall of 30-40% in out of hours (OOH) contacts for mental health problems, starting in early March 2020.
Numbers of OOH contacts for mental health problems remained below the previous average until late April, corresponding to the period of ‘lockdown’ in Scotland. Between April and the end of July numbers of contacts rose to around 10% above the previous average.
The trend in OOH contacts was similar for males and females, and also broadly similar by age and by level of deprivation, with wide fluctuations in numbers of contacts from week to week.
A&E attendances for mental health problems fell by 40-50% from early March 2020 and by the beginning of September had still not fully recovered, remaining at around 10% below previous levels.
The trend in A&E attendances was similar for males and females and also broadly similar by age group and by level of deprivation, with wide fluctuations in numbers of contacts from week to week.
Overall, these falls in the use of unscheduled care for mental health problems are likely to reflect the impact of the Covid-19 pandemic. More detailed discussion of these points is provided on the home page of the dashboard.

Prescribing

Information on the number of patients starting a new treatment course for selected mental health medicines (those commonly used for depression, anxiety or insomnia) through General Practice has been included for the first time on 30 September 2020. This data indicates:

The number of patients starting new treatment with the selected medicines fell by almost 40% between the week prior to the introduction of lockdown and early April compared with the previous years' average for the same period. Since then, the total numbers have been gradually increasing but have generally remained below normal levels .
The number of new treatment courses with medicines for anxiety, depression and insomnia all fell sharply following the introduction of lockdown. The number of new treatments courses for depression has returned to expected levels since mid July. In early September, new treatment courses for insomnia and anxiety are 25% below activity in 2018 and 2019.

Antenatal booking

1 March 2023

In the most recent weeks the average gestation at booking for bookings in NHS Greater Glasgow and Clyde has been higher than the historic average (11.5 weeks in the most recent week compared to 10.5 weeks historic average) gestation at booking although still less than 12 weeks. We have contacted NHS Greater Glasgow and Clyde to make them aware of this. Please note, this also affects the all-Scotland average.

4 May 2022

The numbers of women booked for antenatal care in NHS Fife have shown unusual fluctuations in recent weeks. We have informed NHS Fife of this and are working with them to try to understand the data.

6 April 2022

The numbers of women booked for antenatal care and the average gestation of women booked in NHS Forth Valley have shown unusual fluctuations in recent weeks. We have informed NHS Forth Valley of this and are working with them to try to understand the data.

2 February 2022

The sudden drop in numbers of women booking for antenatal care during the weeks starting 27th December 2021 and 3rd January 2022 is thought to be as a result of the Christmas and new year public holidays. A similar decrease can be seen during the previous year’s Christmas and new year period and the extent of the decrease is likely to depend on whether the four public holidays fall across a two or three week period. Most NHS Boards showed some level of reduction in their numbers of women booked over this period.

3 November 2021

The average gestation at booking for NHS Forth Valley has been noted to be above the revised (Feb 2021 onwards) average line for the last 6 data points. We are linking with NHS Forth Valley to investigate this pattern of increased average gestation at booking further.

1 September 2021

The average gestation is noted to be higher than usual in the latest week presented for NHS Borders. This is likely to be the effect of small numbers of bookings in NHS Borders. A few later bookings can dramatically alter the average gestation at booking for a particular week (e.g. 26 July). Some of these may be in pregnancies that were originally booked elsewhere. There is no evidence of a sustained pattern of increased average gestation in NHS Borders although we will continue to monitor these data.

7 July 2021

In this release of information on antenatal booking data (7th July 2021) data have been updated to include women booking for antenatal care up to the week beginning 7th June 2021. A new centreline line for average gestation has been included for NHS Forth Valley because a technical change to the way their data are recorded is thought to have resulted in data which more accurately represent the timing of when women book for antenatal care in NHS Forth Valley. The new centreline starts from the week beginning 1st March 2021 and will be calculated over the period 1st March - 12th July 2021 after which a projected centreline will be presented on the average gestation chart for NHS Forth Valley.

2 June 2021

In this release of information on antenatal booking data (2nd June 2021) data have been updated to include women booking for antenatal care up to the week beginning 3rd May 2021. Since the previous release, which showed data up until the week beginning 5th April 2021, numbers of women booking for antenatal care in Scotland have reduced (to 869 in week of 3rd May). This is likely to be as a result of fewer women booking over the May public holiday. This reduction is also reflected in the numbers of bookings by NHS Board with NHS Borders, NHS Lothian and NHS Greater Glasgow & Clyde showing notable decreases for the week beginning 3rd May 2021. NHS Forth Valley have recorded six consecutive data points below their average number of bookings.

The updated (all-Scotland) data in this release show that the average gestation at which women booked for antenatal care in recent weeks is around the average based on the pre-pandemic period. Recent data on average gestation by NHS Board are more varied. Lower than average gestation at booking has been observed over at least six consecutive data points in the most recent NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Highland, NHS Lanarkshire and NHS Lothian data. NHS Forth Valley continues to show an increased average gestation at booking in recent weeks compared to their pre-pandemic average. This is believed to be as a result of a technical change in data recording and we are continuing to work with the Health Board to clarify this.

5 May 2021

In this release of information on antenatal booking data (5th May 2021) data have been updated to include women booking for antenatal care up to the week beginning 5th April 2021. Since the previous release, which showed data up until the week beginning 8th March 2021, numbers of women booking for antenatal care in Scotland have reduced slightly (to 971 in week of 5 April) but are still at a level which is very similar to the average numbers seen pre-pandemic. Numbers of bookings in different NHS Boards vary. NHS Borders, NHS Grampian and NHS Highland are all showing runs of at least six consecutive data points above their average number of bookings per week, that continue into April. NHS Ayrshire & Arran have recorded six consecutive data points below their average number of bookings.

The updated (all-Scotland) data in this release show that the average gestation at which women booked for antenatal care is at a very similar level to the average based on the pre-pandemic period: at 9.3 weeks. A higher than average gestation at booking for women aged under 20 is evident in six out of the last seven time points (average gestation of 11.2 weeks, in week of 5 April). Recent data on average gestation by NHS Board are more varied. Lower than average gestation at booking has been observed over at least six consecutive data points in the most recent NHS Ayrshire & Arran, NHS Lanarkshire and NHS Lothian data. NHS Forth Valley has shown a sharp rise in average gestation at booking in recent weeks. This is believed to be as a result of a technical change in data recording and we are continuing to work with the Health Board to clarify this.

7 April 2021

In this release of information on antenatal booking data (7th April 2021) data have been updated to include women booking for antenatal care up to the week beginning 8th March 2021. Since the previous release, which showed data up until the week beginning 1st February 2021, numbers of women booking for antenatal care in Scotland have returned to a level which is very similar to the average numbers seen pre-pandemic at just over 1,000 women per week. Numbers of bookings in different NHS Boards vary. NHS Fife, NHS Greater Glasgow & Clyde, NHS Highland and NHS Lanarkshire are all showing runs of at least six consecutive data points above their average number of bookings per week, that continue into March. NHS Forth Valley have shown a marked decrease over the last five weeks in their recorded data for the number of women booking for antenatal care. This is thought to be as a result of a data recording issue and does not represent the true number of women booking in NHS Forth Valley. We are working with NHS Forth Valley to rectify this.

The updated (all-Scotland) data in this release show that the average gestation at which women booked for antenatal care is at a very similar level to the average based on the pre-pandemic period: at 9.3 weeks. Recent data on average gestation by NHS Board are more varied. Lower than average gestation at booking has been observed over at least six consecutive data points in the most recent NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Highland, NHS Lanarkshire and NHS Lothian data. NHS Forth Valley has shown a sharp rise in average gestation at booking in recent weeks, but as noted above, this is thought to be as a result of a data recording issue which we are working to rectify with the Health Board.

3 March 2021

In this release of information on antenatal booking data (3rd March 2021) data have been updated to include women booking for antenatal care up to the week beginning 1st February 2021. Since the previous release, which showed data up until the week beginning 4th January 2021, numbers of women booking for antenatal care in Scotland reached a peak during the week beginning 11th January 2021 and have since decreased but still remained high, well above the average numbers seen pre-pandemic. Much of this increase in numbers is likely to be due to women delaying booking until after the Christmas and new year holidays. A similar increase can be seen over the same period last year. The extent of the Christmas and new year reduction on numbers and subsequent increase in January is more prominent in the larger NHS Boards such as NHS Greater Glasgow & Clyde, NHS Lothian and NHS Lanarkshire.

The updated (all-Scotland) data in this release show that the average gestation at which women booked for antenatal care remains just below the average based on the pre-pandemic period. The recent data on average gestation by NHS Board are more varied. Lower than average gestation at booking is observed in recent weeks in NHS Ayrshire & Arran, NHS Dumfries and Galloway, NHS Forth Valley and NHS Lanarkshire.

A new average line has been included for NHS Tayside because the data sourced from their Badgernet Maternity information system (introduced in August 2020) are thought to more accurately represent the timing of when women book for antenatal care in NHS Tayside than the earlier (pre-August 2020) data sourced from their Protos information system. Further detail on this is included in the commentary dated 3rd February 2021.

3 February 2021

In this third release of information on antenatal booking data (3rd February 2021) data have been updated to include women booking for antenatal care up to the week beginning 4th January 2021. Previous releases of data have shown that from mid-May to end September the number of women booking for antenatal care had been consistently lower than expected based on pre-pandemic average levels. At the end of September numbers started to rise and have been increasing throughout October, November and most of December. Although this increase may be partly explained by some women planning their pregnancies during these months, having previously delayed their pregnancy during the first Coronavirus lockdown, the increase is also consistent with a seasonal pattern of increasing numbers of bookings that we usually see each year during the Autumn months.

The sudden drop in numbers of women booking for antenatal care during the weeks starting 21st December and 28th December 2020 is thought to be as a result of the Christmas and new year public holidays. A similar decrease can be seen during the previous year’s Christmas and new year period and the extent of the decrease is likely to depend on whether the four public holidays fall across a two or three week period. All NHS Boards showed some level of reduction in their numbers of women booked over this period.

The updated (all-Scotland) data in this release (for November and December 2020) show that the average gestation at which women booked for antenatal care continues to be just below the average based on the pre-pandemic period. The recent data on average gestation by NHS Board are more varied, most notably NHS Tayside have shown higher average gestations of women booking compared to their pre-pandemic average since August 2020. This change reflects a number of factors: transition of local care pathways to accommodate changes resulting from the impact of the Covid-19 pandemic; contemporaneous local transition to the Badgernet Maternity information system, and reinforced compliance with local care pathways to ensure booking of women between 8 to 10 weeks gestation. Data for more recent months for NHS Tayside, which show average gestations of between 8 to 10 weeks, are thought to more accurately represent the timing of when women book for antenatal care in NHS Tayside than the earlier (pre-August 2020) data sourced from the Protos information system.

2 December 2020

In this second release of information on antenatal booking data (2 Dec 2020) data have been updated to include women booking for antenatal care up to the week beginning 26th October 2020. The initial release of data on 28th October 2020 showed that from mid-May to end September the number of women booking for antenatal care had been consistently lower than expected based on previous average levels. During October numbers have increased and the most recent data show numbers are at a similar level to the pre-pandemic period. The average gestation at which women booked for antenatal care fell slightly from the end of March 2020, before increasing back to previous levels around August 2020. The most recent data show that the average gestation at booking during September and October continues to be just below the average based on the pre-pandemic period. Looking at the data for women living in different NHS Board areas across Scotland, the pattern of a temporary dip in gestation at booking coinciding with the first wave of the COVID-19 pandemic in Scotland is evident in some but not all areas. This probably reflects the fact that the detail of how maternity services were reconfigured in response to COVID-19 varied across Scotland. From August 2020 onwards, the recorded gestation at booking has remained higher than usual for women living in NHS Tayside. Public Health Scotland is working with NHS Tayside to explore this issue.

28 October 2020

Information on the number of women booking for antenatal care, and the average gestation (stage of pregnancy) at which they booked, was included in this tool for the first time on 28 October 2020.

The ‘booking’ appointment (external website) is the first main appointment a woman has with her local maternity service once she knows she is pregnant. At the booking appointment, women are assessed by a midwife who can then tailor the subsequent care they receive during their pregnancy to their particular preferences and needs. Women are encouraged to book before they are 13 weeks pregnant, and ideally before they are 10 weeks pregnant.

As an essential service, maternity care including ‘booking’ has been provided throughout the COVID-19 pandemic, and women have been encouraged to attend all their scheduled antenatal appointments (external website) . However, how some elements of maternity care are delivered has changed (external website) , to minimise the number of visits women need to make to clinics and hospitals.

In general, prior to COVID-19, women were offered an initial in-person booking appointment (including various face to face tests such as blood tests and blood pressure monitoring) then a follow up appointment for their early pregnancy ultrasound scan. Since March 2020, in many areas women have been offered an initial remote consultation, for example using the Near Me video consultation system, then an in-person ‘one stop’ follow up appointment for all their face to face tests and their scan.

At the start of the COVID-19 pandemic, Public Health Scotland worked with NHS Boards to set up a new national data return providing information on women booking for antenatal care (see the Data source button on the dashboard page). This provides the information required to monitor in a timely way both the direct impact of COVID-19 on pregnant women, and the wider impacts of changes to maternity services and how women interact with services. The data return is based on an extract of data recorded by midwives in local clinical information systems. The information relates to the first main appointment a woman has with her maternity service: as noted above, during COVID-19 this will have changed from an in-person to a remote consultation in many areas.

The data shows that, at all Scotland level, the number of women booking for antenatal care week by week remained broadly constant from April 2019 (when the data starts) to the end of 2019. As would be expected there was then a dip reflecting the Christmas holidays, with higher numbers of women booking just before and just after the holidays. The number of women booking then returned to previous levels until mid-May 2020. From mid-May to end September (the latest point for which data is currently available), the number of women booking has been consistently lower than expected based on previous average levels. Over the 19 weeks from week beginning 18 May 2020 to week beginning 21 September 2020, around 1,400 fewer women than would have been expected based on pre-pandemic levels have booked for antenatal care in Scotland. As women most commonly book at around 9 weeks gestation, women booking from mid-May onwards will broadly reflect women getting pregnant from late March 2020 onwards, i.e. the point at which the initial UK wide lockdown was implemented in response to COVID-19.

Looking at the data for women living in different NHS Board areas across Scotland, the pattern of a recent fall in the number of women booking for antenatal care is evident in some but not all areas.

Fewer women booking for antenatal care could reflect fewer women who become pregnant choosing to continue with their pregnancy and/or fewer women becoming pregnant. It is therefore helpful to consider the data on antenatal booking alongside the data on terminations of pregnancy provided through this tool (see the Commentary on Terminations of pregnancy for more information). Considering both sets of data, it seems likely that both reasons apply. It is likely that the higher than usual number of terminations of pregnancy provided in March and April 2020 at least partially contributed to the initial fall in the number of women booking for antenatal care from mid-May. Conversely, the subsequent sustained reduction seen in both the number of terminations and the number of women booking for antenatal care is likely to reflect a reduction in the number of women becoming pregnant from April 2020 onwards. Further analysis is required to accurately examine trends in the number of women becoming pregnant during the COVID-19 pandemic, their subsequent choices to continue with or terminate their pregnancy, and what this means for future trends in the number of births in Scotland.

At all Scotland level, prior to COVID-19, the average gestation at which women booked for antenatal care was around 9 and a half weeks of pregnancy. This fell slightly from the end of March 2020, reaching around 8 and a half weeks by end June 2020 before increasing back to previous levels from August 2020 onwards. This temporary reduction in the average gestation at booking means that the recent fall seen in the number of women booking is unlikely to be due to women deferring, or being unable to access, booking until later in their pregnancy. This further confirms that it is likely that the number of women becoming pregnant has been lower than usual from April 2020 onwards.

Looking at the data for women living in different NHS Board areas across Scotland, the pattern of a temporary dip in gestation at booking coinciding with the first wave of the COVID-19 pandemic in Scotland is evident in some but not all areas. This probably reflects the fact that the detail of how maternity services were reconfigured in response to COVID-19 varied across Scotland. From August 2020 onwards, the recorded gestation at booking has been higher than usual for women living in NHS Tayside. This is due to a temporary data recording issue following implementation of a new clinical information system in NHS Tayside at that time. Public Health Scotland is working with NHS Tayside to resolve this and we expect that future releases of the antenatal booking data through this tool will see the average gestation return to a level which is more typical for NHS Tayside.

At all Scotland level, the recent reduction in the number of women booking for antenatal care has been more evident in younger (compared to older) women, and in women living in more (compared to less) deprived areas. In general, there is no substantial variation in average gestation at booking by maternal age group or deprivation level. The temporary dip in average gestation at booking associated with the first wave of COVID-19 in Scotland has been seen in women from all age groups and from all deprivation levels.

Termination of pregnancy

2 June 2021

This latest release reports on the number of terminations of pregnancy in Scotland up to February 2021. In this latest month 981 terminations were provisionally notified and numbers may be updated in subsequent releases. This is the lowest monthly figure reported since January 2018: Previous years have reported 1,093 in February 2018; 1,174 in February 2019; 1,230 in February 2020. In February 2021 two mainland boards notified their lowest number of terminations since January 2018: Grampian (82) and Lothian (176). Average gestation at termination in Scotland for February 2021 (6.9 weeks) remained similar to that reported in recent months and ranged between 6 weeks in Grampian to 8.3 weeks in Fife.

The shift of average gestations below the centreline (average gestation between January 2018 to February 2020) started in March 2020. To a greater or lesser extent this shift has been mirrored across all the mainland boards except in Ayrshire and Arran, Borders and Fife. Also of note, the average gestation in Highland has been trending upwards (but remains below board average), and the lowest average gestations since January 2018 were reported in this release in Ayrshire and Arran (6.7 weeks), Dumfries and Galloway (6.5 weeks) and Grampian (6.0 weeks).

There continued to be little variation in average gestation by either age group or deprivation category in February 2021. The drop in numbers (referred to above) in February 2021 was reflected across all age groups and deprivation categories. The range in average gestation by age group was 6.8 weeks (25 to 29 and 40 and over) to 7.2 weeks (35 to 39). For deprivation category the range was from 6.8 week (SIMD 3 and 4) to 7.1 weeks (SIMD 1 - most deprived).

5 May 2021

This latest release reports on the number of terminations of pregnancy in Scotland up to January 2021. In this latest month 1,108 terminations were provisionally notified, which is comparable with the January average for 2018, 2019 and 2020 of 1,191.

Observing these figures are provisional and may be updated in subsequent reports, we note that Dumfries and Galloway’s terminations for January 2021 are not shown this month as their total numbers fell below the threshold that we can safely report numbers of terminations without potentially compromising patient confidentiality. Ayrshire and Arran notified their lowest number of terminations (42) since January 2018. We noted in the last release a downward trend in Tayside, which reversed in January 2021.

Average gestation at termination in Scotland for January 2021 (6.8 weeks) remained similar to that reported in recent months. It is the eleventh consecutive month where the average gestation was below the Scotland average gestation (to end February 2020). The average gestation ranged from 6.1 weeks in Grampian (the lowest notified by Grampian since January 2018) to 8 weeks in Highland.

