Chamber and committees

Smoking, including passive smoking, increases the risk of developing lung cancer. The Scottish Government has introduced a legislative programme on smoke-free public places and on tobacco sales. This includes the Tobacco and Primary Medical (Scotland) Act 2010, which is designed to discourage people becoming addicted at an early stage.

In March 2013, the Scottish Government published its new Tobacco Control Strategy - Creating a Tobacco-Free Generation. The new strategy sets out the Scottish Government's ambition for a smoke-free Scotland (less than 5% smoking population) by 2034. A key action within the strategy charged NHS Health Scotland with leading a review of smoking cessation services in Scotland. In addition, the current HEAT target for smoking cessation focuses on addressing health inequalities.

The Scottish Government is also committed to improving survival rates from lung cancer. Our 'Detect Cancer Early' initiative, which was launched in February 2012 with £30 million of investment, focuses on raising public awareness and encouraging people with early symptoms of cancer to see their GP.

Our lung cancer social marketing campaign, led by Sir Alex Ferguson as spokesperson, has been running from November 2013, with the aim of building belief that something can be done for lung cancer if detected earlier, reinforcing that people can live well after lung cancer if it’s detected earlier, and impressing on people that it is worthwhile seeing their GP as soon as possible.

The revised Scottish Referral Guidelines for Suspected Cancer were published in October 2013 and updated May 2014. This version updates referral guidelines for lung cancer, and takes account of new research evidence and the findings of audits undertaken since the last revision. The aim of these updated guidelines is to facilitate appropriate referral between primary and secondary care for patients whom a GP suspects may have cancer. The guidelines should help GPs, the wider primary care team, other clinicians and patients and carers to identify those patients who are most likely to have cancer and who therefore require urgent assessment by a specialist. Work is also being undertaken to support the effective dissemination and implementation of the revised guidelines when they are published by August 2014.

The quality performance indicators programme also aims to drive up the standard of cancer services available in NHS Scotland. This programme contains specific indicators for prostate cancer. These indicators will be used to monitor and drive quality improvement in prostate cancer care across the NHS in Scotland and ensure that people have access to timely, safe and effective services.

Table 1 shows European age-sex standardised mortality rates for heart failure, cancer and stroke from 2008 to 2012, as published by Information Services Division Scotland. Further information is available on the ISD website at the following web addresses:

Cancer: http://www.isdscotland.org/Health-Topics/Cancer/

Heart Disease (including heart failure): http://www.isdscotland.org/Health-Topics/Heart-Disease/

Stroke: http://www.isdscotland.org/Health-Topics/Stroke/

Table 1: European age-sex standardised mortality rates per 100,000 population per

year for heart failure, cancer and stroke; Scotland, all ages and both sexes; 2008-

2012.

Notes: 1. International Classifications of Diseases, 10^th revision (ICD-10) codes used:

Heart Failure – I50.

Cancer – C00-C97 excluding C44.

Stroke – I61, I63-I64.

2. Rates are directly standardised to the 1976 European Standard Population

Source: National Records of Scotland (NRS), death registrations and population estimates. Reference: IR2014-01155.

The first year of lung cancer quality performance indicators data analysis (for patients diagnosed from 1 April 2013 to 31 March 2014) is scheduled for submission to ISD on 13 November 2014. The national comparative report is due to be published May 2015.

Since 1999-2000 Borderline has received more than £1.4 million from the Scottish Government to provide assistance to Scottish people in London who find themselves homeless.

Funding has been provided through the Scottish Government’s Housing Voluntary Grant Scheme. Application forms for the 2015-16 grant scheme will shortly be sent to all interested organisations, including Borderline. All submitted applications for funding will be evaluated with a view to announcing successful recipients by 31 December 2014.

Since 1999-2000 the Scottish Government has provided £1.4 million to Borderline in 2014-15 to assist homeless Scots in London. Borderline is a charity that provides support and assistance to homeless Scots in London.

If someone is homeless and approaches a Scottish local authority they will be assessed under the homelessness legislation. If they are unintentionally homeless they will be entitled to settled accommodation

In England a homeless person can approach an English local authority for homelessness assistance. The local authority will then assess the case against the English homelessness legislation

To support GPs in Scotland to refer patients with suspected cancer as early as possible, the Scottish Government published referral guidance in 2007, called the ‘Scottish Executive Health Department Letter (2007) 9: Scottish Referral Guidelines for Suspected Cancer’.

Healthcare Improvement Scotland have been leading on a review of these Scottish Referral Guidelines for Suspected Cancer. Review groups have been established for each tumour group, with membership of each including clinicians from secondary and primary care, members of the Scottish Cancer Coalition and patient representatives. The lung cancer review group produced draft guidelines for suspected lung cancers, which were sent out for wide clinical, patient and public consultation prior to being published in October 2013.

To support effective communication and implementation of the revised guidelines a series of primary care education session were held in autumn 2014 in partnership with Roy Castle Lung Cancer Foundation. These sessions are now available for primary care professionals to view online.

The remaining guidelines are under review and all guidelines will be published by late summer 2014.

A further sub-group has being convened to support the effective dissemination and implementation of the revised guidelines with support from Macmillan Cancer Support.

The Detect Cancer Early (DCE) Programme aims to increase the proportion of Scots diagnosed in the first stage of cancer, initially focusing on breast, colorectal and lung cancer. Survival rates from cancer are often poorest in those living in the most deprived communities and uptake of the cancer screening programmes is lowest in these areas.

The DCE social marketing campaigns are targeted to the most hard to reach groups and include targeted TV, radio and press adverts, translated materials as well as extensive field marketing and road shows. Indeed, over 75% of this target audience have reported high levels of awareness of the DCE social marketing campaigns through an independent evaluation.

In addition we have introduced a two year primary care initiative to support informed uptake of the national bowel screening programme in areas of poorest uptake and have recently launched a targeted breast screening campaign aimed at women over 50 who do not currently take up the offer to screen.

Information on the number of qualified nurses can be found through Information Services Division.

Due to the multidisciplinary nature of the role, a qualified nurse may work in more than on specific speciality, however only one specialist area is recorded for each nurse.

Heart failure services are covered by the Scottish Government 18 weeks to referral to treatment waiting time standard. To deliver this standard all parts of the patient pathway, outpatient consultation, diagnostic test and treatment, must be as short as possible. If a patient goes on to inpatient and day case treatment they will also be covered by the 12 weeks legal treatment time guarantee. However, within the standard and guarantee we would expect that the more urgent patients will be seen much quicker.

There are no waiting time targets for follow up appointments as the timing of such appointments need to reflect each individual patients condition and treatment. We would expect clinicians to keep patients fully informed of their care and the frequency of any follow-up care.

The Scottish Government does not centrally hold the cost of a brain natriuretic peptide test.

The 2012-13 Scottish Health Service Costs (Costs Book) publication provides a cost per examination for ultrasonics (£42.87) and for ‘other radiology’ (£54.79), which includes conventional x-rays:

http://www.isdscotland.org/Health-Topics/Finance/Costs/Detailed-Tables/Radiology.asp). The cost of chest x-rays is not separately identified.