Chamber and committees

The ScottishGovernment believes that palliative care should be available to anyonesuffering from any life threatening illness from the time of diagnosis onwardsand expects NHS boards to ensure people’s needs are met through a range of servicesincluding hospice care. The Gold Standards Framework (Scotland) is being usedby GP practices throughout Scotland to improve the care of individualsrequiring palliative care in the community. In addition, the ScottishGovernment continues to provide support for the Scottish Partnership forPalliative Care and to promote the role of Managed Clinical Networks (MCNs) inpalliative care. These provide a co-ordinated approach involving the NHS,patient groups, social work, voluntary organisations and other key partners.Together all of these measures contribute to high standards of palliative carefor all patients who require it.

Scotland hasadopted a generic approach to the management of long-term conditions, such aslung disease. The aim is to support people to live with long-term conditions byproviding services which are fully responsive to people’s needs, delivered asclose to home as possible, as early as feasible in the course of the diseaseand which are properly integrated across health and local authority services.The Community Health Partnerships have a key role in providing care which isfully integrated across health and NHS boards’ local planning partners.

The SPARRA (Scottish Patients at Risk of Re-admission and Admission) risk prediction tool, developed by ISD, is being used by NHS boards to identify those who are at highest risk of unscheduled admission to hospital. It shows COPD as thecondition which makes the most significant contribution to unscheduled hospitaladmissions. A Scottish approach to integrated case management is being developed so that the people identified by SPARRA can be supported to maintain their independence at home.

GPs are incentivised, through the Quality and Outcomes Framework (QOF), to undertake regular checks and maximise the effectiveness of medication and other forms of treatment, reducing the adverse symptoms from the condition and improvingquality of life. This includes immunisation against influenza and pneumococcaldisease, which can cause conditions to deteriorate, precipitating a crisis, andlifestyle interventions such as smoking cessation. COPD and asthma also featureas clinical domains in the QOF.

A number of stepshave been taken to develop and implement national standards on chronic lung disease.NHS Quality Improvement Scotland (NHS QIS), Scottish Intercollegiate GuidelinesNetwork (SIGN), the National Institute for Health and Clinical Excellence (NICE),the Department for Health in England and the British Thoracic Society have all publishedor are reviewing guidance on these conditions.

NHS boards in Scotland should take account of this information when developingservices for chronic lung disease and associated conditions.

Specific initiativesinclude:

NHS QIS publishedstandards on asthma care for children in March 2007, and plans to undertake a series of review visits to assess NHSboard’s performance against these standards. This review will commence in October2007 and run until May 2008. In2005 the Scottish Intercollegiate Guidelines Network (SIGN), in association withthe British Thoracic Society, published the British Guideline on the Managementof Asthma.

In June 2003 SIGNalso published Guideline 73, the Management of Sleep Apnoea/hypopnoea syndrome inAdults. We expect NHS boards to develop services in line with standards and guidancefrom NHS QIS and SIGN.

The British ThoracicSociety published Guidance on the Management of Chronic Obstructive PulmonaryDisorder (COPD) in 1997 and The National Institute for Health and Clinical Excellence(NICE) has published Clinical Guideline 12 in February 2004 on COPD.

The Department forHealth in England is developing a National Framework to address(COPD). NHS QIS is working alongside them on this, and will review the work andconsider how it may be applied in Scotland.

Burden of diseaseis used as a comparator for research investment across different diseases. Thisis frequently measured in terms of disability adjusted life years (DALYs) whichmeasure the sum of life years lost due to premature mortality and years livedwith a disability adjusted for the severity and thus they take into account theimpact of mortality and morbidity in a single measure. Trends in the level ofresearch investment generally correlate with the overall trend in the DALYranking. In a recent analysis performed by the UK Clinical ResearchCollaboration (UKCRC), it was clear that for lung disease the level of researchfunding was lower than the comparative burden of disease. Further informationcan be obtained from the UKCRC website www.ukcrc.org.

Researchinvestment does not increase automatically in proportion to the number ofpeople affected by lung conditions. However, when assessing the quality ofresearch proposals, reviewers do take into account the burden and increasedprevalence of disease.

As part of thespecialist children’s services project, a review of respiratory serviceprovision for children and young people is underway. The key outcome of thisprocess is to ensure the sustainable provision of local respiratory serviceswithin both hospital and community settings.

As I said in my statement toParliament on 23 May I am currently considering a range of options, which may offeropportunities to further scrutinise the consent process associated with the proposedship to ship transfers in the Firth of Forth, including whether or not changes inlegislation should apply retrospectively. However, no decision has been taken byForth Ports to approve the proposed operations. What I will aim to ensure is thatany activities in the Firth of Forth are fully compliant with environmental legalobligations.

Further to my response to HelenEadie on 2 November 2006, Transport Scotland has now received the first two reports from the fiveexpected. These will be published as soon as is practicable, following completionof the necessary review process.

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Court-appointed solicitors receiveno specific training with regard to gathering such information.

As regards any particular case,the judge will give direction should there be elements of the case that requireparticular scrutiny, or should there be areas in which he/she requires specificinformation. Should the reporter have any doubts as regards their particular roleor responsibility in the case, they may request further direction from the judge.