As in previous releases, we see little variation in average gestation by deprivation (most deprived - 7 weeks and least deprived - 6.6 weeks). The average gestation was slightly higher in the under 20 age group (7.3 weeks) and the 40 and over age group (7.1 weeks) compared with 6.6 weeks in the 25 to 29 age group.

7 April 2021

This latest release reports on the number of terminations of pregnancy in Scotland up to December 2020. In this latest month 1,053 terminations were provisionally notified, which is comparable with the same months in 2019 and 2018 (1,076 and 1,092 respectively).

We reported in last month’s release that terminations in Lothian had been steadily rising, reaching a 7-month high in November 2020 (248 terminations). This trend reversed in December 2020 with notifications dropping to 193. This is close to the number of terminations notified in December 2019 (192). We also reported that Forth Valley recorded their lowest number of terminations (44) since January 2018. This increased to 76 in December 2020 and was the highest number of terminations recorded by Forth Valley since October 2019. We note a downward trend in numbers of terminations reported by Tayside from 107 in August 2020 to 79 in December 2020.

Average gestation at termination in Scotland for December (6.7 weeks) remained similar to that reported in recent months. The average gestational range in mainland Boards in December was between 6.3 weeks (Lothian and Greater Glasgow & Clyde) and 7.9 weeks (Highland). All areas remained under their Board averages except Borders. This is probably a reflection of the small numbers of terminations carried out by this Board.

Latest data also continues to show little variation in average gestation by age or deprivation.

3 March 2021

This latest release reports on the number of terminations of pregnancy in Scotland up to November 2020. In this latest month 1,060 terminations were provisionally notified and although this is below the Scotland average, it is comparable with the number of terminations reported in November 2019 (1,068) and November 2018 (1,111).

There was some variation in numbers reported across the Boards. Of note, Lothian reported a seven month high in November (245 terminations), above the Board average of 218. For the first time since March 2020, Ayrshire and Arran also reported terminations above the board average, the third consecutive monthly increase in the number of terminations. In contrast, Forth Valley recorded their lowest number of terminations since January 2018. Dumfries and Galloway’s terminations for November 2020 are not shown this month as their total numbers fell below the threshold that we can safely report numbers of terminations without potentially compromising patient confidentiality.

Average gestation at termination in Scotland for November (6.8 weeks) remained similar to that reported in recent months. The pattern varied by Board, but all areas remained under their Board averages except Borders, their variation is probably related to the small numbers of terminations carried out by this Board. The combination of telemedicine (a remote consultation by telephone or video call) and early medical abortion at home (where both drugs are taken at home) continued to affect gestation at termination.

The numbers of terminations between age groups and between the most and least deprived areas continues to show little clear variation this has remained the case since July 2020. There is even less variation between age groups and between the most and least deprived areas in respect of the average gestation at termination [range 6.7 to 6.9 weeks].

3 February 2021

In this latest release of information on terminations of pregnancy up to September 2020, the provisional numbers reported in Scotland showed numbers of terminations rising gradually over the last four months. With numbers of terminations at 1072 in September 2020, since May 2020 the number of terminations in Scotland has remained below the Scotland average from January 2018. The majority of Boards recorded an increase in terminations between August and September 2020.

Average gestation at termination in Scotland decreased in the period February to August 2020 from 8 weeks to 6.6 weeks. This probably reflects changes in the configuration of termination care services in response to COVID-19 across Scotland. For Scotland as a whole, average gestation of terminations in Scotland has remained below 7 weeks since May 2020. This is most clearly seen in Health Board returns from NHS Greater Glasgow and Clyde and NHS Tayside. Overall, the variation in gestation at termination between Board areas in September was minor (range 7.7 to 6.4 weeks).

The numbers of terminations between age groups and between most and least deprived areas in Scotland have showed little clear variation since July 2020.

In Scotland in September 2020, there was a slight widening in the gap of average gestation at time of termination between the most and least deprived areas. In the most deprived areas the average gestation was 7 weeks compared to 6.3 weeks in the least deprived areas.

There was little variation across the six age groups at time of termination (range 6.9 to 6.6 weeks).

2 December 2020

In this second release of information on terminations of pregnancy, the provisional numbers of terminations reported in Scotland in August 2020 fell to the lowest level reported since January 2018. This continues the trend of a fall in numbers from May 2020 onwards and is consistent across some but not all Board areas. The decrease in the average gestation at termination (6.6 weeks in the last month) has also continued in Scotland as a whole and any variation between Boards probably reflects minor variation in service provision between Boards.

The impact of reductions in numbers of terminations in younger women continues to be evident. The observation of an increase in the average gestation reported in women aged over 40 (to 7.5 weeks in August) may simply represent the impact of variation within small numbers of terminations in this age group. Overall, there remains no substantial variation in average gestation at termination by maternal age group or deprivation level.

28 October 2020

Information on the number of terminations of pregnancy carried out in Scotland, and the average gestation (stage of pregnancy) at which they occurred, was included in this tool for the first time on 28 October 2020.

Termination of pregnancy (also referred to as a therapeutic or induced abortion) is provided under the terms of the Abortion Act 1967 and subsequent regulations. When a healthcare practitioner provides a termination of pregnancy, there is a legal requirement for them to notify the Chief Medical Officer of the termination within seven days of it taking place. Public Health Scotland is responsible for the collation of data derived from notifications of terminations of pregnancy on behalf of the Chief Medical Officer. This notification data has been used in this tool (see Data source button on the dashboard page). Detailed information on terminations is published each year by Public Health Scotland. The most recent report covers the year to December 2019.

As an essential service, care relating to termination of pregnancy has been provided throughout the COVID-19 pandemic (external website) . Termination of pregnancy can be carried out as a medical procedure or, less commonly, a surgical procedure. Medical terminations involve the woman taking two different medicines 24-48 hours apart to end her pregnancy. Prior to Oct 2017, women having a medical termination were required to attend a clinic or hospital on two occasions to take the first and then, separately, the second medicine. From October 2017 (external website) , women requiring an early medical termination (at up to 9 weeks and 6 days gestation) were able to take the second medicine away with them at the end of their first appointment, and subsequently take that at home. From 31 March 2020 (external website) , in response to the COVID-19 pandemic, women requiring an early medical termination (at up to 11 weeks and 6 days gestation) have been able to have an initial remote consultation, by telephone or video call, then take both medicines at home.

Since 31 March 2020, there has been variation between NHS Boards across Scotland in exactly how care relating to termination of pregnancy has been provided. Almost all Boards have provided some remote consultations. After their initial consultation, some women have been required to attend for an ultrasound scan (for example to confirm how far along their pregnancy is if there is some doubt about that, or to see if they have an ectopic pregnancy) before medicines are provided. Once a woman has been confirmed as eligible for an early medical termination, in some areas both sets of medicine have been delivered to the woman’s home, whereas in other areas women have been required to pick up their medicine from a clinic reception. On 30 September 2020, the Scottish Government issued a consultation (external website) on whether the recent changes extending women’s access to early medical termination at home should be retained after the COVID-19 pandemic. The consultation will be open until 5 January 2021.

The data shows that, at all Scotland level, the number of terminations of pregnancy provided month by month remained broadly constant from January 2018 (when the data shown starts) to February 2020 inclusive. The number of terminations was then higher than usual in March and April 2020, before falling to lower than usual levels in May, June, and July 2020 (with July 2020 being the latest month for which data are currently available). Over March and April 2020, around 500 more terminations than would have been expected based on pre-pandemic average levels were provided in Scotland. This is likely to reflect a higher proportion than usual of women who found they were pregnant at the start of the COVID-19 pandemic in Scotland choosing not to continue with their pregnancy. As discussed in the commentary on the Antenatal booking data provided through this tool, it is likely that the lower than usual numbers of termination provided from May 2020 onwards reflects a reduction in the number of women becoming pregnant from April 2020 onwards. Further analysis is required to accurately examine trends in the number of women becoming pregnant during the COVID-19 pandemic, their subsequent choices to continue with or terminate their pregnancy, and what this means for future trends in the number of births in Scotland.

Looking at the data for women living in different NHS Board areas across Scotland, the pattern of an increase in the number of terminations of pregnancy in March and April 2020, then a subsequent fall from May 2020 onwards is evident in some but not all areas.

At all Scotland level, prior to COVID-19, the average gestation at which terminations of pregnancy took place was around 7 and a half weeks of pregnancy. This fell slightly to around 7 weeks in April 2020, then fell further to around 6 and a half weeks in May to July 2020. This decrease in the average gestation at termination means that the recent reduction seen in the number of terminations is unlikely to be due to women deferring, or being unable to access, termination until later in their pregnancy.

Looking at the data for women living in different NHS Board areas across Scotland, the pattern of a reduction in average gestation at termination from April 2020 onwards is evident in some but not all areas. This probably reflects the fact that the detail of how termination care was reconfigured in response to COVID-19 varied across Scotland.

At all Scotland level, the recent reduction in the number of terminations of pregnancy has been more evident in younger (compared to older) women. The reduction has been seen in women living in areas with all levels of deprivation. In general, there is no substantial variation in average gestation at termination by maternal age group or deprivation level. The reduction in average gestation at termination from April 2020 onwards has been seen in women from all age groups and from all deprivation levels.

Induction of labour

7 September 2023

Data are thought to be incomplete for NHS Fife and NHS Borders in Apr 2023 and NHS Highland in May 2023, so the proportions of births that are induced in these months are likely to change in future data presentations. Results for boards with incomplete data must be treated with significant caution.

3 August 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb, Mar and Apr 2023 and NHS Borders in Apr 2023, so the proportions of births that are induced in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

6 July 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb and Mar 2023 and NHS Highland in Feb 2023, so the proportions of births that are induced in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

1 June 2023

Data are thought to be incomplete for NHS Fife in Jan and Feb 2023 and NHS Highland in Feb 2023, so the proportions of births that are induced in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

1 May 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Jan 2023, so the proportions of births that are induced in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

5 April 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Dec 2022, so the proportions of births that are induced in this month are likely to change in future releases of the dashboard.Results for boards with incomplete data must be treated with significant caution.

1 March 2023

Data are thought to be incomplete for NHS Fife in Nov 2022, so the proportion of births that are induced in this month is likely to change in future releases of the dashboard.

7 December 2022

Data are thought to be incomplete for NHS Forth Valley in August 2022, so the proportion of births that are induced in this month is likely to change in future releases of the dashboard.

2 November 2022

Data are thought to be incomplete for NHS Forth Valley in July 2022, so the proportion of births that are induced in this month is likely to change in future releases of the dashboard.

5 October 2022

Data are thought to be incomplete for NHS Forth Valley and NHS Borders in June 2022, so the proportion of births that are induced in this month is likely to change in future releases of the dashboard.

7 September 2022

Data are thought to be incomplete for NHS Forth Valley in May 2022, so the proportion of births that are induced in this month is likely to change in future releases of the dashboard.

3 August 2022

Data are thought to be incomplete for NHS Fife in April 2022, so the proportion of births that are induced in this month is likely to change in future releases of the dashboard. Data submissions from NHS Forth Valley were insufficient to report for April 2022. These will be updated in future dashboard releases.

6 July 2022

Data are thought to be incomplete for NHS Forth Valley in March 2022 and for NHS Fife in February 2022, so the proportion of births that are induced in these months is likely to change in future releases of the dashboard.

1 June 2022

Data are thought to be incomplete for NHS Forth Valley and for NHS Fife in February 2022, so the proportion of births that are induced in February 2022 is likely to change in future releases of the dashboard.

4 May 2022

Data are thought to be incomplete for NHS Forth Valley for December 2021 and January 2022 so the proportion of births that are induced for these months is likely to change in future releases of the dashboard.

1 December 2021

The percentage in NHS Greater Glasgow & Clyde of singleton live births at 37-42 weeks gestation that followed induction of labour has been consistently higher than the pre-pandemic average since October 2020, and reached 44% in August 2021. When undertaken for appropriate reasons, and by appropriate methods, induction is useful and benefits both mothers and newborn. We will continue to monitor and are working with NHS Greater Glasgow & Clyde to explore further.

1 September 2021

The data at all Scotland level show that the proportion induced (the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour) has continued to show little change across the period presented (January 2018 to May 2021). However, some NHS Boards have shown recent increases in the proportion of women induced with NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Fife and NHS Greater Glasgow & Clyde all now reporting 40% of women induced or higher.

2 June 2021

In this release of information on induction of labour (2nd June 2021) data have been updated to include women discharged after delivery up to and including February 2021. The data at all Scotland level show that the proportion induced (the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour) has continued to show little change across the period presented (January 2018 to February 2021). The data by NHS Board of residence are more varied. In February 2021, NHS Borders, NHS Dumfries & Galloway and NHS Forth Valley have continued the pattern of at least 6 consecutive months showing a lower proportion of inductions compared to their pre-pandemic average. NHS Ayrshire & Arran have recorded an 11th consecutive month showing a higher proportion of inductions compared to their pre-pandemic average. However there has been a sequential month-on-month decrease in the proportion of inductions in the last 3 consecutive months in NHS Ayrshire and Arran.

5 May 2021

In this release of information on induction of labour (5th May 2021) data have been updated to include women discharged after delivery up to and including January 2021. The data at all Scotland level show that the proportion induced (the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour) has continued to show little change across the period presented (January 2018 to January 2021). The data by NHS Board of residence are more varied. In January 2021, NHS Dumfries & Galloway and NHS Forth Valley have continued the pattern of at least 6 consecutive months showing a lower proportion of inductions compared to their pre-pandemic average (although both also showed periods of lower proportions of inductions in 2019). NHS Ayrshire & Arran have recorded a 10th consecutive month showing a higher proportion of inductions compared to their pre-pandemic average.

7 April 2021

In this third release of information on induction of labour (7th April 2021) data have been updated to include women discharged after delivery up to and including December 2020. The data at all Scotland level show that the proportion induced (the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour) has continued to show little change across the period presented (January 2018 to December 2020). Data show that the percentage of women aged under 20 who were induced in December 2020 was recorded at its highest level (55%) during the last 3 years. The data by NHS Board of residence are more varied. In December 2020, NHS Dumfries & Galloway and NHS Forth Valley have continued the pattern of at least 6 consecutive months showing a lower proportion of inductions compared to their pre-pandemic average (although both also showed periods of lower proportions of inductions in 2019). NHS Ayrshire & Arran have recorded a 9th consecutive month showing a higher proportion of inductions compared to their pre-pandemic average.

3 March 2021

In this third release of information on induction of labour (3rd March 2021) data have been updated to include women discharged after delivery up to and including November 2020. The data at all Scotland level show that the proportion induced (the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour) has continued to show little change across the period presented (January 2018 to November 2020). The data by NHS Board of residence are more varied. In November 2020, NHS Dumfries & Galloway and NHS Forth Valley have continued the pattern of a number of consecutive months showing a lower proportion of inductions compared to their pre-pandemic average (although both showed periods of lower proportions of inductions in 2019). After a period where the proportion of births following induction was below the pre-pandemic average, the proportion in NHS Highland is noted to have increased in November 2020 to a level higher than the Health Board average (42%). NHS Ayrshire & Arran and NHS Fife have continued the pattern of a number of consecutive months showing a higher proportion of inductions compared to their pre-pandemic average. However, data are thought to be incomplete for NHS Fife for November 2020 so this proportion could change in future releases of the dashboard.

3 February 2021

In this second release of information on induction of labour (3rd February 2021) data have been updated to include women discharged after delivery up to and including October 2020. The data at all Scotland level show that the proportion induced (the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour) has continued to show little change across the period presented (January 2018 to October 2020). The data by NHS Board of residence are more varied. NHS Dumfries & Galloway, NHS Forth Valley and NHS Highland have shown lower proportions of inductions in recent months than their pre-pandemic average (although both NHS Dumfries & Galloway and NHS Forth Valley also showed periods of lower proportions of inductions in 2019). NHS Lanarkshire showed a period of lower inductions in January to July 2020 but this has returned close to the long-term pre-pandemic average. NHS Ayrshire & Arran have shown slightly higher proportions since April 2020. Data for NHS Fife also show higher proportions of induction than their pre-pandemic average over recent months, particularly in October 2020. However, data are thought to be incomplete for NHS Fife for October 2020 so this proportion is likely to change in future releases of the dashboard.

16 December 2020

Information on induction of labour was included in this tool for the first time on 16 December 2020.

' Induction of labour (external website) ' is when a woman is given a medical intervention to start her labour, rather than waiting for labour to start spontaneously. It is offered because there are medical reasons meaning it is considered safer (for the mother or baby) for the baby to be born, or because a woman is past her ‘due date’. There are different approaches to inducing labour, for example using medicines, a medical ‘balloon’ device that sits at the neck of the womb, and/or breaking the woman’s waters.

Care for women around the time they are giving birth is an essential, time critical service that cannot be deferred. As such, it has been provided throughout the COVID-19 pandemic, and maternity staff have not been redeployed to support other services. The way that some elements of this care are provided has changed in response to COVID-19 however, to minimise the risk of infection and to allow services to continue to provide safe care during times when a high number of staff may be off work, for example due to needing to isolate.

Guidance issued by the Scottish Government (external website) and Royal College of Obstetricians and Gynaecologists (external website) to maternity services at the height of the first wave of the pandemic noted that:

It may be necessary for services to temporarily suspend the option for women to deliver at home or in midwife led units, and to concentrate delivery care within obstetric units
Additional restrictions on the use of water births were recommended
Care pathways for women requiring induction of labour should be amended to ensure the early stages of the induction process were delivered on an outpatient basis wherever possible
Services should consider deferring a planned induction of labour or elective caesarean section if a woman was isolating due to having COVID-19, or having been in contact with a case, if it was safe to do so
Services should support low risk women in the early latent phase of labour to remain at home wherever possible
In general, strict restrictions on visitors for patients in hospital were advised, however women giving birth could still be accompanied by their chosen birth partner

The information on induction of labour presented through this tool is taken from hospital discharge records, specifically records relating to the care of women delivering a singleton live birth (i.e. one baby, not twins or more) at 37-42 weeks gestation (i.e. up to 3 weeks before or after their due date). Further technical information is available through the ‘Data source’ button on the dashboard page.

The data shows that, at all Scotland level, the percentage of singleton live births at 37-42 weeks gestation that followed induction of labour (the ‘induction rate’) has remained broadly constant (at around 34%) from January 2018 (when the data shown starts) to end September 2020 (the latest point for which data is currently available). Prior to the COVID-19 pandemic, the induction rate was somewhat variable between NHS Board areas of residence. There is also variation between areas in how the induction rate has changed around the time of the pandemic, with some areas (for example NHS Ayrshire & Arran and NHS Greater Glasgow & Clyde) showing a small increase and other areas (for example NHS Dumfries & Galloway, NHS Forth Valley, and NHS Lanarkshire) showing a small decrease.

The induction rate tends to be highest among mothers in the youngest (<20 years) and oldest (40+ years) age groups, and among mothers living in the most deprived areas of Scotland. These patterns have persisted during the COVID-19 pandemic.

Method of delivery

7 September 2023

Data are thought to be incomplete for NHS Fife and NHS Borders in Apr 2023 and NHS Highland in May 2023, so the proportions of births that are delivered by caesarean section in these months are likely to change in future data presentations. Results for boards with incomplete data must be treated with significant caution.

3 August 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb, Mar and Apr 2023 and NHS Borders in Apr 2023, so the proportions of births that are delivered by caesarean section in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

6 July 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb and Mar 2023 and NHS Highland in Feb 2023, so the proportions of births that are delivered by caesarean section in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

1 June 2023

Data are thought to be incomplete for NHS Fife in Jan and Feb 2023 and NHS Highland in Feb 2023, so the proportions of births that are delivered by caesarean section in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

3 May 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Jan 2023, so the proportions of births that are delivered by caesarean section in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

5 April 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Dec 2022, so the proportions of births that are delivered by caesarean section in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

1 March 2023

Data are thought to be incomplete for NHS Fife in Nov 2022, so the proportion of births that are delivered by caesarean section in this month is likely to change in future releases of the dashboard.

1 February 2023

Data for NHS Borders for elective and emergency caesarean sections show some unusual patterns between April and September 2022. We have been liaising with NHS Borders and believe this to be a recording issue rather than a true reflection of the numbers. We are working with the board to try to further understand and rectify the issue.

7 December 2022

Data are thought to be incomplete for NHS Forth Valley in August 2022, so the proportion of births that are delivered by caesarean section in this month is likely to change in future releases of the dashboard.

2 November 2022

Data are thought to be incomplete for NHS Forth Valley in July 2022, so the proportion of births that are delivered by caesarean section in this month is likely to change in future releases of the dashboard.

5 October 2022

Data are thought to be incomplete for NHS Forth Valley and NHS Borders in June 2022, so the proportion of births that are delivered by caesarean section in this month is likely to change in future releases of the dashboard.

7 September 2022

Data are thought to be incomplete for NHS Forth Valley in May 2022, so the proportion of births that are delivered by caesarean section in this month is likely to change in future releases of the dashboard.

3 August 2022

Data are thought to be incomplete for NHS Fife in April 2022, so the proportion of births that are delivered by caesarean section in this month is likely to change in future releases of the dashboard. Data submissions from NHS Forth Valley were insufficient to report for April 2022. These will be updated in future dashboard releases.

6 July 2022

Data are thought to be incomplete for NHS Forth Valley in March 2022 and for NHS Fife in February 2022, so the proportion of births that are delivered by caesarean section in these months is likely to change in future releases of the dashboard.

1 June 2022

Data are thought to be incomplete for NHS Forth Valley and for NHS Fife in February 2022, so the proportion of births that are delivered by caesarean section in February 2022 is likely to change in future releases of the dashboard.

4 May 2022

Data are thought to be incomplete for NHS Forth Valley for December 2021 and January 2022 so the proportion of births that are delivered by caesarean section for these months is likely to change in future releases of the dashboard.

6 April 2022

Data are thought to be incomplete for NHS Forth Valley for December 2021 so the proportion of births that are delivered by elective caesarean section, which appears lower than that for most other NHS Boards, is likely to change in future releases of the dashboard

6 October 2021

The proportion of all caesarean sections in Scotland has risen and remains higher than the pre-pandemic average for a number of consecutive months with the proportion approaching 40%. Over the last five months the proportions of births recorded as caesarean sections in NHS Greater Glasgow & Clyde have been consistently above 40%. We are linking with NHS Greater Glasgow & Clyde to investigate this further.

1 September 2021

In this release of information on method of delivery (1st September 2021) data have been updated to include women discharged after delivery up to and including May 2021. The data for all Scotland show that the proportion of all caesarean sections has risen, they remain higher than the pre-pandemic average in the last 12 consecutive months and are now approaching 40%. In recent months the proportions recorded for NHS Grampian have been particularly high, approaching 50%. We are linking with NHS Grampian to investigate this further.

7 July 2021

In this release of information on method of delivery (7th July 2021) data have been updated to include women discharged after delivery up to and including March 2021. The data for all Scotland show that the proportion of all caesarean sections has risen, they remain higher than the pre-pandemic average in the last 12 consecutive months and are now approaching 40%.

A sharp increase was noted for NHS Fife in the most recent month. We are linking with NHS Fife to explore possible reasons for this.

2 June 2021

In this release of information on method of delivery (2nd June 2021) data have been updated to include women discharged after delivery up to and including February 2021. The data for all Scotland show that the proportion of both emergency caesarean sections and elective caesarean sections have remained higher than the pre-pandemic average in recent months (at least the last 11 consecutive months). However, the shift in the proportion of elective caesarean sections (and of all caesarean sections) predates the COVID-19 pandemic. Including February 2021, NHS Grampian, NHS Greater Glasgow & Clyde and NHS Highland recorded a higher proportion of elective sections than their pre-pandemic average for at least the last 6 consecutive months. In NHS Ayrshire & Arran there has been a sequential month-on-month decrease in the proportion of emergency caesarean sections in the last 5 consecutive months. NHS Dumfries & Galloway, NHS Fife, NHS Grampian, NHS Greater Glasgow & Clyde, and NHS Lothian have continued, in February 2021, to show at least 6 consecutive months with a higher proportion of emergency sections than their pre-pandemic average. Including February 2021, NHS Dumfries & Galloway, NHS Fife, NHS Grampian, NHS Greater Glasgow & Clyde and NHS Lothian have continued to show at least 6 consecutive months with a higher proportion of all caesarean sections than their pre-pandemic average. However there has been a sequential month-on-month decrease in the proportion of all caesarean sections in the last 5 consecutive months in NHS Lothian.

5 May 2021

In this release of information on method of delivery (5th May 2021) data have been updated to include women discharged after delivery up to and including January 2021. The data for all Scotland show that the proportion of both emergency caesarean sections and elective caesarean sections have remained higher than the pre-pandemic average in recent months (at least the last 10 consecutive months). However, the shift in the proportion of elective caesarean sections predates the COVID-19 pandemic. Including January 2021, NHS Grampian and NHS Highland recorded a higher proportion of elective sections than their pre-pandemic average for at least the last 6 consecutive months. NHS Dumfries & Galloway, NHS Greater Glasgow & Clyde and NHS Lothian have continued, in January 2021, to show at least 6 consecutive months with a higher proportion of emergency sections than their pre-pandemic average. In January 2021, NHS Dumfries & Galloway and NHS Lothian have continued to show at least 6 consecutive months with a higher proportion of all caesarean sections than their pre-pandemic average. Including Jan 2021, NHS Greater Glasgow & Clyde have shown 5 consecutive months where a sequential month-on-month decrease in the proportion of all caesarean sections has occurred.

7 April 2021

In this third release of information on method of delivery (7th April 2021) data have been updated to include women discharged after delivery up to and including December 2020. The data for all Scotland show that the proportion of both emergency caesarean sections and elective caesarean sections have remained higher than the pre-pandemic average in recent months (at least the last nine consecutive months). However, the shift in the proportion of elective caesarean sections predates the COVID-19 pandemic. In December 2020, NHS Grampian recorded a higher proportion of elective sections than their pre-pandemic average for the 14th consecutive month. NHS Dumfries & Galloway and NHS Greater Glasgow & Clyde have continued in December 2020 to show at least 6 consecutive months with a higher proportion of emergency sections than their pre-pandemic average. In December 2020, NHS Fife and NHS Lothian have continued to show at least 6 consecutive months with a higher proportion of all caesarean sections than their pre-pandemic average. However, data are thought to be incomplete for NHS Fife for December 2020 so this proportion could change in future releases of the dashboard.

3 March 2021

In this third release of information on method of delivery (3rd March 2021) data have been updated to include women discharged after delivery up to and including November 2020. The data for all Scotland show that both the proportion of emergency caesarean sections and elective caesarean sections have remained higher than the pre-pandemic average for a number of consecutive months. However, the shift in the proportion of elective caesarean sections predates the COVID-19 pandemic. In November 2020, NHS Ayrshire & Arran and NHS Grampian continue their run of consecutive months showing a higher proportion of elective sections than their pre-pandemic average. NHS Dumfries & Galloway, NHS Greater Glasgow & Clyde and NHS Fife have continued to show consecutive months with a higher proportion of emergency sections than their pre-pandemic average. However, data are thought to be incomplete for NHS Fife for November 2020 so this proportion could change in future releases of the dashboard.

3 February 2021

In this second release of information on method of delivery (3rd February 2021) data have been updated to include women discharged after delivery up to and including October 2020. Both the proportion of emergency caesarean sections and elective caesarean sections in Scotland as a whole have increased over this time. The rise appears to be driven by the increase in elective caesarean proportions with a notable increase in deliveries by elective caesarean from 16.4% to 18.4% between August and October 2020. The data by NHS Board of residence show more varied patterns. An increase in the proportion of elective caesareans is evident in some, but not all, NHS Board areas. For example NHS Greater Glasgow & Clyde (GGC), NHS Tayside and NHS Ayrshire and Arran, have a higher proportion of elective sections, although the shift precedes the pandemic period in GGC and the proportion of emergency sections in GGC is also elevated from April to October 2020. NHS Lothian and NHS Grampian also show an increase in both categories of caesarean section during 2020. The percentage of emergency and all caesarean sections are up in NHS Dumfries & Galloway from May to October 2020. The percentage of emergency caesarean sections is down in NHS Lanarkshire from February to September 2020. NHS Fife shows a sharper increase in emergency caesarean section proportions than elective caesareans, however, data are thought to be incomplete for NHS Fife for October 2020 so this proportion is likely to change in future releases of the dashboard.

16 December 2020

Information on method of delivery was included in this tool for the first time on 16 December 2020.

The ‘ method of delivery (external website) ' refers to the way a baby is born. Different methods of delivery include spontaneous vaginal delivery (a natural birth); assisted vaginal delivery (including vaginal delivery by forceps or ventouse, or vaginal delivery of a breech baby); or a caesarean section (an operation to deliver the baby through a cut in the mother’s abdomen). A caesarean section can be elective (planned in advance and provided before labour has started) or emergency (unplanned, and usually but not always provided after labour has started).

It may be necessary for services to temporarily suspend the option for women to deliver at home or in midwife led units, and to concentrate delivery care within obstetric units
Additional restrictions on the use of water births were recommended
Care pathways for women requiring induction of labour should be amended to ensure the early stages of the induction process were delivered on an outpatient basis wherever possible
Services should consider deferring a planned induction of labour or elective caesarean section if a woman was isolating due to having COVID-19, or having been in contact with a case, if it was safe to do so
Services should support low risk women in the early latent phase of labour to remain at home wherever possible
In general, strict restrictions on visitors for patients in hospital were advised, however women giving birth could still be accompanied by their chosen birth partner

The information on method of delivery presented through this tool is taken from hospital discharge records, specifically records relating to the care of women delivering a singleton live birth (i.e. one baby, not twins or more) at any stage of pregnancy. Further technical information is available through the ‘Data source’ button on the dashboard page.

The data shows that, at all Scotland level, the percentage of singleton live births delivered by caesarean section (the ‘caesarean section rate’) has gradually increased from January 2018 (when the data shown starts) to end September 2020 (the latest point for which data is currently available). The increase is particularly seen in the elective caesarean section rate, but is also evident in the emergency caesarean section rate. The upward trend in the elective and emergency caesarean section rates predates the COVID-19 pandemic, and it has continued during the pandemic. Whilst caesarean section can be a lifesaving operation for mothers and babies, the high and rising caesarean section rate seen in many countries over recent years is a cause for concern (external website) . Excessive use of caesarean sections can carry unnecessary risks for mothers and babies.

Prior to the COVID-19 pandemic, the caesarean section rate was somewhat variable between NHS Board areas of residence. There is also some variation between areas in how the caesarean section rate has changed around the time of the pandemic, for example the emergency caesarean section rate has increased noticeably for women living in NHS Fife, whereas the elective and emergency caesarean section rates have decreased for women living in NHS Lanarkshire.

There is a very clear gradient in the caesarean section rate by maternal age, with the rate being lowest among mothers in the youngest (<20 years) age group and highest among mothers in the oldest (40+ years) age group. These patterns have persisted during the COVID-19 pandemic. As women from the least deprived areas of Scotland tend to have their children at older ages than women from more deprived areas, this means that the caesarean section rate tends to be highest among mothers living in the least deprived areas.

Gestation at delivery

7 September 2023

Data are thought to be incomplete for NHS Fife and NHS Borders in Apr 2023 and NHS Highland in May 2023, so the proportions of births that are delivered pre-term and post-term in these months are likely to change in future data presentations. Results for boards with incomplete data must be treated with significant caution.

3 August 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb, Mar and Apr 2023 and NHS Borders in Apr 2023, so the proportions of births that are delivered pre-term and post-term in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

6 July 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb and Mar 2023 and NHS Highland in Feb 2023, so the proportions of births that are delivered pre-term and post-term in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

1 June 2023

Data are thought to be incomplete for NHS Fife in Jan and Feb 2023 and NHS Highland in Feb 2023, so the proportions of births that are delivered pre-term and post-term in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

3 May 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Jan 2023, so the proportions of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

5 April 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Dec 2022, so the proportions of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

1 March 2023

Data are thought to be incomplete for NHS Fife in Nov 2022, so the proportion of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard.

7 December 2022

Data are thought to be incomplete for NHS Forth Valley in August 2022, so the proportion of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard.

2 November 2022

Data are thought to be incomplete for NHS Forth Valley in July 2022, so the proportion of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard.

5 October 2022

Data are thought to be incomplete for NHS Forth Valley and NHS Borders in June 2022, so the proportion of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard.

7 September 2022

Data are thought to be incomplete for NHS Forth Valley in May 2022, so the proportion of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard.

3 August 2022

Data are thought to be incomplete for NHS Fife in April 2022, so the proportion of births that are delivered pre-term and post-term in this month are likely to change in future releases of the dashboard. Data submissions from NHS Forth Valley were insufficient to report for April 2022. These will be updated in future dashboard releases.

6 July 2022

Data are thought to be incomplete for NHS Forth Valley in March 2022 and for NHS Fife in February 2022, so the proportion of births that are delivered pre-term and post-term in these months are likely to change in future releases of the dashboard.

1 June 2022

Data are thought to be incomplete for NHS Forth Valley and for NHS Fife in February 2022, so the proportions of births that are delivered pre-term and post-term in February 2022 are likely to change in future releases of the dashboard.

4 May 2022

Data are thought to be incomplete for NHS Forth Valley for December 2021 and January 2022 so the proportions of births that are delivered pre-term and post-term for these months are likely to change in future releases of the dashboard.

6 April 2022

Data are thought to be incomplete for NHS Forth Valley for December 2021 so the proportion of births that are preterm, which appears lower than that for most other NHS Boards, is likely to change in future releases of the dashboard.

2 March 2022

The percentage of singleton live births delivered at or over 42 weeks (‘post-term’) in NHS Grampian has been increasing and has remained above the pre-pandemic average for the last 8 consecutive months, although it should be noted that numbers of post-term births delivered each month are very small. NHS Grampian have been made aware of the data and PHS will continue to monitor.

1 December 2021

NHS Tayside have shown a recent drop in their proportion of births delivered at 32-36 weeks gestation, however, numbers involved are very small and so are likely to fluctuate from month to month.

3 November 2021

Following 11 months (October 2019 to September 2020) where the percentage of singleton live births in NHS Lothian delivered at or over 42 weeks (‘post-term’) was below the pre-pandemic average of 1.9%, the proportion of post-term births has now been above the pre-pandemic average for 10 consecutive months (October 2020 to July 2021). We are working with the board in order to investigate this further.

2 June 2021

In this release of information on gestation at delivery (2nd June 2021) data have been updated to include women discharged after delivery up to and including February 2021. The data at all Scotland level show that the preterm proportion (the percentage of singleton live births delivered at under 37 weeks gestation) has decreased in February 2021 to a level of 5.5%, although the previous two months were either side of the pre-pandemic average. The data by NHS Board vary. In February 2021, NHS Borders and NHS Ayrshire & Arran have recorded a preterm proportion lower than their pre-pandemic average for at least 6 consecutive months. In the last 5 consecutive months, NHS Fife have shown a sequential month-on-month increasing trend in the proportion of singleton live births delivered at under 32 weeks gestation. Including February 2021, NHS Borders have shown 8 consecutive months where the proportion of births delivered between 32-36 weeks gestation was lower than their pre-pandemic average.

In February 2021, the percentage of singleton live births in Scotland delivered at or over 42 weeks (‘post-term’) has continued to be below its usual historical level (for a 16th consecutive month). In February 2021, NHS Greater Glasgow & Clyde recorded a lower than average post-term proportion for the 17th consecutive month.

5 May 2021

In this release of information on gestation at delivery (5th May 2021) data have been updated to include women discharged after delivery up to and including January 2021. The data at all Scotland level show that the preterm proportion (the percentage of singleton live births delivered at under 37 weeks gestation) in January 2021 is 6.5%, a level similar to the pre-pandemic average. The data by NHS Board vary. In January 2021, NHS Borders has recorded a preterm proportion lower than their pre-pandemic average for the 7th consecutive month albeit based on very small numbers. NHS Fife has recorded unusually high preterm proportions in December 2020 and January 2021. However, data are thought to be incomplete for NHS Fife for these two periods so these proportions could change in future releases of the dashboard. PHS are working with NHS Fife to clarify this situation. Including Jan 21, NHS Tayside have shown 6 consecutive months where the proportion of births delivered between 32-36 weeks gestation was lower than their pre-pandemic average.

In January 2021, the percentage of singleton live births in Scotland delivered at or over 42 weeks (‘post-term’) has continued to be below its usual historical level (for a 15th consecutive month). In January 2021, NHS Greater Glasgow & Clyde recorded a lower than average post-term proportion for the 16th consecutive month. Including Jan 21, NHS Highland have shown 5 consecutive months where a sequential month-on-month decrease in the proportion of post-term births has occurred.

7 April 2021

In this third release of information on gestation at delivery (7th April 2021) data have been updated to include women discharged after delivery up to and including December 2020. The data at all Scotland level show that the preterm proportion (the percentage of singleton live births delivered at under 37 weeks gestation) in December 2020 is at a level very similar to the pre-pandemic average at 7.0%. The data by NHS Board vary. In December 2020, NHS Borders has recorded a preterm proportion lower than their pre-pandemic average for the sixth consecutive month albeit based on very small numbers. NHS Fife has recorded an unusually high preterm proportion in December 2020. However, data are thought to be incomplete for NHS Fife for December 2020 so this proportion could change in future releases of the dashboard.

In December 2020, the percentage of singleton live births in Scotland delivered at or over 42 weeks (‘post-term’) has continued to be below its usual historical level (for a 14th consecutive month). In December 2020, NHS Greater Glasgow & Clyde recorded a lower than average post-term proportion for the 15th consecutive month.

3 March 2021

In this third release of information on gestation at delivery (3rd March 2021) data have been updated to include women discharged after delivery up to and including November 2020. The data at all Scotland level show that the preterm proportion (the percentage of singleton live births delivered at under 37 weeks gestation) still remains fractionally below the pre-pandemic average in November 2020. The data by NHS Board vary but there are no notable changes in the preterm proportion for November 2020.

In November 2020, the percentage of singleton live births in Scotland delivered at or over 42 weeks (‘post-term’) has continued to be below its usual historical level. NHS Greater Glasgow & Clyde have continued their run of consecutive months showing a lower than average post-term proportion.

3 February 2021

In this second release of information on gestation at delivery (3rd February 2021) data have been updated to include women discharged after delivery up to and including October 2020. The data at all Scotland level show that the preterm proportion (the percentage of singleton live births delivered at under 37 weeks gestation), having been lower than the pre-pandemic average during the period March to July 2020, has increased slightly but still remains fractionally below the pre-pandemic average at 6.7% in October 2020.

The data by NHS Board of residence show more varied patterns. NHS Forth Valley has shown quite low proportions of preterm births in recent months compared to their pre-pandemic average with 4.9% in October 2020. NHS Ayrshire & Arran, NHS Dumfries & Galloway and NHS Lothian also show periods where the percentage of preterm births is lower than the long-term average. However these periods start before the pandemic period. No NHS Boards are showing particularly high preterm numbers. Data are thought to be incomplete for NHS Fife for October 2020 so the proportion of births that are preterm, which is higher than that for most other NHS Boards, is likely to change in future releases of the dashboard.

The percentage of singleton live births in Scotland delivered at or over 42 weeks (‘post-term’) has continued to be fractionally below its usual historical level. This pattern began in November 2019, and no specific change in the post-term proportion has been seen during the COVID-19 pandemic. The pattern at board level is more variable. NHS Greater Glasgow & Clyde has shown a decrease over recent months with the percentage for October 2020 being the lowest in the period shown at 0.7%.

16 December 2020

Information on gestation at delivery was included in this tool for the first time on 16 December 2020.

‘Gestation at delivery’ refers to the number of completed weeks pregnant a woman is when she delivers her baby. Babies are ‘due’ at 40 completed weeks gestation. Those born between 37 and 41 weeks inclusive are considered to be born ‘at term’. Babies born at under 37 weeks (more than three weeks before their due date) are considered preterm or premature (external website) , with those born at under 32 weeks considered very preterm and those born at 32 to 36 weeks inclusive considered moderately preterm. Babies born at or over 42 weeks (more than two weeks after their due date) are considered post-term or over-due. Babies born preterm are at increased risk of both short and long term health and developmental problems, with the risk increasing the earlier a baby is born (external website) . Babies are also at increased risk when pregnancies extend post-term, in particular the risk of stillbirth (external website) increases from 42 weeks gestation onwards.

Care for women and babies around the time they are giving birth/being born is an essential, time critical service that cannot be deferred. As such, it has been provided throughout the COVID-19 pandemic, and maternity and neonatal staff have not been redeployed to support other services. The way that some elements of this care are provided has changed in response to COVID-19 however, to minimise the risk of infection and to allow services to continue to provide safe care during times when a high number of staff may be off work, for example due to needing to isolate. Relevant guidance has been issued by the Scottish Government (external website) , the Royal College of Obstetricians and Gynaecologists (external website) , and the British Association for Perinatal Medicine (external website) .

The current evidence suggests that women with COVID-19 are at increased risk of preterm delivery (external website) . Conversely, several studies (for example from the Netherlands (external website) , Denmark (external website) , and Ireland (external website) ) have reported that the overall number or proportion of babies born preterm or with low birthweight fell during the ‘lockdown’ period implemented in response to COVID-19. The reasons for this finding are currently unclear, but may reflect the combined impact of factors such as a reduction in infections other than COVID-19, improved air quality, and changes to antenatal care, which together more than outweigh any direct effect of COVID-19.

The information on gestation at delivery presented through this tool is taken from hospital discharge records, specifically records relating to the care of women delivering a singleton live birth (i.e. one baby, not twins or more) at a known gestation (between 18-44 weeks inclusive). Further technical information is available through the ‘Data source’ button on the dashboard page.

The data shows that, at all Scotland level, the percentage of singleton live births delivered at under 37 weeks gestation (the ‘preterm rate’) was slightly lower than usual over the period March to July 2020 (at just over 6% compared to the more usual 6.8%). This was driven by a dip in the percentage of births delivered at 32-36 weeks (the ‘moderately preterm rate’): there has been no change in the percentage of births delivered at under 32 weeks (the ‘very preterm rate’). The percentage of singleton live births delivered at or over 42 weeks (the ‘post-term rate’) has been fractionally below its usual historical level since November 2019, but no specific change in the post-term rate has been seen during the COVID-19 pandemic.

Prior to the COVID-19 pandemic, the preterm rate was somewhat variable between NHS Board areas of residence. There is also some variation between areas in how the preterm rate has changed around the time of the pandemic. The preterm rate for women living in NHS Ayrshire & Arran and NHS Lothian has shown a particularly pronounced fall during the pandemic. No area has seen a sustained increase in the preterm rate during the pandemic. The hospital delivery discharge records returned to Public Health Scotland that are used in this tool are incomplete for NHS Fife for September 2020: this is likely to account for the unusually high very preterm rate seen for women living in NHS Fife in this month specifically. We expect this unusually high rate to change when more records are received and this page of the dashboard is refreshed.

The preterm rate tends to be highest among mothers in the youngest (<20 years) and oldest (40+ years) age groups, however differences between age groups are not pronounced. There is a clear gradient in the preterm rate by deprivation, with the rate being highest among mothers living in the most deprived areas of Scotland. These patterns have persisted during the COVID-19 pandemic.

Apgar scores

7 September 2023

Data are thought to be incomplete for NHS Fife and NHS Borders in Apr 2023 and NHS Highland in May 2023, so the proportions of births with an Apgar score < 7 in these months are likely to change in future data presentations. Results based on incomplete data must be treated with significant caution.

3 August 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb, Mar and Apr 2023 and NHS Borders in Apr 2023, so the proportions of births with an Apgar score < 7 in these months are likely to change in future releases of the dashboard.Results for boards with incomplete data must be treated with significant caution.

6 July 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb and Mar 2023 and NHS Highland in Feb 2023, so the proportions of births with an Apgar score < 7 in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

5 April 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Dec 2022, so the proportions of births with an Apgar score < 7 in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

3 August 2022

Data are thought to be incomplete for NHS Fife and NHS Forth Valley in April 2022, so the proportion of babies with a low Apgar score in this month is likely to change in future releases of the dashboard.

2 June 2021

In this release of information on Apgar scores (2nd June 2021) data have been updated to include women discharged after delivery up to and including February 2021. The data show that, at all Scotland level, the percentage of singleton live born babies delivered at 37-42 weeks gestation which have a low 5 minute Apgar score (less than 7) in February 2021 was at a very similar level to the pre-pandemic average at 1.8%.

The Apgar score data by NHS Board are presented quarterly and this information will next be updated on 7th July 2021.

14 April 2021

Information on Apgar scores was included in this tool for the first time on 14 April 2021.

The Apgar score measures the condition of newborn babies. It was developed to allow health professionals to quickly identify babies needing resuscitation after delivery. Babies are scored 0, 1, or 2 for each of their heart rate; respiratory effort; muscle tone; response to stimulation; and colour. Scores therefore range from 0 to 10, with higher scores indicating a better condition. Scores of 7 or over are generally interpreted as ‘reassuring’, with scores of 4-6 considered moderately low, and scores of 0-3 considered very low. The Apgar score is measured at 1 and 5 minutes after delivery for all babies in Scotland.

Low Apgar scores at 5 minutes after delivery are associated with a higher risk of neonatal death, neonatal morbidity, and longer term problems with babies’ development. Babies born preterm can have lower scores due to their overall immaturity rather than a specific problem such as lack of oxygen during delivery. Due to this, the association between low Apgar scores and poor outcomes is generally stronger for babies born at term (at 37-41 weeks gestation) or post-term (at ≥42 weeks gestation) compared to those born preterm (at <37 weeks gestation).

The information on Apgar scores presented through this tool is taken from hospital discharge records, specifically records relating to the care of women delivering a singleton live birth (i.e. one baby, not twins or more) at 37-42 weeks gestation inclusive. Further technical information is available through the ‘Data source’ button on the dashboard page.

The data shows that, at all Scotland level, just under 2% of singleton, live born babies delivered at 37-42 weeks gestation have a low 5 minute Apgar score (less than 7). The percentage of babies with a low score has been broadly similar over the whole period examined (January 2018 to, currently, December 2020). In particular, no increase in the percentage of babies with a low score has been seen during the COVID-19 pandemic. In fact the percentage of babies born with a 5 minute Apgar score of less than 7 was consistently slightly lower from Jan to Sep 2020 than the Jan 2018 to Feb 2020 average.

Prior to the COVID-19 pandemic, the percentage of babies with a low 5 minute Apgar score was similar across mainland NHS Boards, ranging from around 1% of babies born to mothers living in NHS Highland to around 2.5% of babies born to mothers living in NHS Lanarkshire. Within each Board, the percentage of babies with a low score fluctuates over time, as would be expected by chance. No increase in the percentage of babies with a low score has been seen during the COVID-19 pandemic in any Board.

The percentage of babies with a low 5 minute Apgar score is similar for babies born to mothers from different age groups, and for babies born to mothers living in areas with different levels of deprivation. No changes to these patterns have been seen during the COVID-19 pandemic.

Location of extremely preterm deliveries

6 July 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb and Mar 2023 and NHS Highland in Feb 2023, so the proportion of preterm deliveries at hospitals with a neonatal unit on site in Scotland during the quarter Jan-Mar 2023 is likely to change in future releases of the dashboard. Results based on incomplete data must be treated with significant caution.

5 April 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Dec 2022, so the proportion of preterm deliveries at hospitals with a neonatal unit on site in this month is likely to change in future releases of the dashboard.

6 October 2021

The ‘location of extremely preterm deliveries’ measure is used to monitor whether babies born at 23-26 weeks gestation are born at a hospital with a neonatal intensive care unit. It is desirable that this percentage is as high as possible, but inevitably some extremely preterm deliveries occur in other locations, for example, a woman presenting to her local maternity unit may be considered too far advanced in labour to safely transfer to a different hospital before her baby is born. Control charts are used to help differentiate between expected random variation (which is a particular issue for rare events such as extremely premature births), and substantial changes which warrant further investigation, with expected levels based on previous data. Last quarter (April-June 2021) it was noted that the percentage of extremely preterm deliveries occurring in a hospital with a neonatal intensive care unit was lower than expected, with 70.8% of babies delivered at such a site, compared with the warning limit of 71.3%. However, the value remained above the lower control limit of 64.1%, indicating that this observation is within the range of expected random variation. The data will continue to be monitored on a quarterly basis.

14 April 2021

Information on the location of extremely preterm deliveries was included in this tool for the first time on 14 April 2021.

Babies born preterm (at least 3 weeks before their due date) are at increased risk of neonatal death, neonatal morbidity, and longer term developmental problems compared to babies born at term (around their due date). The earlier in pregnancy a baby is born, the higher the risks.

There is evidence that the outcomes of extremely preterm babies (here defined as those born between 23 and 26 weeks gestation inclusive) are influenced by where they are born. Extremely preterm babies are more likely to survive and be healthy if they are born in a hospital that has an on-site neonatal intensive care unit. In addition, extremely preterm babies cared for in larger neonatal intensive care units (those caring for high numbers of very unwell babies) have better outcomes than babies cared for in smaller units.

Reflecting this evidence, the British Association of Perinatal Medicine recommends (external website) that when a woman is thought to be at imminent risk of extremely preterm delivery she should be transferred to a maternity unit in a hospital with an on-site neonatal intensive care unit to allow her baby (or babies in the case of a multiple pregnancy of twins or more) to be born in the safest place. In addition, whilst the overall number of neonatal units is not changing in Scotland, the number of units that are classed as neonatal intensive care units (external website) (also known as level III units, those able to provide the most complex, specialist care) is reducing over time in line with national policy (external website) to concentrate expertise and improve babies’ outcomes.

The information on location of extremely preterm deliveries presented through this tool is taken from hospital discharge records relating to the care of women delivering one or more live born babies at 23-26 weeks gestation inclusive. The charts presented show the number and percentage of these deliveries that occurred in a hospital that had a neonatal intensive care unit on site at the time of the delivery. Information on which hospitals have had a neonatal intensive care unit on site over the time period of interest (from January 2018), and associated dates, has been provided by the Scottish Perinatal Network (external website) . Due to the small number of deliveries at this very early gestation, data is only shown at all Scotland level, and no breakdown is provided by maternal age group or deprivation level. Further technical information is available through the ‘Data source’ button on the dashboard page.

The data shows that, at all Scotland level over the whole time period examined (January 2018 to, currently, December 2020), just under 9 in every 10 (87%) extremely preterm deliveries occurred in a hospital with a neonatal intensive care unit on site at the time of the delivery. The percentage has been consistently within both the warning and control limits over the whole time period examined, suggesting that any fluctuation seen has been due to chance, with no unexpected changes evident. In particular, no decline in the percentage of extremely preterm deliveries that occurred in a hospital with a neonatal intensive care unit on site has been seen during the COVID-19 pandemic.

In general, it is inevitable that some extremely preterm deliveries occur in locations other than hospitals with a neonatal intensive care unit on site. For example, a woman presenting to her local maternity unit may be considered too far advanced in labour to safely transfer to a different hospital before her baby is born.

Perineal tears

7 September 2023

Data are thought to be incomplete for NHS Fife and NHS Borders in Apr 2023 and NHS Highland in May 2023, so the proportions of women with a perineal tear in these months are likely to change in future data presentations. Results based on incomplete data must be treated with significant caution.

3 August 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb, Mar and Apr 2023 and NHS Borders in Apr 2023, so the proportions of women with a perineal tear in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

6 July 2023

Data are thought to be incomplete for NHS Fife in Jan, Feb and Mar 2023 and NHS Highland in Feb 2023, so the proportions of women with a perineal tear in these months are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

5 April 2023

Data are thought to be incomplete for NHS Fife and NHS Highland in Dec 2022, so the proportions of women with a perineal tear in this month are likely to change in future releases of the dashboard. Results for boards with incomplete data must be treated with significant caution.

3 August 2022

Data are thought to be incomplete for NHS Fife and NHS Forth Valley in April 2022, so the proportion of births that result in a tear in this month is likely to change in future releases of the dashboard.

2 February 2022

The percentage of women resident in NHS Lanarkshire giving birth vaginally to a singleton live or stillborn baby with a cephalic presentation between 37-42 weeks gestation, and who have a third or fourth degree perineal tear has been above the pre-pandemic average for six successive quarters (covering the period April 2020 - September 2021). The pre-pandemic rate was 3% and that for July-September 2021 3.7%. It is important to note that some women resident in NHS Lanarkshire receive delivery care from bordering health boards. At Scotland level the pre-pandemic rate of third and fourth degree perineal tears was 3.5% and that for July-September 2021 was 3.2%. NHS Lanarkshire have been made aware of this data and PHS will continue to monitor.

3 November 2021

The percentage of women giving birth vaginally to a singleton live or stillborn baby with a cephalic presentation between 37-42 weeks gestation who have a third or fourth degree perineal tear has been above the pre-pandemic average for seven successive quarters (including April-June 2021) in both NHS Dumfries & Galloway and NHS Greater Glasgow & Clyde. We are working with these two boards in order to investigate this further. NHS Dumfries & Galloway have indicated that their overall numbers of third and fourth degree tears are small. They routinely review all women who have had a third or fourth degree tear at their Clinical Incident Review Group and they have not so far identified any common themes.

16 June 2021

Information on perineal tears was included in this tool for the first time on 16 June 2021.

When a woman is giving birth, the baby stretches the mother’s vagina and perineum. Occasionally, the tissues cannot stretch enough, and a tear (called a 'perineal tear (external website)' ) occurs. The perineum is the area between a woman’s vagina and anus.

Perineal tears are classified as 1st to 4th degree, with 4th degree tears being the most serious. First degree tears just involve the skin of the perineum or lining of the lower vagina. Second degree tears also involve the muscles of the perineum. Third degree tears extend further back and also involve the muscles surrounding the anus. Fourth degree tears extend further into the lining of the anus or rectum (lower bowel).

Third and 4th degree tears are also known as obstetric anal sphincter injury. These tears require surgical repair immediately after delivery. Most women recover completely following a 3rd or 4th degree tear, however some are left with persistent problems controlling their bowels (anal incontinence).

Most tears are unexpected and it’s hard to predict which women will have a tear, although tears are more common during a woman’s first vaginal delivery, if the baby is big (over 4kg birthweight), or if the second stage of labour goes on for a long time.

An episiotomy (external website) may be offered if a woman is thought to be at risk of a tear. An episiotomy is a controlled cut made by a healthcare professional through the vaginal wall and perineum that is repaired with stitches after delivery. An episiotomy does not guarantee that a tear will not happen, as the episiotomy cut may extend and become a tear. Women requiring assisted vaginal delivery (with forceps or ventouse) are at high risk of a tear so would generally be offered an episiotomy.

However, there have been some changes to how delivery care is provided in response to COVID-19, to minimise the risk of infection and to allow services to continue to provide safe care during times when a high number of staff may be off work, for example due to needing to isolate. These changes have varied over time and between areas. For example, guidance issued by the Scottish Government (external website) and Royal College of Obstetricians and Gynaecologists (external website) to maternity services at the height of the first wave of the pandemic (spring 2020) noted that it may be necessary for services to temporarily suspend the option for women to deliver at home or in midwife led units, and to concentrate delivery care within obstetric units. This tool allows us to monitor whether changes to care provision associated with COVID-19 have led to any changes in the outcomes of women or babies.

The information on perineal tears presented through this tool is taken from hospital discharge records, specifically records relating to the care of women undergoing spontaneous or assisted vaginal delivery of a singleton live or stillborn baby (i.e. one baby, not twins or more) with cephalic (i.e. ‘head first’) presentation at 37-42 weeks gestation (i.e. up to 3 weeks before or after their due date). Further technical information is available through the ‘Data source’ button on the dashboard page.

The data shows that, at all Scotland level, the percentage of women giving birth vaginally to a singleton live or stillborn baby with a cephalic presentation between 37-42 weeks gestation who have a 3rd or 4th degree perineal tear (the ‘tear rate’) has remained broadly constant at around 3.5% from January 2018 (when the data shown starts) to end February 2021 (the latest point for which data is currently available).

The tear rate varies somewhat between NHS Board areas of residence: for example the average rates in mainland Boards in the period prior to the COVID-19 pandemic ranged from 1.5% for women in NHS Dumfries & Galloway to 4.6% in NHS Lothian. No areas have shown a clear change in the tear rate since the start of the COVID-19 pandemic.

The tear rate does not show any clear relationship to maternal age. The tear rate tends to be highest among mothers living in the least deprived areas of Scotland, and this pattern has not changed during the COVID-19 pandemic.

Stillbirths and infant deaths

6 Sept 2023

In this release of information on stillbirths and infant deaths data have been updated to include events that occurred in July 2023.

In July the rate of neonatal deaths was 4.1 per 1,000 live births, which was higher than the warning limit of 3.6, but below the control limit of 4.3. Control charts help to differentiate between random variation and a change which is less likely to be due to chance. The neonatal death rate in July was within the control limit, indicating that this observation is within the range of expected random variation in the occurrence of these tragic but rare events.

As there is a relationship between the rate of stillbirth and neonatal mortality, the extended perinatal mortality rate is used to present a combined figure for these two measures. In July 2023 this was 7.6 per 1,000 total births, which is below the warning limit (8.3 per 1,000 total births). There is also a relationship between neonatal and postneonatal deaths , and the infant mortality rate reflects the overall across these two figures. In July 2023 the infant mortality rate was 4. 3 per 1,000 live births, which is below the warning limit (5.0 per 1,000 live births).

This September 2023 release will be the last update of the ‘pregnancy’ and ‘births and babies’ sections of the Wider Impacts Dashboard. They will be replaced by a new Scottish Pregnancy, Births and Neonatal Data (SPBAND) Dashboard in October 2023. Information on stillbirths, extended perinatal mortality, neonatal deaths, postneonatal deaths and infant mortality will be presented quarterly on this new dashboard.

6 July 2023

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in May 2023.

With these updated data, it is now identified that in April 2023 the post-neonatal mortality rate (2.79 per 1,000 live births) exceeded the upper control limit of 2.77. Post-neonatal deaths refer to deaths occurring after the first 4 weeks but within the first year of life. There were relatively few neonatal deaths (those occurring in the first four weeks of life) in April 2023; the neonatal mortality rate was 0.6 per 1,000 live births. This meant that overall infant mortality (all deaths occurring in the first year of life) of 3.3 per 1,000 live births was within the expected range.

These data also identify the period October 2022 to May 2023 as an upward ‘shift’ in the infant mortality rate. A ‘shift’ describes when there is a sequence of 8 or more months of data that are above (or below) the average level, which here is based on the pre-pandemic mortality rates from 2017 to 2019. These ‘shifts’ are indicated by the blue markers on the chart for the relevant sequence of months. This pattern suggests there has been a sustained period when infant mortality rates were higher than pre-pandemic levels, rather than fluctuating around this level as would be expected with random variation. In contrast to the previous shift in infant mortality that was noted in 2021, this recent period is not associated with a shift in neonatal mortality rates, nor was it associated with a shift in the post-neonatal mortality rate. The increase in neonatal mortality in 2021/22 is the subject of a national review that is ongoing.

Each of these events is a tragedy for those involved. All child deaths in Scotland are reviewed to ensure that contributing factors are understood, and that learning is used in Prevention and improving quality care (external website)

1 June 2023

In this release of information on stillbirths and infant deaths (1 June 2023) data have been updated to include events that occurred in April 2023.

In April the rate of stillbirths was 6.1 per 1,000 total births, which was higher than the warning limit of 5.8, but below the control limit of 6.8. Whilst each event is important and a tragedy for those involved, the numbers of stillbirths are small overall, and therefore rates do fluctuate from month to month just by chance. Control charts help to differentiate between expected random variation and a change which is less likely to be due to chance. The stillbirth rate in April was within the control limit, indicating that this observation is within the range of expected random variation.

The neonatal mortality rate was relatively low (0.6 per 1,000 live births), whilst the post-neonatal mortality rate (2.23 per 1,000 live births) was just above the warning limit (2.21 per 1,000), but below the control limit (2.77 per 1,000). The overall infant mortality rate remained within the expected range in April 2023 (2.8 per 1,000 live births).

Monthly monitoring of these data will continue.

4 May 2022

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in March 2022.

In March 2022 the neonatal mortality rate (4.6 per 1,000 live births) exceeded the upper control limit of 4.4 per 1,000. The extended perinatal mortality rate, which captures both stillbirths and neonatal deaths was 9.1 per 1,000 live and stillbirths; this was above the upper warning limit of 8.4 per 1,000 but did not exceed the control limit of 9.6 per 1,000. Similarly, the overall infant mortality rate (5.9 per 1,000 live births) exceeded the warning limit (5.1 per 1,000), but not the upper control limit 6.0 per 1,000). Post-neonatal deaths (those that occur after 4 weeks of age) were within the expected range.

Each of the losses reflected in the information reported here is a tragedy for those involved. The review processes described below (2nd March 2022) will be important in understanding and learning from these events.

The effects of COVID-19 infection, and the safety and protection of COVID-19 vaccination in pregnancy, continue to be monitored in Scotland (external website) and internationally (external website) . There is evidence that COVID-19 infection during pregnancy is associated with worse outcomes for mothers and babies. In Scotland it has been found that among babies born to mothers who had COVID-19 infection in the month prior to birth, the extended perinatal mortality rate was 13.4 per 1,000 live and stillbirths (95% confidence interval 8.1-21.9) (COVID-19 winter publication report) .

COVID-19 vaccination is a safe and effective way to reduce the risk of COVID-19 in pregnancy, and vaccination is strongly recommended. By mid-February 28,301 women had been vaccinated during pregnancy in Scotland, and 54% of women who gave birth in January 2022 had received at least two doses of vaccine, either during or prior to pregnancy. Among babies born to mothers who received a dose of COVID-19 vaccination in the month prior to birth, the extended perinatal mortality rate was 5.2 per 1,000 live and stillbirths (95% confidence interval 2.9-8.9) (COVID-19 winter publication report). More information and support with decision-making is available from the Royal College of Obstetricians and Gynaecologists (https://www.rcog.org.uk/guidance/coronavirus-covid-19-pregnancy-and-women-s-health/vaccination/covid-19-vaccines-pregnancy-and-breastfeeding-faqs/) and NHS Inform (https://www.nhsinform.scot/covid-19-vaccine/the-vaccines/pregnancy-breastfeeding-and-the-coronavirus-vaccine) .

2 March 2022

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in January 2022, when all reported measures of perinatal and infant mortality were within expected limits.

As described in the dashboard information box ‘How do we identify patterns in the data?’, control charts are used to provide an indication of when changes in these data are less likely to be due to chance alone. In refreshed data now available for 2021, the months March to October are identified as a ‘shift’ in the neonatal mortality rate, and the months April to November as a ‘shift’ in the infant mortality rate. A ‘shift’ describes when there is a sequence of 8 or more months of data that are above (or below) the average level, which here is based on the pre-pandemic mortality rates from 2017 to 2019. These ‘shifts’ are indicated by the blue markers on the chart for the relevant sequence of months. This pattern suggests there was a sustained period in the middle part of 2021 when neonatal and infant mortality rates were higher than pre-pandemic levels, rather than fluctuating around this level as would be expected with random variation. In the most recent months, the rates for both measures have been below the average level. No shifts are noted for stillbirths, extended perinatal mortality or post-neonatal deaths.

As noted below, neonatal and infant deaths are subject to a number of review and learning processes to identify and mitigate any contributing factors. Systematic information on deaths occurring in neonatal units is gathered via the Perinatal Mortality Review Tool (external website); the UK-wide collaboration, MBRRACE-UK (external website), provides surveillance and investigation of maternal deaths, stillbirths and infant deaths, and there is a standardised approach to review of perinatal adverse events in Scotland (external website). All child deaths in Scotland are now reviewed to ensure that contributing factors are understood, and that learning is used in prevention and improving care quality (external website). A number of agencies consider the outcomes of these review processes, including the Scottish National Neonatal Network (external website), the Maternity and Children Quality Improvement Collaborative (external website) and the Scottish Government.

Annual data on stillbirths and infant deaths are produced by National Records of Scotland (external website) and information for 2021 is scheduled to be published in June 2022.

2 February 2022

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in November and December 2021. In these months all reported measures of perinatal and infant mortality were within expected limits.

In addition, in this dashboard release information on gestation at delivery has been updated under the ‘Births and babies’ tab to include births in September and October 2021, which is of interest in follow up to the commentary below on neonatal mortality in September 2021. These data show that in September 2021, 0.8% of singleton live births occurred at under 32 weeks gestation, and 5.5% at 32-36 weeks gestation. Both of these figures are close to the expected level based on the average over the period January 2018 to February 2020. As these data are based on singleton births only, data were also reviewed separately to assess the total number and percentage of premature babies, including those from multiple births. This showed that the total number of babies born at under 32 weeks gestation in September 2021 was relatively high, and in the upper quartile for monthly values in January to October 2021, however it was not exceptional in comparison to the observed values in this period.

Further information on COVID-19 infection and vaccination in pregnancy in Scotland, including data on neonatal infections and extended perinatal mortality rate have also been published recently (see SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland (external website) and Public Health Scotland publications ). The information in these publications provides further reassurance regarding the safety of vaccination in pregnancy and highlights the effective protection it provides for pregnant women and their babies.

1 December 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in October 2021.

In October 2021 all reported measures of perinatal and infant mortality were within expected limits. The neonatal mortality rate, which was raised in September 2021, was 3.3 per 1,000 live births in October 2021 and returned to within the warning limit (3.6 per 1,000). The overall infant mortality rate (4.9 per 1,000 live births) in October 2021 was close to, but did not breach the upper warning limit (5.0 per 1,000), whereas in September 2021 it was above this (5.5 per 1,000). Stillbirths and post-neonatal deaths (those that occur after 4 weeks of age) were at expected levels in October 2021.

As referenced in the commentary on September 2021 data, all neonatal deaths are the subject of local and national review processes. In addition to this, the higher than expected numbers that month prompted additional review of available data at national level, in particular with respect to the role of prematurity, and to understand any relationship with COVID-19 infections. Findings from this review are preliminary, as relevant information at national level on the total number of births and gestational age of babies in that period is not yet fully complete, but will be by February 2022 (see below).

Initial findings suggest that, overall, the number of births in September 2021 was at the expected level. Preliminary information on prematurity suggests that the number of babies born at less than 32 weeks gestation in September 2021 was at the upper end of monthly numbers seen in 2021 to date. This may contribute to the neonatal mortality rate, as prematurity is associated with an increased risk of neonatal death. The relevant dashboard indicators on live births and gestational age will be updated to include September 2021 information, using the most complete data available, in the next dashboard update in February 2022.

There is no information at this stage to suggest that any of the neonatal deaths in September 2021 were due to COVID-19 infection of the baby. Likewise, preliminary review does not indicate that maternal COVID-19 infection played a role in these events. Several surveillance programmes focussing on direct impact of COVID-19 on pregnant women and babies are underway. The COVID-19 in Pregnancy in Scotland study (COPS) (external website) has been established to provide population-level monitoring and analysis of the occurrence and outcomes of COVID-19 infection in pregnancy. Monthly reporting of cases is available within the PHS COVID-19 Statistical Report and will next be updated on the 8th December. At UK-level, surveillance of any complications of COVID-19 among neonates is being undertaken through the British Paediatric Surveillance Unit (external website) .

Whilst COVID-19 does not appear to have played a role in the tragic deaths which occurred in September 2021, there is international evidence which shows that COVID-19 infection during pregnancy is associated with a higher chance of problems for both mother and baby. The Royal College of Obstetricians and Gynaecologists (RCOG) maintains a review of the literature on COVID-19 in pregnancy, with an update published in November 2021 (external website) . COVID-19 infection during pregnancy has been linked to an increased risk of stillbirth. Symptomatic COVID-19 is associated with an increased likelihood of premature birth due to a need to deliver the baby early for the health of mother or baby.

In view of the small but important risks of COVID-19 infection in pregnancy, pregnant women are encouraged to take up the offer of COVID-19 vaccination. Information on this is available from the RCOG (external website) , and from NHS Inform (external website) . There is good evidence that it is effective at preventing severe COVID-19 illness. In Scotland, in data available to the end of September 2021, 99 women had been admitted to critical care within 21 days of testing positive for COVID-19 during pregnancy, of whom 98 were unvaccinated. Vaccine safety monitoring takes place within Scotland and internationally, with more than 200,000 women having received the vaccine during pregnancy across the UK and US, with no concerning safety signals (see Coronavirus (COVID-19) Infection in Pregnancy report (external website) ). Recently published data (external website) from England provides further reassurance regarding birth outcomes among vaccinated women.

3 November 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in September 2021.

In September 2021 both the neonatal mortality rate (4.9 per 1,000 live births) and the extended perinatal mortality rate (9.9 per 1,000 live and stillbirths) exceeded their upper control limits of 4.3 and 9.4, respectively. Extended perinatal death rate is a measure which combines stillbirths and neonatal deaths. Examining the data shows that the increase in extended perinatal mortality reflects the higher than expected neonatal deaths, and stillbirths that were at, but not lower than, their expected level. The overall infant mortality rate (5.5 per 1,000 live births) exceeded the warning limit (5.0), but not the upper control limit (5.9). This was due to the high number of neonatal deaths. Post-neonatal deaths (those that occur after 4 weeks of age) were not increased.

Each of these events is a tragedy for those involved. There are a number of existing processes through which these events, in common with all neonatal deaths, will be reviewed. All child deaths in Scotland are now reviewed to ensure that contributing factors are understood, and that learning is used in prevention and improving care quality (external website) . Systematic information on deaths occurring in neonatal units is gathered via the Perinatal Mortality Review Tool (external website) and the UK-wide collaboration, MBRRACE-UK, provides surveillance and investigation of maternal deaths, stillbirths and infant deaths. A standardised approach (external website) to review of perinatal adverse events has also recently been adopted in Scotland

As the overall number of deaths occurring each month is fortunately small, mortality rates tend to fluctuate from month to month just by chance. Control charts are a tool that help tell the difference between expected chance variation and changes which warrant further investigation. Exceeding the upper control limit indicates there is a higher likelihood that there are factors beyond random variation that may have contributed to the number of deaths that occurred. In view of this, in addition to the processes outlined above, Public Health Scotland is working with the Scottish National Neonatal Network (external website) , the Maternity and Children Quality Improvement Collaborative (external website) and the Scottish Government to understand any possible contributing factors to the most recent infant mortality patterns, and to incorporate findings into existing prevention and improvement work. Further information on the results of this work will be provided in future commentary.

2 June 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in April 2021. The rate of stillbirths, and all reported infant death measures, remained within the warning threshold limits this month. The stillbirth rate in April 2021 was 2.4 per 1,000 total births (baseline, pre-pandemic average 3.8 per 1,000 total births), the neonatal death rate was 2.7 per 1,000 live births (average 2.2 per 1,000 live births), and the infant mortality rate was 3.5 per 1,000 live births (average 3.3 per 1,000 live births).

5 May 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in March 2021. The rate of stillbirths, and all reported infant death measures, remained within the warning threshold limits this month. The stillbirth rate in March 2021 was 4.5 per 1,000 total births (average 3.8 per 1,000 total births), and the infant mortality rate was 3.3 per 1,000 live births (average 3.3 per 1,000 live births).

All the stillbirth and infant death data have been revised in this latest release. Originally we reported these events from January 2017, and this has now been changed to July 2017. Also, a fixed centreline (average) has been recalculated for every chart using the data for the months July 2017 to December 2019. The dotted centreline continues that average through the more recent time period to allow determination of whether the values seen in these months are unexpectedly low or high. The use of a fixed centreline increases sensitivity of detection of signals in more recent data, since recent observations within the pandemic period do not contribute to this reference centreline.

7 April 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in February 2021. The rate of stillbirths, and all reported infant death measures, remained within the warning threshold limits this month. The stillbirth rate in February 2021 was 4.3 per 1,000 total births, and infant mortality rate was 3.2 per 1,000 live births.

Further background information is available within the commentary for July 2020.

3 March 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in January 2021. The rate of stillbirths, and all reported infant death measures, remained within the warning threshold limits this month. The stillbirth rate in January 2021 was 4.9 per 1,000 total births, and infant mortality rate was 3.6 per 1,000 live births.

Last month we reported an issue involving a small number of infant deaths which were not included in the data files sent from NRS to PHS (affecting less than 3% of infant deaths). We now believe that this discrepancy has been resolved and any data affected have been retrospectively updated on the dashboard.

3 February 2021

In this release of information on stillbirths and infant deaths, data have been updated to include events that occurred in December 2020. In the intervening months since previous reporting on deaths up to October 2020, the rate of stillbirths and infant deaths remained within the warning threshold limits. The stillbirth rate in December 2020 was 3.5 per 1,000 total births, the lowest rate since August 2020 (2.4 per 1,000 total births).

Presenting rates for post-neonatal deaths (PNND) has been changed from a P chart to a U chart. Both types of chart are a means of identifying any important changes in the data (see the ‘How do we identify patterns in the data?’ box for more information). Changing to a U chart brings the reporting of the PNNDs into line with that for infant deaths. Neither the rates nor the control and warning limits are materially affected by this change.

The data for these indicators are sourced from NRS, however, a recent issue has come to light whereby a small number of infant deaths are not included in the data files sent from NRS to PHS. The numbers involved are thought to be very small (less than 3% of infant deaths) and affect data since July 2020. Any impact on the overall rates included in the dashboard are likely to be minimal. We are working with NRS to resolve this discrepancy as soon as possible. Once resolved data relating to these deaths will be included retrospectively on the dashboard.

2 December 2020

In this release of information on stillbirths and infant deaths (2 Dec 2020), data have been updated to include events that occurred in October 2020. Last month it was noted that the rate of post-neonatal deaths in September breached the warning limit (though not the control limit). Continued monitoring shows that this rate has returned to a lower level in October, at 1.4 per 1,000 live births. Whilst each of these events is a tragedy for those involved, in October the numbers remained small, and all stillbirth and infant death measures were within the warning limits.

4 November 2020

In this release of information on stillbirths and infant deaths (4 Nov 2020) data have been updated to include events that occurred in September 2020. In September the rate of stillbirths, neonatal deaths and extended perinatal deaths remained within control limits. Post-neonatal deaths are those which occur after 4 weeks of age, but within the first year of life. In September the rate of post-neonatal deaths was 2.2 per 1,000 live births. This is above the warning limit of 2.1 per 1,000, but below the control limit of 2.6 per 1,000. These thresholds are shown on the control charts, and are used to help differentiate between expected random variation and substantial changes which warrant further investigation. The overall infant mortality rate, which includes all deaths of children aged under 1 year (both below and above 4 weeks of age), remained within the warning limit. This pattern suggests that the higher rate of post-neonatal deaths in September reflects random variation in what is a tragic, but fortunately rare event. Monthly monitoring of these data will continue.

7 October 2020

In this release of information on stillbirths and infant deaths (7 Oct 2020), data have been updated to include events that occurred in August 2020.
Last month it was noted that the rate of stillbirths in July breached the warning limit (though not the control limit). Continued monitoring shows that this rate has returned to a lower level in August, at 2.4 per 1,000 total births.
Neonatal, post-neonatal and infant deaths have remained within the expected range, and were relatively low in August 2020.

2 September 2020

In this release of information on stillbirths and infant deaths (2 Sept 2020) data have been updated to include events that occurred in July 2020.
In July the rate of stillbirths was 6.0 per 1,000 total births, which was higher than the warning limit of 5.8, but below the control limit of 6.7. Whilst each event is important and a tragedy for those involved, the numbers of stillbirths are small overall, and therefore rates fluctuate from month to month just by chance. Control charts are used to help differentiate between expected random variation and substantial changes which warrant further investigation. The stillbirth rate in July was within the control limit, indicating that this observation is within the range of expected random variation.
As there is a relationship between the rate of stillbirth and neonatal mortality, the extended perinatal mortality rate is used to present a combined figure for these two measures. In July 2020, this was 7.4 per 1,000 total births, which is below the warning limit. Monthly monitoring of these data will continue.
Post-neonatal and infant deaths have remained within the expected range, and were relatively low in July 2020.

5 August 2020

In this second release of information on stillbirths and infant deaths (5 Aug 2020) data have been updated to include June 2020. Whilst each of these events is a tragedy for those involved, in June the numbers remained small, and all stillbirth and infant death measures were within the warning limits.
Rates of stillbirths and extended perinatal deaths approached, but did not breach, the upper warning limit in May 2020. However, rates for both fell below the average in June 2020.
Further background information on the data sources used to monitor stillbirths and infant death rates, and how to interpret the control charts, is provided in the commentary for 1 July 2020 below.

1 July 2020

Background

It is important to monitor the levels of stillbirth and infant mortality during the COVID-19 pandemic, as they may be influenced by maternal health and well-being, by how maternity and child health services are provided, and by how people seek and interact with care. NHS Scotland and Scottish Government have produced guidelines (external website) for attending antenatal and postnatal care appointments during the pandemic.

The tool shows monthly data for stillbirths and infant deaths (those occurring under the age of one year). These are based on data from National Records for Scotland (NRS), and are presented as rates per 1,000 live births for neonatal, post-neonatal and infant deaths and per 1,000 total (live and still) births for stillbirths and extended perinatal deaths.

Control Charts

Control charts have been used to support interpretation of these data. As numbers of deaths are relatively low, mortality rates tend to fluctuate from month to month just by chance: control charts help differentiate between expected random variation and changes which warrant further investigation.

In this first release of information on stillbirths and infant deaths (1 July 2020), data are shown for January 2017 to May 2020, with the most recent three months (March-May 2020) being those when health and health services may have been affected by COVID-19. In this period the only observations which have reached a ‘warning limit’ as indicated by the relevant control chart were neonatal deaths in March 2020, where the rate was just above the upper warning limit (3.7/1,000 compared to the UWL of 3.6/1,000), but did not breach the upper control limit (the trigger for further investigation). In April and May there were fewer neonatal deaths, and the rate fell to below the upper warning limit. Rates of stillbirths and extended perinatal deaths are being closely monitored, as these approached, but did not breach, the upper warning limit in May 2020.

Data Sources

NRS publishes (external website) information on stillbirths and infant deaths registered in Scotland.

Across the UK, surveillance of perinatal deaths is undertaken by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). The latest MBRRACE-UK perinatal mortality report (external website) (providing information on babies born in 2017) provides background information on factors that influence perinatal deaths.

Within Scotland, the Maternal and Children Quality Improvement Collaborative (MCQIC) (external website) focuses on care quality to improve outcomes for babies, children and their mothers. One of the key outcomes they track is stillbirths.

Immunisations

5 April 2023

PHS have been notified that NHS Grampian now offer the second dose of MMR from 3 years 4 months of age. Data for cohorts becoming eligible in January 2023 for the second dose of MMR will now include NHS Grampian and this will be reflected in the data reported at Scotland and NHS Grampian Health Board level geographies.

2 March 2022

When a cohort becomes eligible for any of the immunisations reported this data will now only be refreshed for the next 12 months; as the data becomes more complete, uptake rates for these cohorts stabilise within this period. Only minor changes to uptake rates are observed if the data is updated monthly beyond 12 months and this is mainly driven by movements into or out of the cohort, such as a child leaving Scotland. Older data will continue to be reported but will no longer be refreshed.

6 October 2021

Information on the uptake of pre-school immunisations was updated in this tool on 6 October and includes information on cohorts eligible for their immunisations to week beginning 9 August 2021. It should be noted that the data recorded for the most recent eligible cohorts will not be fully complete at this stage. This means that immunisation uptake is likely to be under-reported and will be updated as the data becomes more complete.

Please note that going forward the dashboard will continue to be updated on the first Wednesday of each month, but the commentary will only be updated in the case of exceptions. Background information on interpreting the data is provided in the commentary for previous updates below. Information on final achieved uptake will continue to be provided through official statistics publications .

1 September 2021

Information on the uptake of pre-school immunisations was updated in this tool on 1 September and includes information on cohorts eligible for their immunisations to week beginning 5 July 2021.

Background information on interpreting the data is provided in the commentary for previous updates below.

4 August 2021

Information on the uptake of pre-school immunisations was updated in this tool on 4 August and includes information on cohorts eligible for their immunisations to week beginning 7 June 2021.

Background information on interpreting the data is provided in the commentary for previous updates below.

7 July 2021

Information on the uptake of pre-school immunisations was updated in this tool on 7 July. It should be noted that the data recorded for the most recent eligible cohorts will not be fully complete at this stage. This means that immunisation uptake is likely to be under-reported and will be updated as the data becomes more complete.

Uptake of pre-school immunisations has remained high for children who became eligible during the Covid-19 pandemic. Information on final achieved uptake will continue to be provided through official statistics publications .

2 June 2021

Information on the uptake of pre-school immunisations was updated in this tool on 2 June. It should be noted that the data recorded for the most recent eligible cohorts will not be fully complete at this stage. This means that immunisation uptake is likely to be under-reported and will be updated as the data becomes more complete.

5 May 2021

Information on the uptake of pre-school immunisations was updated in this tool on 5 May. Information is provided on children becoming eligible for immunisation during the Covid-19 pandemic (in March 2020 to February 2021) as well as before the pandemic (2019, January 2020, and February 2020). The data downloads include more detailed information, including by Health and Social Care Partnership, and weekly cohorts (note that due to small numbers of children in the Island Boards, results for NHS Orkney, NHS Shetland and NHS Western Isles are presented for monthly and yearly cohorts only).

It should be noted that the data recorded for the most recent eligible cohorts will not be fully complete at this stage. This means that immunisation uptake is likely to be under-reported and will be updated as the data becomes more complete.

7 April 2021

Information on the uptake of pre-school immunisations was updated in this tool on 7 April. The charts and table show annual data for children who became eligible for immunisation in 2019 (before the pandemic) and in this update we have added annual data for children who became eligible in 2020. To ensure the display is not over-crowded we have also reduced the number of monthly cohorts shown in the charts and table to the latest available 6 months (August 2020 to January 2021).

The full data including monthly data for children eligible from January 2020 and weekly data for children eligible up to week beginning 8 February 2021 are available through the data download. In future updates we plan to add drop-down functionality so that users have the option to choose the time-periods to show in the charts and table.

It should be noted that the data recorded for the most recent eligible cohorts, including for 2020, will not be fully complete at this stage. This means that immunisation uptake is likely to be under-reported and will be updated as the data becomes more complete. Data for a few children are not included in the eligible cohort and uptake figures due to an issue in the source data. The impact of this on the reported rates at Scotland level will be minor.

Uptake of pre-school immunisations has remained high for children who became eligible during the Covid-19 pandemic. The data shows that early uptake (achieved by 4 weeks after the children became eligible for their immunisation) was higher in 2020 than in 2019. For detail on some observations in the pattern of uptake during the pandemic see previous commentary. Information on final achieved uptake will continue to be provided through official statistics publications .

3 March 2021

Information on the uptake of pre-school immunisations was updated in this tool on 3 March. Monthly data are provided on children who became eligible during the COVID-19 pandemic (in March 2020 to December 2020) as well as before the pandemic (2019, January 2020 and February 2020). Weekly data are available through the data download, and includes data for children eligible up to week beginning 4 January 2021. It should be noted the immunisation uptake data recorded for the most recent eligible cohorts will not be fully complete at this stage. Data for a few children are not included in the eligible cohort and uptake figures due to an issue in the source data. The impact on the reported rates at Scotland level will be minor.

Although early uptake of each of the vaccines appears noticeably lower for children who became eligible in December 2020 compared with previous months, additional investigation of the 2019 baseline data showed comparable decreases in early uptake were also seen for children who became eligible in December 2019. The data also showed that while early uptake was lower, uptake among children eligible in December 2019 subsequently increased to levels comparable with 2019 as a whole. The decreases in early uptake for children who became eligible in December 2020 are therefore not unusual and are thought to relate to the Christmas holiday period.

Uptake of pre-school immunisations has remained high for children who became eligible during the Covid-19 pandemic. For detail on some observations in the pattern of uptake during the pandemic see previous commentary including 2 September 2020 below. Information on final achieved uptake will continue to be provided through official statistics publications .

3 February 2021

Information on the uptake of pre-school immunisations was updated in this tool on 3 February. Monthly data are provided on children who became eligible during the COVID-19 pandemic (in March 2020 to November 2020) as well as before the pandemic (2019, January 2020 and February 2020). Weekly data are available through the data download, and includes data for children eligible up to week beginning 7 December 2020. It should be noted the immunisation uptake data recorded for the most recent eligible cohorts will not be fully complete at this stage.

The data issue affecting the figures in the previous release appears to be resolved, with further checks on the data ongoing (see commentary for 23 December 2020 below).

23 December 2020

Information on the uptake of pre-school immunisations was updated in this tool on 23 December. Monthly data are provided on children who became eligible during the COVID-19 pandemic (in March 2020 to September 2020) as well as before the pandemic (2019, January 2020 and February 2020). Weekly data are no longer shown in the charts and tables but are available through the data download, and includes data for children eligible up to week beginning 19 October 2020. It should be noted the immunisation uptake data recorded for the most recent eligible cohorts will not be fully complete at this stage.

In this update some uptake rates are slightly under-reported; this is due to an issue this month with the source data which has affected the accuracy of the eligible cohort data for all time-periods. At Scotland level the monthly and weekly uptake rates are thought to be under-reported by -0.1 to -1.0 %. The impact on some NHS Board and Health & Social Care Partnership rates will be greater. It is anticipated the data issue will have been corrected in the next planned update of the dashboard on 3 February 2020.

4 November 2020

In this release of information on uptake of pre-school immunisations data have been updated to include children who became eligible until early September.

7 October 2020

In this release of information on uptake of pre-school immunisations data have been updated to include children who became eligible until early August. The overall trends described in the commentary for 2 September 2020 below continue to apply.

2 September 2020

Information on uptake of pre-school immunisations was updated in this tool on 2 September. The updated data show that uptake of pre-school immunisations for children who became eligible during March 2020 was maintained at a similar level to that seen before the Covid-19 pandemic (children becoming eligible in 2019 and early 2020). Early uptake for children becoming eligible for their immunisation more recently (April 2020 through to early July 2020) has increased, and is now noticeably higher than that seen before the pandemic.

The data also show that the increase in early uptake of immunisations seen from April 2020 onwards has been seen for children from all deprivation levels. For the 3 doses of the 6-in-1 immunisation, the recent increase in early uptake has been highest in children from the most deprived areas, resulting in a reduction in inequality in early uptake for these immunisations. For the 2 doses of the MMR immunisation, the recent increase in early uptake has been broadly similar across deprivation groups.

As discussed in the previous commentary below, there are a number of likely reasons for the recent improvement in early uptake of pre-school immunisations. These include increased awareness among parents of the importance of immunisation reinforced by national communications to encourage attendance, as well as local communications and new processes introduced in response to the pandemic. For example, immunisation teams in some NHS Boards have recently been phoning parents/carers shortly before the day of appointment to ensure families are free of symptoms of Covid-19 before attending, reassure them, and answer questions.

Although recent improvements in early immunisation uptake rates are evident, often among children living in the most deprived areas in particular, it is too soon to determine whether this early improvement will translate into improved final uptake and a reduction in the inequalities gap when measured at later ages. Information on final achieved uptake will continue to be provided through official statistics publications .

12 August 2020

Information on uptake of pre-school immunisations was updated in this tool on 12 August (and new information was added to the data download function on uptake in Health and Social Care Partnerships and in the Island NHS Boards). The updated data show that uptake of pre-school immunisations for children who became eligible during March 2020 was maintained at a similar level to that seen before the Covid-19 pandemic (children becoming eligible in 2019 and early 2020). Early uptake for children becoming eligible for their immunisation more recently (April 2020 through to early June 2020) has increased, and is now noticeably higher than that seen before the pandemic.

New information on uptake of pre-school immunisations for children living in areas with different levels of deprivation (Scotland level only) was also added to this tool on 12 August. Early uptake (achieved by 4 weeks after the children became eligible for their immunisation) is considered, as this indicator is available for the most recent cohorts of children as well as the baseline 2019 cohort. The data show that before the Covid-19 pandemic, children living in the most deprived areas of Scotland were less likely to have received their pre-school immunisations within 4 weeks of becoming eligible than children living in the least deprived areas.

The new data show that the increase in early uptake of immunisations seen from April 2020 onwards has been seen for children from all deprivation levels. For the 3 doses of the 6-in-1 immunisation, the recent increase in early uptake has been highest in children from the most deprived areas, resulting in a reduction in inequality in early uptake for these immunisations. For the 2 doses of the MMR immunisation, the recent increase in early uptake has been broadly similar across deprivation groups.

8 July 2020

On 8 July, information on uptake of the first and second doses of MMR vaccine was added to the tool.

The first dose of MMR vaccine is offered from 12 months of age at the immunisation appointment scheduled at 12-13 months. Data before the pandemic, for children eligible (turning 12 months) in 2019 show that uptake in Scotland was 65.4% by the time children turned 13 months old. Uptake rates by 13 months were maintained for children eligible in March 2020 and have increased for children eligible in April and early May 2020, with uptake in each of the latest 4 weeks exceeding 75%. This means in April and early May, more children than usual received their immunisation soon after they first became eligible, indicating fewer non-attendances at, or postponements of, scheduled appointments.

There are a number of likely reasons for this improved early uptake, including increased awareness among parents of the importance of immunisation reinforced by national communications to encourage attendance, as well as local communications and new processes introduced in response to the pandemic. For example, immunisation teams in some NHS Boards have recently been phoning parents/carers shortly before the day of appointment to ensure families are free of symptoms of Covid-19 before attending, reassure them, and answer questions. Although more children received the first dose of MMR immunised by 13 months of age, it is too early to determine whether this will result in any increase in the uptake of the vaccine at 16 months of age, as measured in the tool, or later when measured at the standard reporting age of 2 years in the routinely published statistics .

The second dose of MMR vaccine is offered at 3 year 4 months. Data before the pandemic, for children eligible in 2019 show that uptake was 52.0% by 3 years 5 months. There was a small decrease in uptake rates by 3 years 5 months for children eligible for immunisation in March 2020 to 49.6%. However, as seen for the first dose of MMR, early uptake rates (by 3 years 5 months) have since increased for children eligible in April and early May 2020, with uptake in each of the latest 3 weeks exceeding 60%.

This release also includes updated uptake data on each of the doses of the 6-in-1 vaccine, offered at 8, 12 and 16 weeks, to include children eligible in each week in April and early May 2020. Uptake of each of the doses have been maintained throughout the pandemic. For children eligible in April and early May, the pattern of more children than usual receiving their immunisations soon after becoming eligible, is also observed, most notably for the third dose of vaccine, although the effect is less pronounced than was observed for the MMR immunisations. This is because uptake within 4 weeks of becoming eligible is already high for immunisations offered at the earliest ages, as shown in the data before the pandemic. Doses of vaccine which are routinely offered later in schedule of childhood immunisations take longer to reach the high levels of uptake compared to the immunisations offered at the first appointment due to the cumulative effect of missed appointments, and the need to have appropriate intervals between receiving doses of vaccine.

17 June 2020

Information on the uptake of immunisations that are routinely offered to all preschool children (external website) has been included in this tool for the first time on 3 June 2020.
Immunisation protects children against many serious infectious diseases including diphtheria, whooping cough, and measles. Immunisation services throughout Scotland are continuing during the Covid-19 pandemic (external website) . It is important to maintain the best possible immunisation uptake rates to ensure children remain protected and to prevent a resurgence of these infections. Including information on childhood immunisation rates in this tool will help us to ensure that immunisation rates remain high throughout the pandemic.

The 6-in-1 vaccine is given to babies at 8, 12 and 16 weeks of age. The vaccine protects against diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib) and Hepatitis B.

On 3 June 2020, information was provided on the uptake of the first dose of the 6-in-1 vaccine, offered at 8 weeks of age. This showed uptake continues to exceed 90% among children who were due their first dose of the 6-in-1 vaccine in March and early April.

On 17 June, information on the uptake of the second and third doses was added to the tool. The second dose of 6-in-1 vaccine is offered at 12 weeks of age. Data before the pandemic, for children eligible in 2019, show that uptake of the second dose by 16 weeks was 84.5%. Uptake by 16 weeks continues to exceed 80% among children who were due their second dose of the 6-in-1 vaccine in March and early April.

The third dose of 6-in-1 vaccine is offered at 16 weeks of age. Data before the pandemic, for children eligible in 2019, show that uptake of the third dose by 20 weeks was 72.3%. Uptake by 20 weeks continues to exceed 70% among children who were due their third dose of the 6-in-1 vaccine in March and early April.

It is important to note that uptake of the second and third doses take longer to reach 90% and above compared to the first dose, as demonstrated by the data on uptake before the pandemic. This is because some children receive the first dose later than when first offered the vaccine, for example due to missed appointments. As each dose of vaccine is offered 4 weeks apart, missed appointments has a cumulative effect in increasing the time it takes for uptake of the second and third doses to reach and exceed 90%.

3 June 2020

On 3 June 2020, information has been provided on the uptake of the first dose of the 6-in-1 vaccine, which is offered to children at 8 weeks of age. The vaccine protects against diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib) and Hepatitis B. Children should also receive a second dose of the vaccine at 12 weeks and a third dose at 16 weeks.

Uptake rates for this immunisation have remained high during the pandemic. Uptake continues to exceed 90% among children who were due their first dose of the 6-in-1 vaccine in March and early April. The recording of data on immunisations given by the reporting date will not be fully complete at this stage, particularly for the most recent cohorts, so uptake rates are slightly under-reported. In addition, some children will receive the vaccine at a later age, for example due to missed or rescheduled appointments, so uptake rates are expected to continue to increase as children age (as shown in the 2019 data provided for comparison).

Child health reviews

1 June 2023

An issue has been identified with the HSCP data on child health review coverage for the years 2021 and 2022, which is available via the data download function. The percentages are displaying correctly but the numbers are showing as exactly double what they should be. The NHS Board and Scotland level data is unaffected. This issue has affected the data in the April 23 and May 23 updates but has now been resolved. We apologise for any inconvenience this may have caused.

1 September 2021

Information on uptake of pre-school child health reviews was updated in this tool on 1 September, and includes information on children becoming eligible for review up to June 2021. Background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

Please note that going forward the dashboard will continue to be updated on the first Wednesday of each month, but the commentary will only be updated in the case of exceptions.

4 August 2021

Information on uptake of pre-school child health reviews was updated in this tool on 4 August, and includes information on children becoming eligible for review up to May 2021. Background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

7 July 2021

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 7 July. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to April 2021) as well as before the pandemic (2019, January 2020, and February 2020). The month and year time periods for which data is shown in the chart and table is now selectable using “Step 3. Select time periods of interest.” The data downloads include more detailed information, including by Health and Social Care Partnership, and weekly cohorts (note that due to small numbers of children in the Island Boards, results for NHS Orkney, NHS Shetland and NHS Western Isles are presented for monthly and yearly cohorts only).

Findings

For the later child health reviews, which have a much longer timeframe for reviews to be delivered, particularly the 4-5 year review, it will take some time for final achieved coverage to be known. Information on final achieved coverage will continue to be provided through PHS official statistics publications .

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

2 June 2021

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 2 June. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to March 2021) as well as before the pandemic (2019, January 2020, and February 2020). The month and year time periods for which data is shown in the chart and table is now selectable using “Step 3. Select time periods of interest.” The data downloads include more detailed information, including by Health and Social Care Partnership, and weekly cohorts (note that due to small numbers of children in the Island Boards, results for NHS Orkney, NHS Shetland and NHS Western Isles are presented for monthly and yearly cohorts only).

Findings

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

5 May 2021

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 5 May. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to February 2021) as well as before the pandemic (2019, January 2020, and February 2020). Due to the volume of data available, the charts and table now show annual data for children who became eligible for review in 2019 and 2020, and monthly data for children who became eligible for review in the most recent 6 months for which data are available. The data downloads include more detailed information, including by Health and Social Care Partnership, and weekly cohorts (note that due to small numbers of children in the Island Boards, results for NHS Orkney, NHS Shetland and NHS Western Isles are presented for monthly and yearly cohorts only).

Findings

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

7 April 2021

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 7 April. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to January 2021) as well as before the pandemic (2019, January 2020, and February 2020). Due to the volume of data available, the charts and table now show annual data for children who became eligible for review in 2019 and 2020, and monthly data for children who became eligible for review in the most recent 6 months for which data are available. The data downloads include more detailed information, including by Health and Social Care Partnership, and weekly cohorts (note that due to small numbers of children in the Island Boards, results for NHS Orkney, NHS Shetland and NHS Western Isles are presented for monthly and yearly cohorts only).

Data for a small number children are not included in the eligible cohort and coverage figures due to an issue in the source data. The impact on the reported rates at Scotland level will be minor.

Findings

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

3 March 2021

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 3 March. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to December 2020) as well as before the pandemic (2019, January 2020, and February 2020). Weekly data are no longer shown in the charts and tables but are available through the data download, and includes data for children eligible up to week beginning 4 January 2021. It should be noted that the coverage data recorded for the most recent eligible cohorts will not be fully complete at this stage. Data for a few children are not included in the eligible cohort and coverage figures due to an issue in the source data. The impact on the reported rates at Scotland level will be minor.

Findings

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

3 February 2021

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 3 February. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to November 2020) as well as before the pandemic (2019, January 2020, and February 2020). Weekly data are no longer shown in the charts and tables but are available through the data download, and includes data for children eligible up to week beginning 7 December 2020. It should be noted that the coverage data recorded for the most recent eligible cohorts will not be fully complete at this stage.

Data quality

The data issue affecting the figures in the previous release appears to be resolved, with further checks on the data ongoing (see commentary for 23 December 2020 below).

Findings

Coverage of the Health Visitor first visit has remained high for children becoming eligible throughout the pandemic, with more than 95% of babies receiving their review by 6 weeks of age. Coverage of the 6-8 week review (at 10 weeks), was 6 percentage points lower in March 2020 than in 2019, but in subsequent months coverage has been similar to the previous year. For the older age group reviews, an impact on coverage is apparent for children who became eligible in March and April 2020. There is some evidence of ‘catch-up’, with coverage for these cohorts improving with time, however coverage to date still lags behind 2019 levels for these months. For children becoming eligible from May to September 2020, coverage to date for the 13-15 month review is slightly higher than the 2019 level, and for the 27-30 month review is slightly lower. Although, for the later child health reviews, which have a much longer timeframe for reviews to be delivered, particularly the 4-5 year review, it will take some time for final achieved coverage to be known. Information on final achieved coverage will continue to be provided through PHS official statistics publications.

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

23 December 2020

What is reported?

Information on uptake of pre-school child health reviews was updated in this tool on 23 December. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to September 2020) as well as before the pandemic (2019, January 2020, and February 2020). Weekly data are no longer shown in the charts and tables but are available through the data download, and includes data for children eligible up to week beginning 19 October 2020. It should be noted that the coverage data recorded for the most recent eligible cohorts will not be fully complete at this stage.

Data quality

In this update some coverage rates are slightly under-reported; this is due to an issue this month with the source data which has affected the accuracy of the eligible cohort data for all time-periods. At Scotland level the monthly and weekly coverage rates are thought to be under-reported by -0.1 to -1.0 %. The impact on some NHS Board and Health & Social Care Partnership rates will be greater. It is anticipated the data issue will have been corrected in the next planned update of the dashboard on 3 February 2020.

It should also be noted that NHS Greater Glasgow & Clyde have a backlog of 13-15 month, 27-30 month, and 4-5 year reviews to be entered into CHSP due to staffing shortages. Entry of the first visit and 6-8 week review data has been prioritised, so these are up-to-date.

Findings

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

4 November 2020

Information on uptake of pre-school child health reviews was updated in this tool on 4 November. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to August 2020) as well as before the pandemic (2019, January 2020, and February 2020). Information has now been added at Health & Social Care Partnership level and this available through the data download function. Weekly data are no longer shown in the charts but are available through the data download.

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

7 October 2020

Information on uptake of pre-school child health reviews was updated in this tool on 7 October. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to early August 2020) as well as before the pandemic (2019, January 2020, and February 2020).

Coverage of the Health Visitor first visit has remained high for children becoming eligible during the pandemic, with more than 95% of babies receiving their review by 6 weeks of age. Coverage of all other reviews was lower for children who became eligible in March and April 2020, than in 2019. Recent data show that rates are recovering in the majority of NHS Boards, with coverage for the 6-8 week and 13-15 month reviews returning to pre-pandemic levels by May 2020. For the later child health reviews, which have a much longer timeframe for reviews to be delivered, particularly the 4-5 year review, it will take some time for final achieved coverage to be known. There is some evidence of ‘catch-up’, with coverage for March and April improving with time, and in some boards coverage in May and June exceeds pre-pandemic levels. Information on final achieved coverage will continue to be provided through PHS official statistics publications .

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

2 September 2020

Information on uptake of pre-school child health reviews was updated in this tool on 2 September. Information is provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to early July 2020) as well as before the pandemic (2019, January 2020, and February 2020).

Coverage of the Health Visitor first visit has remained high for children becoming eligible during the pandemic, with more than 95% of babies receiving their review by 6 weeks of age. Coverage of all other reviews had fallen for children eligible since March 2020. Recent data show that rates are beginning to recover in most, but not all, NHS Boards. There is some evidence of ‘catch-up’, with coverage for March and April improving with time, but this has still not reached the levels achieved in 2019. For the later child health reviews, which have a much longer timeframe for reviews to be delivered, particularly the 4-5 year review, it will take some time for final achieved coverage to be known. Information on final achieved coverage will continue to be provided through official statistics publications.

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

12 August 2020

Information on uptake of pre-school child health reviews was updated in this tool on 12 August. Information is now provided on children becoming eligible for a review during the Covid-19 pandemic (in March 2020 to early June 2020) as well as before the pandemic (2019, January 2020, and February 2020).

Further background information on interpreting the data is provided in the commentary for 8 and 15 July 2020 below.

15 July 2020

Information on coverage of the 4-5 year review was included for the first time on 15 July 2020. Data from before the pandemic, for children becoming eligible in 2019, show that coverage of the 4-5 year review by 49 months was 11%, rising to 29% by 52 months. Coverage continues to increase as children age beyond this point. Overall coverage for children eligible in 2019 was 52% by the time data was extracted for analysis (22 June 2020). This is a fairly new review, which has actually not been implemented in all board areas yet (no data is shown for NHS Dumfries & Galloway as they implemented the review in May 2020, and NHS Highland are scheduled to implement the review on 3 August 2020) and Government policy states that this review should be offered to all children turning 4 years old from April 2020 onwards. Therefore, we expect the baseline for 2019 to be low for this review as it is still becoming established. However, data for children eligible in January and February 2020 show that coverage was gradually beginning to rise before it fell in March 2020, and weekly data for April shows coverage by 49 months is between 5-9%. These children have not yet reached 52 months of age, and we would expect coverage to increase over time.

In general, the impact of the Covid-19 pandemic on early coverage of the 4-5 year review has been very variable between Boards. Coverage has been well maintained in some areas, but is very low for children becoming eligible for review during the pandemic in other areas. In areas showing low coverage, this may be due to Health Visitors prioritising the earlier reviews (first visit and 6-8 weeks). In addition, national guidance (external website) during the pandemic has recommended that the earlier reviews (first visit, 6-8w) should continue as face to face contacts whereas the later reviews (13-15m, 27-30m, 4-5 yr) should also continue, but be provided via NHS near-me (a secure video conferencing facility) or telephone where possible. In some NHS Board areas this remote delivery of reviews has not been possible, and this is reflected in the data.

8 July 2020

Information on the uptake of child health reviews that are routinely offered to all preschool children by Health Visitors was included in this tool for the first time on 10 June 2020. Child health reviews incorporate assessment of children's health, development, and wider wellbeing alongside provision of health promotion advice and parenting support. Routine child health reviews help ensure that children’s health and development is progressing as expected for their age and stage, and allow any concerns to be addressed. It is important that children continue to receive their routine health reviews during the Covid-19 pandemic. On 10 June 2020, information was provided on the coverage of the Health Visitor first visit, which is offered to children at 10-14 days of age. Coverage of the 6-8 week review was added on 24 June, and coverage of the 13-15 month and 27-30 month review were added on 8 July (and data for the first visit and 6-8 week review were also updated).

Coverage rates for the Health Visitor first visit have remained high during the pandemic. Coverage continues to exceed 90% among children who were due their review in March and April.

Data from before the pandemic, for children becoming eligible in 2019, show that coverage of the 6-8 week review by 10 weeks was 83%. Coverage has gradually fallen since the beginning of 2020, and was around 69-77% for children becoming eligible for the review in March and April.

There are a number of important factors to take into account when interpreting this information. Unlike all the other pre-school child health reviews, the 6-8 week review is a two stage process involving the baby’s Health Visitor and their GP. Usually, the Health Visitor first visits the family at home to conduct a general assessment of the baby’s progress and the family’s wellbeing. Then, the GP offers an appointment in the practice to conduct a detailed physical examination of the baby. Usually the GP appointment happens shortly after the Health Visitor visit, and the data from both assessments is then returned together to the NHS Board child health administrative department for entry into the CHSP-PS system. Since the start of the Covid-19 pandemic, Scottish Government policy has been that the 6-8 week review should continue to be provided. In practice, to minimise the number of times babies are brought into the practice, in some areas the GP element of the review may have been deferred, for example until the baby is due a routine immunisation appointment at a later stage. Areas may then vary in terms of whether Health Visitors return information on their part of the 6-8 week review for entry into the baby’s CHSP-PS record, or whether no information is returned until the GP part of the review is completed. As GPs start to ‘catch up’ with their part of outstanding 6-8 week reviews, we would expect to see coverage rates for children becoming eligible for this review during the pandemic increasing. It is important to note therefore that no record of a 6-8 week review on the CHSP-PS system does not necessarily mean that the baby has not been seen at all: they may have been visited by their Health Visitor, but not yet examined by their GP.

For babies born prematurely, the 6-8 week review is offered to children 6-8 weeks following their expected date of delivery rather than their actual date of birth. This is to ensure a ‘fair’ assessment of children’s progress against what would be expected of a baby at that stage. As the information shown in the dashboard is based on children’s actual date of birth rather than due dates, premature babies will appear to have their review ‘late’, when in fact it was offered appropriately. This partially accounts for why coverage of the 6-8 week review continues to increase as babies attain older ages. Finally, it should also be restated that we have allowed a 6 week window for review completion and data entry, that is we have reported on reviews provided to children becoming eligible for their reviews up to 6 weeks prior to the date we extracted data from the CHSP-PS system. The results of a completed review would generally be expected to be entered into the CHSP-PS system within this 6 week time frame. In practice however occasional data entry delays occur. These may be worse during the Covid-19 pandemic, and may vary between areas. For all these reasons, review coverage for the most recent cohorts should therefore be taken as provisional, and is likely to increase over time as relevant data accumulates.

Data for the 13-15 month review show that 41% of children becoming eligible for review in 2019 had received their review by 14 months, rising to 81% by 17 months. Coverage continues to increase as children age beyond this point. Overall coverage for children eligible in 2019 was 84% by the time data was extracted for analysis (22 June 2020). Early coverage of the 13-15 month review was noticeably lower for children becoming eligible during the Covid-19 pandemic. Among children eligible in March and April 2020, 26-35% had received their review by 14 months. These children have not yet reached 17 months of age, and we would expect coverage to increase over time.

Data for the 27-30 month review show that 33% of children becoming eligible for review in 2019 had received their review by 28 months, rising to 81% by 31 months. Coverage continues to increase as children age beyond this point. Overall coverage for children eligible in 2019 was 90% by the time data was extracted for analysis (22 June 2020). Early coverage of the 27-30 month review was noticeably lower for children becoming eligible during the Covid-19 pandemic. Among children eligible in March and April 2020, 20-26% had received their review by 28 months. These children have not yet reached 31 months of age, and we would expect coverage to increase over time. It should be noted that NHS Greater Glasgow & Clyde have a different policy for calling children for this review: they call at 30 months rather than 27 months as in the rest of Scotland. Hence, coverage by 28 months for children in NHS Greater Glasgow & Clyde is very low: this also affects the overall figures for Scotland as NHS GG&C is a large Board.

In general, the impact of the Covid-19 pandemic on early coverage of the 13-15 month and 27-30 month reviews has been very variable between Boards. Coverage has been well maintained in some areas, but is very low for children becoming eligible for review during the pandemic in other areas. In areas showing low coverage, this may be due to Health Visitors prioritising the earlier reviews (first visit and 6-8 weeks). In addition, national guidance (external website) during the pandemic has recommended that the earlier reviews (first visit, 6-8w) should continue as face to face contacts whereas the later reviews (13-15m, 27-30m) should also continue, but be provided via NHS near-me (a secure video conferencing facility) or telephone where possible. In some NHS Board areas this remote delivery of reviews has not been possible, and this is reflected in the data.

Breastfeeding

1 September 2021

Information on breastfeeding has been updated in this tool on 1 September 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old. Data is shown by month of review from January 2019 to June 2021. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

Please note that going forward the dashboard will continue to be updated on the first Wednesday of each month, but the commentary will only be updated in the case of exceptions.

4 August 2021

Information on breastfeeding has been updated in this tool on 4 August 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old. Data is shown by month of review from January 2019 to May 2021. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

7 July 2021

Information on breastfeeding has been updated in this tool on 7 July 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to April 2021, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information at Health & Social Care Partnership level is available in the data download function.

At Scotland level, the data show that there was a small increase in the overall proportion of babies recorded as having been breastfed at both the Heath Visitor first visit, and 6-8 week review in the early months of the pandemic, but this now appears to have fallen back to pre-pandemic levels.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

2 June 2021

Information on breastfeeding has been updated in this tool on 2 June 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to March 2021, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information at Health & Social Care Partnership level is available in the data download function.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

5 May 2021

Information on breastfeeding has been updated in this tool on 5 May 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to February 2021, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information at Health & Social Care Partnership level is available in the data download function.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

7 April 2021

Information on breastfeeding has been updated in this tool on 7 April 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to January 2021, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information at Health & Social Care Partnership level is available in the data download function.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

3 March 2021

Information on breastfeeding has been updated in this tool on 3rd March 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to December 2020, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information is shown at Health & Social Care Partnership level, but this is only available in the data download function.

At Scotland level, the data show that the small increase in the overall proportion of babies recorded as having been breastfed has been maintained through to December 2020, for both the Heath Visitor first visit, and 6-8 week review.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

3 February 2021

Information on breastfeeding has been updated in this tool on 3rd February 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to November 2021, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information is shown at Health & Social Care Partnership level, but this is only available in the data download function.

At Scotland level, the data show that the small increase in the overall proportion of babies recorded as having been breastfed has been maintained through to November 2020, for both the Heath Visitor first visit, and 6-8 week review.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

23 December 2020

Information on breastfeeding has been updated in this tool on 23rd December 2020. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to September 2020, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information is shown at Health & Social Care Partnership level, but this is only available in the data download function.

At Scotland level, the data show that the small increase in the overall proportion of babies recorded as having been breastfed has been maintained through to September 2020, for both the Heath Visitor first visit, and 6-8 week review.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

4 November 2020

Information on breastfeeding has been updated in this tool on 4th November 2020. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown by month of review from January 2019 to August 2020, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

Information is now included for NHS Grampian, as their data recording issues have now been resolved. Information is also shown at Health & Social Care Partnership level, but this is only available in the data download function.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

30 September 2020

Information on breastfeeding has been included in this tool for the first time on 30 September 2020. This is based on data recorded at child health reviews undertaken by health visiting teams when babies are 10-14 days (Health Visitor [HV] First Visit) and 6-8 weeks old.

Data is shown on breastfeeding initiation (has the child ever been breastfed), and the child’s breastfeeding status over the 24 hours prior to their child health review (exclusive breastfeeding and overall breastfeeding [includes mixed breast and formula feeding]).

Data is shown by month of review from January 2019 to July 2020, so comparisons can be made for babies receiving their reviews before and during the COVID-19 pandemic.

At Scotland level, there was a small increase in the proportion of babies recorded at their HV First Visit as ever having been breastfed, and as still receiving some breastfeeding, in April and May 2020 (babies born March/April/May). For example, 56% of babies having their HV First Visit in April 2020 were recorded as overall breastfed, compared to the pre-pandemic average of 52%. Similarly, there was a small increase in the proportion of babies recorded at their 6-8 week review as still receiving breastfeeding in May 2020 (babies born March/April). Breastfeeding rates have returned to previous average levels for babies receiving their HV First Visit and 6-8 week review from June 2020 onwards.

The proportion of babies receiving a HV First Visit (and having their review record entered into the CHSP-PS electronic system) is usually very high (>95%) and this has been well maintained during the COVID-19 pandemic. The proportion of babies receiving a 6-8 week review is also usually high (>90% if sufficient follow up time allowed) and this has been reasonably well maintained during the COVID-19 pandemic in most, but not all, NHS Board areas. This can be seen by examining the number of HV First Visits and 6-8 week reviews provided month by month on the Breastfeeding page of this tool, and through the more detailed data provided on review coverage on the Child Health Reviews page.

This means that the trends seen in the proportion of babies recorded as being breastfed are likely to be real, rather than the result of changes in data recording. A temporary increase in breastfeeding rates for babies born during the first wave of the COVID-19 pandemic in Scotland may reflect women having more time to initiate and maintain breastfeeding during lockdown due to fewer competing demands on their time, for example through reduced visits from friends and family.

Child development

6 April 2022

Information on child development has been updated on 6 April 2022 to include information on reviews undertaken up to January 2022. This is based on child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

In this release, information is provided for the first time on the percentage of children with developmental concerns by developmental domain (examples of development domains include vision, fine motor skills and personal/social development). This information has been added in response to the rise in the percentage of children with one or more developmental concerns observed in 2021, as noted in the commentary below for November and December 2021. These data are provided at Scotland level only due to small numbers in some domains in individual Health Boards. More information on developmental domains and how they are assessed is provided in the annual, Early Child Development report produced by PHS.

In January 2022 the most frequent domain in which there was a concern about development at 13-15 months was gross motor skills (5.6% of children reviewed), and at 27-30 months was speech, language and communication (12.0% of children reviewed). Formal analysis of trends and change is not presented here, however the proportion of children at 13-15 months with a documented concern about speech, language and communication in 2021 appears higher than that observed in 2019 and 2020. Likewise at 27-30 months the proportion of children identified with concerns about development in the speech, language & communication, emotional/behavioural, personal/social, and problem solving domains appears higher in 2021 than in the previous two years.

PHS will continue to provide monthly monitoring of these data, and the next annual report with detailed analysis by developmental domain and population group for children eligible for review in 2020/21 will be published on 26th April 2022.

1 December 2021

Information on child development has been updated on 1st December 2021 to include information on reviews undertaken up to September 2021. This is based on child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

As reported last month, the percentage of children who are reported to have a concern in at least one developmental domain remains above the pre-pandemic centreline for both reviews. In September 2021 11.8% of children reviewed at 13-15 months of age had a concern documented, compared with a pre-pandemic baseline of 9.6%. At 27-30 months 18.7% of children reviewed had a concern documented, compared with a pre-pandemic baseline of 14.6%.

In this release, information is provided for the first time on the percentage of children with at least one developmental concern, by socioeconomic deprivation (as measured by Scottish Index of Multiple Deprivation (SIMD) of area of residence). Annual reporting of data on child development has previously demonstrated that a higher proportion of children living in more deprived areas are identified as having developmental concerns, than those in less deprived areas. The data in this release show that, at 27-30 months, an increase in the percentage of children with at least one developmental concern has been observed across all deprivation groups. There remains a steep socioeconomic gradient; in September 2021, 27.4% of children in the most deprived areas had a least one concern, compared with 13.7% in the least deprived areas. At 13-15 months the recent changes among deprivation groups are less clear. This is likely, in part, to be due to the adoption, in May 2019, of this review in NHS Greater Glasgow and Clyde, which contains a substantial proportion of children who live in more deprived areas in Scotland.

The commentary below includes potential reasons for the recent observed changes; PHS will continue to provide monthly monitoring of these data, and a full annual report with more detailed analysis by developmental domain and population group will be published in April 2022.

3 November 2021

Information on child development has been updated on 3rd November 2021 to include information on reviews undertaken in August 2021. This is based on child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

This release shows that there has been a recent increase in the percentage of children reviewed who are reported to have a concern in at least one developmental domain. In August 2021 12.6% of children reviewed at 13-15 months of age had a concern documented, compared with a pre-covid baseline of 9.6%. At 27-30 months 19.3% of children reviewed had a concern documented, compared with a pre-covid baseline of 14.6%. Both measures have been consistently above the expected level since February 2021, suggesting that these findings are less likely to be due to chance variation alone.

A number of factors may influence these data. They may reflect a true change in the proportion of children who are experiencing developmental delay or disorders in this period. Public Health Scotland is working to understand the impact of the COVID-19 pandemic on younger children and their families, through the COVID-19 early years resilience and impact survey ( CEYRIS ). The findings from CEYRIS help to identify areas for action to support the health, wellbeing and development of children. In addition, changes in the data may reflect changes in the way child health reviews are undertaken and reported. It appears that such changes may contribute to the findings in some health board areas. However, the sustained nature and consistency of the finding across several areas, in combination with a quite consistent proportion of reviews having full meaningful information recorded, suggests that there are likely to be common contributing factors.

PHS will continue to provide monthly monitoring of these data, and a full annual report with more detailed analysis by developmental domain and population group will be published in April 2022.

1 September 2021

Information on child development has been updated on 1 September 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown by month of review from January 2019 to June 2021. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

Please note that going forward the dashboard will continue to be updated on the first Wednesday of each month, but the commentary will only be updated in the case of exceptions.

4 August 2021

Information on child development has been updated on 4 August 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown by month of review from January 2019 to May 2021. Background information on interpreting the data is provided in the commentary for 30 September 2020 below.

7 July 2021

What is reported?

Information on child development has been updated on 7 July 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown on the proportion of children with 1 or more developmental concern recorded on their child health review record. Data is also shown on the overall number of reviews provided, and on the number of reviews with full meaningful data recorded for every development domain.

Data is shown by month of review from January 2019 to April 2021, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

Data quality

The proportion of reviews which have meaningful data recorded for all development domains was substantially lower in April and May 2020, than the level seen in 2019. Data from more recent months show that this has improved, with full meaningful data recording returning to around 90% for both reviews in autumn 2020.

Findings

At Scotland level, the data show that the proportion of children having at least one developmental concern documented remain similar to pre-pandemic levels, having been much lower in April 2020. This drop was associated with the reduction in complete data recording, and is likely to reflect changes in ascertainment of developmental concerns (either identification or recording).

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

2 June 2021

What is reported?

Information on child development has been updated on 2 June 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown on the proportion of children with 1 or more developmental concern recorded on their child health review record. Data is also shown on the overall number of reviews provided, and on the number of reviews with full meaningful data recorded for every development domain.

Data is shown by month of review from January 2019 to February 2021, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

Data quality

Findings

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

5 May 2021

What is reported?

Information on child development has been updated on 5 May 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown on the proportion of children with 1 or more developmental concern recorded on their child health review record. Data is also shown on the overall number of reviews provided, and on the number of reviews with full meaningful data recorded for every development domain.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

Data quality

Findings

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

7 April 2021

What is reported?

Information on child development has been updated on 7 April 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown on the proportion of children with 1 or more developmental concern recorded on their child health review record. Data is also shown on the overall number of reviews provided, and on the number of reviews with full meaningful data recorded for every development domain.

Data is shown by month of review from January 2019 to January 2021, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

Data quality

Findings

At Scotland level, the data show that the proportion of children having at least one developmental concern documented remain similar to the levels observed in 2019, having been much lower in April 2020. This drop was associated with the reduction in complete data recording, and is likely to reflect changes in ascertainment of developmental concerns (either identification or recording).

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

3 March 2021

What is reported?

Information on child development has been updated on 3rd March 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old. Data is shown on the proportion of children with 1 or more developmental concern recorded on their child health review record. Data is also shown on the overall number of reviews provided, and on the number of reviews with full meaningful data recorded for every development domain.

Data is shown by month of review from January 2019 to December 2020, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

Data quality

Findings

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

3 February 2021

Information on child development has been updated on 3rd February 2021. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old.

Data is shown on the proportion of children with 1 or more developmental concern recorded on their child health review record. Data is also shown on the overall number of reviews provided, and on the number of reviews with full meaningful data recorded for every development domain.

Data is shown by month of review from January 2019 to November 2020, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

At Scotland level, the data show that the proportion of children having at least one developmental concern documented has returned towards almost the levels observed in 2019, having been much lower in April 2020. This supports the interpretation that the observed lower levels in April 2020 were most likely to be attributable to changes in ascertainment of developmental concerns (either identification or recording).

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

23 December 2020

Information on child development has been updated on 23rd December 2020. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old.

Data is shown by month of review from January 2019 to September 2020, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards. It should also be noted that NHS Greater Glasgow & Clyde have a backlog of 13-15 month and 27-30 month reviews to be entered into CHSP due to staffing shortages, so numbers will increase in subsequent updates.

Data is available at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

At Scotland level, the data show that the proportion of children having at least one developmental concern documented has returned towards the levels observed in 2019, having been much lower in April 2020. This supports the interpretation that the observed lower levels in April 2020 were most likely to be attributable to changes in ascertainment of developmental concerns (either identification or recording).

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

4 November 2020

Information on child development has been updated on 4th November 2020. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old.

Data is shown by month of review from January 2019 to August 2020, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards. Data for NHS Grampian has now been included as their data entry issues have now been resolved.

Data has been added at Health & Social Care Partnership (HSCP) level, but this is only available through the data download function.

Further background information on interpreting the data is provided in the commentary for 30 September 2020 below.

30 September 2020

Information on child development has been included in this tool for the first time on 30th September 2020. This is based on data recorded at child health reviews undertaken by health visiting teams when children are 13-15 months and 27-30 months old.

Data is shown by month of review from January 2019 to July 2020, so comparisons can be made for children receiving their reviews before and during the COVID-19 pandemic. For the 13-15 month review specifically, no data is available for the period January to April 2019 for NHS Greater Glasgow & Clyde, as this review has only been delivered in NHS GG&C from May 2019 onwards. This means that information for ‘Scotland’ excludes NHS GG&C for January to April 2019, and includes NHS GG&C for May 2019 onwards. ‘Scotland’ also excludes NHS Grampian for the whole time period shown, due to problems with entry of data into the CHSP-PS system in Grampian during the COVID-19 pandemic.

At Scotland level, the proportion of children recorded at their 13-15 month review as having at least one developmental concern fell in March and April 2020 before returning to pre-pandemic levels by May 2020. A similar, but more pronounced, pattern was seen for the 27-30 month review, with the proportion of children reviewed having at least one developmental concern recorded falling in March and April 2020 before returning to pre-pandemic levels by June 2020. In April 2020, 9% of children undergoing a 27-30 month review had a developmental concern identified compared to the pre-pandemic average of 16%.

The proportion of children receiving their 13-15 month or 27-30 month review (and having their review record entered into the CHSP-PS electronic system) is usually high (around 90% if sufficient follow up time allowed). Delivery of these reviews was inevitably disrupted at the start of the COVID-19 pandemic, as shown by the dip in the number of reviews delivered in March to May 2020. The number of reviews delivered per month recovered to pre-pandemic levels in June 2020. Further information on review coverage is provided on the Child Health Reviews page of this tool.

When the number of 13-15 month and 27-30 month reviews delivered fell at the start of the COVID-19 pandemic, so did the proportion that had full meaningful data recorded against each of the eight developmental domains assessed during reviews. In April 2020, 77% of 13-15 month review records and 73% of 27-30 month review records had full meaningful data on child development recorded, compared to previous averages of around 90%. National guidance (external website) issued at the start of the pandemic recommended that the 13-15 month and 27-30 month reviews should be conducted remotely (by phone or video consultation) where feasible. The fall in data completeness relating to child development on review records may therefore reflect difficulties in completing a full developmental assessment without face to face contact.

Given this, it is likely that the dip in March to May 2020 in the proportion of children undergoing 13-15 month and 27-30 month reviews who were identified as having a developmental concern reflects a fall in the ascertainment of developmental problems, rather than a genuine fall in the proportion of children with developmental delay.

The combined impact of fewer children having reviews, and a lower proportion of those reviewed having developmental concerns identified, means that across Scotland during the period March to July 2020 around 300 children fewer than would have been expected based on pre-pandemic levels were identified as having a developmental concern at 13-15 months, and 800 children fewer were identified as having a developmental concern at 27-30 months. It is not currently clear to what extent these ‘missing’ children may be identified in coming months, either through ‘catch up’ reviews provided later than usual, or through their parents proactively raising concerns about their development with relevant services such as their Health Visitor, GP, or early learning and childcare staff.

Substance use

Take home naloxone kits

Since January 2020 the monthly number of THN kits supplied in Scotland has remained consistently higher than the 2018 & 2019 average.
Overall THN supply in Scotland showed peaks between March and May 2020 and around December 2020 and January 2021. Most NHS Boards showed either one or both of these increases.
Supply by community outlets was the most common source of THN, although this varied between NHS Boards and source distribution has varied over the time period presented here.

Community

The trend in community outlet supplies per month shows an exceptionally large number of THN kits supplied in April and May 2020 during the initial response to the COVID-19 pandemic (from 961 in March to 2,546 in April and 1,675 in May). Large-scale distributions by NHS Fife and NHS Ayrshire and Arran accounted for the notable increases in supplies observed in April and May 2020 respectively.
Monthly supply numbers in 2020 were broadly the same as the combined 2018 and 2019 average until January 2021. The two minor exceptions to this were smaller peaks in September and December 2020. Although the December 2020 figure was lower than that of the 2018 & 2019 average, the regular peak observed at that time of year increase suggests a seasonal increase in THN supply.
From January 2021 to December 2022, the number of THN kits provided have been consistently higher than the 2018 & 2019 average, with a notable increase observed between August 2021 and October 2021. This is a result of a new Scottish Government campaign to increase the supply of THN kits to members of the public.

Pharmacy

The number of THN kits dispensed by pharmacies on the basis of a community prescription was consistently higher from March 2020 to December 2022 than the average for 2018 & 2019. In particular, three large peaks in supply were observed in April 2020, December 2020, and December 2021.

Prisons

The number of THN supplies issued by prisons per month was consistently higher for the period February 2020 to December 2022 than the corresponding 2018 & 2019 averages. The exception to this was November 2020 when supplies were 21% lower than the 2018 & 2019 average for the same month
The peak in May 2020 may partially have been a result of the Scottish Prison Service's COVID Early Release scheme (external website) in which the Coronavirus (Scotland) Act 2020 provided new powers for the early release of a specific class of prisoners held in Scottish prisons. Early release was deemed necessary in order to provide the Scottish Prison Service with additional operational capacity including allowing for a greater use of single cell occupancy, keeping prison staff and the people in their care safe. It is understood that that scheme is no longer operational, so subsequent increases may reflect other factors.

Drug and alcohol treatment referrals

The number of specialist drug and alcohol treatment referrals in January and February 2020 was broadly comparable to the 2018 and 2019 average for the corresponding weeks. Subsequently, referrals decreased ahead of the UK lockdown implemented week beginning 23 March 2020, (424 referrals) to approximately one third the number observed as at the beginning of March (1,156 referrals, week beginning 9 March 2020).
Since the UK lockdown was implemented on 23 March 2020, drug and alcohol treatment referral numbers have been consistently lower than in the comparable period in 2018 and 2019. From April 2020, a gradual increase has been observed, rising to a broadly stable average of just below 1,000 referrals per week between August and December 2020. A seasonal decrease in treatment referrals occurred in late November and December 2020 broadly comparable with the decreases observed in previous years.
During 2021, weekly drug and alcohol referral numbers remained at a similar level seen in the latter half of 2020, at around 1,000 referrals per week, approximately 15-20% lower than the 2018 and 2019 weekly average.
Throughout 2022 and 2023 the number of drug and alcohol referrals was lower than observed in the corresponding months of 2020 and 2021, around 850-950 referrals per week.
A similar pattern was seen separately for both drug and alcohol referrals. In the latter half of 2021 and throughout 2022 and 2023, the number of drug referrals fall below the 2020 levels for the corresponding weeks. However, combined with the co-dependency referrals, the combined number of referrals were broadly similar to the 2020 drug referral levels. This apparent fall in drug referrals is possibly an artifact of the introduction of DAISy (the new data system) and the new co-dependency category.
The Scotland trends described were observed across many NHS Boards and Alcohol and Drug Partnerships, although there will have been some variation between areas.

SAS naloxone administration

The trends for SAS naloxone administration in 2020 and 2021 are generally in line with the trend seen in the average of 2018 and 2019. The 3-week average in both 2020 and 2021 data and the historic average show considerable variation over time.
From January 2020 to the beginning of June 2020 the number of SAS naloxone incidents were roughly similar those seen on average in 2018 and 2019. The biggest difference between the two trend lines can be seen at the end of June to beginning of July where the historic average line peaked at 131 Naloxone incidents compared with 95 incidents in 2020.
From August 2020 there was a decreasing trend in the number of SAS naloxone incidents followed by an increase from January 2021. This increase in the number of SAS naloxone incidents reaches a peak of 127 at the beginning of July 2021, followed by a small decrease to around 110 incidents in August 2021. This trend, beginning in January 2021, closely follows the trend seen on average in 2018 and 2019.
Weekly numbers of naloxone incidents diverged from observed trends throughout 2022 to early 2023, remaining lower than the same time period in previous years. Incidents were lower in May 2023 (316) compared to the same period in 2018-19 (402), 2020 (479), 2021 (379), and 2022 (332).

OST prescribing

Methadone

The total quantity of methadone prescribed has remained fairly consistent since January 2018, at around 40 million mg per month. This suggests that the changes in methadone dispensing observed during the COVID-19 pandemic did not have a marked effect on the total quantity of methadone prescribed. The key changes during the pandemic period were a decrease from March 2020 to May 2020, in the number of methadone items prescribed, accompanied by an increase in the amount of methadone prescribed per item. These changes were made by specific NHS Boards, on a person-by-person basis following a risk assessment, in order to limit access to pharmacies and restrict the spread of COVID-19.
The average number of doses of methadone supplied has decreased over time from an average of around 650,000 at the beginning of 2018, to an average of 540,000 by the end of February 2023.

Oral Buprenorphine

There was an increase in the total quantity of buprenorphine prescribed, from 1.2 million mg per month in January 2018 to 1.6 million mg per month in July 2020. The total quantity prescribed per month has been roughly the same since July 2020.
The average number of doses of methadone supplied has decreased over time from an average of around 650,000 at the beginning of 2018, to an average of 540,000 from January to March 2023.

Injectable Buprenorphine

Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased steadily from an average of around 2,000 in March 2020 to 88,000 from January to March 2023.

A&E attendances for drug overdose/intoxication

2020

There was a large decrease in the number of drug-related overdose/intoxication attendances at Emergency Departments in Scotland in the weeks immediately prior to the UK lockdown.
Following the introduction of the UK lockdown, attendances increased throughout Spring and Summer 2020.
This was followed by a decreasing trend of attendances from September to the end of 2020.

2021

Between January and August 2021, a long-term increasing trend in number of drug-related attendances was observed.
In September, October and November 2021, the weekly average numbers of drug-related ED attendances decreased.

2022

Between December 2021 and February 2022 the numbers of drug-related attendances fell below the 2018 & 2019 average and remain lower than observed in the corresponding months of 2020 and 2021.
In March 2022 number of attendances for drug overdoses or intoxications fell to their lowest point since the start of the 2020 Lockdown, but increased steadily in April 2022, reaching the historic average trend.
In May 2022, drug related A&E attendances increased sharply. Further investigations are ongoing to understand this increase.
Drug related A&E attendances decreased in June and remained stable through June to December 2022.

2023

Drug related A&E attendances remained stable through January to February 2023.
The average weekly number of drug-related attendances at emergency departments increased between March and May 2023. Attendances were 13% higher than the same period in 2022.

For further information, contact phs.drugsteam@phs.scot .

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