Chamber and committees

The Scottish Government recognises the unique challenges that face Scotland''s rural and island communities - including those on the Small Isles of Muck, Eigg, Rum and Canna - and is committed to ensuring that appropriate support is provided to enable them to seize the opportunities available and allow them to take control of their own development going forward.

Support is available through the Scottish Rural Development Programme (SRDP), a £1.5 billion programme to develop all parts of rural Scotland. The LEADER scheme is one part of the SRDP. It provides a bottom up approach to delivery of innovative approaches to rural problems. LEADER Local Action Groups are based in 95% of rural Scotland and cover all of the remote rural areas. Local Action Groups are a local partnership of local public agencies working in the rural field and private  socio-economic individuals or businesses.

Further to this, Highlands and Islands Enterprise (HIE), the Scottish Government''s economic and community development agency for the Highlands and Islands, has a Strengthening Communities remit, which recognises that social and economic development are complementary in achieving growth in remote, sparsely populated areas. HIE''s Growth at the Edge/Fas aig an Oir initiative is undertaken across all of HIE''s fragile communities and involves a higher rate of financial assistance, Community Account Management, assistance to social enterprises and voluntary organisations with aspirations to grow into social enterprises, and selective assistance to small private businesses which have clear community as well as economic benefit.

Schools, provide a strong focal point for the whole community, and are a major factor in ensuring sustainability in remote areas. Local access to educational opportunities plays an important role in creating a wealthier and fairer Scotland, particularly in island communities where the range of opportunities and services available locally may already be less than is available in urban areas. That is why the Scottish Government has legislated to update and strengthen the statutory consultation process required when education authorities are considering changes to their school estate and provides for authorities in rural areas to have a special regard to prescribed factors before proposing the closure of one of their schools. This effectively creates a legislative presumption against the closure of a rural school by making such a decision one of last resort and supports viable and sustainable rural communities.

The Scottish Government has as part of its suite of HEAT Targets, a target in place which seeks to increase the proportion of new-born children exclusively breastfed at six to eight weeks from 26.6% in 2006-07 to 33.3% in 2010-11. HEAT Targets provide support to NHS boards to focus on delivering improvements to patient services. Performance against HEAT targets is reported through Scotland Performs and the Cabinet Secretary for Health and Wellbeing addresses performance against HEAT targets with NHS chairs and chief executives at each board''s NHS Annual Review.

Individual staff members are not held accountable for the performance of NHS boards against HEAT targets and are therefore not subject to disciplinary processes resulting from boards not achieving these targets.

The Scottish Government is currently developing a Maternal and Infant Nutrition Strategy, providing advice to all those involved in infant nutrition and emphasising the importance of breastfeeding as part of supporting optimal infant nutrition.

There is a large and robust body of evidence demonstrating the short and long term health benefits of breastfeeding for both mothers and infants, including evidence from the World Health Organization, the Agency for Healthcare Research and Quality, Rockville, MD and the World Cancer Research Fund.

The Scottish Government has adopted as policy the World Health Organization guidance recommending exclusive breastfeeding for the first six months of an infant''s life.

Guidance to parents regarding optimal growth and development is contained within publications such as Ready Steady Baby! and Ready Steady Toddler! which are given to parents by health care professionals. Parents can discuss any concerns with health care professionals. If concerns are raised increased surveillance and education of parents will be introduced. All healthcare professionals dealing with children are trained to detect growth and other problems and to provide information and education for parents.

Parents and carers are advised to contact their general practitioner or health visitor if they have any concerns regarding their child''s development.

Most people with myalgic encephalomyelitis/chronic fatigue syndrome (ME-CFS) will initially present to their general practitioner (GP) for diagnosis and help with management of their condition. GPs, as generalists, are trained to manage all initial contact with patients and deal with all problems. GPs are expected to update their knowledge through continuing professional development (CPD), particularly to suit the needs of their patients, including the annual appraisal process. This seeks to enable GPs to practise high quality medicine, including early recognition and optimal treatment of illnesses such as ME-CFS.

The Scottish Government strongly supports the development of robust clinical guidance to facilitate the proper management of illnesses. Work is under way to produce up to date guidance for use by GPs on the diagnosis and management of ME-CFS, as part of the development of a Scottish Good Practice Statement on ME-CFS.

We want to encourage the development of specialist services to which GPs can refer patients with ME-CFS, as part of a recognised care pathway. The Scottish Public Health Network has therefore been commissioned to undertake a Needs Assessment exercise to determine optimal services for ME-CFS. That work is at an advanced stage.

The Scottish Government is keen to ensure consistently high standards of care for ME-CFS are available throughout NHS Scotland. In January 2010, NHS Quality Improvement Scotland launched Clinical Standards for Neurological Health Services. The generic standards 1-4, in particular, will underpin improvements in services for all neurological conditions, including ME-CFS.

No research has been carried out to audit breastfeeding rates in relation to these scenarios; however there is no lack of Health Visitor support in the community. Health visitors provide a universal service to families and children as laid out in Health for all Children (HALL 4), including providing advice and support on breastfeeding.

The Scottish Government has set a HEAT Target of increasing the population of new-born children exclusively breastfed at six to eight weeks from 26.6% in 2006-07 to 33.3% in 2010-11. Information on how health boards are performing against the HEAT Target is available from the Scotland Performs website:

http://www.scotland.gov.uk/About/scotPerforms/partnerstories/NHSScotlandperformance/breastfeeding.

Statistics on Breastfeeding by NHS board, Council area and Community Health Partnership are available on the ISD Scotland website http://www.isdscotland.org/isd/1764.html.

Same Day Surgery is the preferred delivery for a wide number of surgical procedures, which provides safe, effective and efficient use of resources. There are a number of actions being undertaken to maximise the number of day case operations.

The HEAT Target for same day surgery is due for delivery in March 2011 and NHS boards are making steady progress towards this challenging target. The 18 weeks Referral to Treatment Improvement Programme continue to work closely with boards to make day surgery the norm through locally driven improvement work.

There is a renewed focus with the establishment of a national same day surgery and pre-op assessment Delivery Group which is made up of experts from the service and performance support is currently being provided to NHS boards who find progress against the target a challenge.

This is a matter for NHS boards. The information requested is not held centrally.

The Scottish Government is committed to improving the health and wellbeing of the Scottish population and ensuring that all children get the best possible start in life. All NHS boards have been set a performance target specifically to increase the number of women who are exclusively breastfeeding their baby at six to eight weeks.

Parents who choose not to breastfeed are offered unbiased information from health professionals to enable them to make an informed decision on how to feed their infants.

It is not appropriate for health professionals to recommend one brand of formula over another. However parents who have chosen to formula feed are advised that whey based formula should be used from birth till the age of one year.

The screening process for postnatal depression is set out in the Scottish Intercollegiate Guidelines Network (SIGN) Guideline NO 60 “ Postnatal Depression and Puerperal Psychosis. This guideline states that the Edinburgh Postnatal Depression Scale (EDPS) should be offered to all women in the postnatal period as part of a screening programme for postnatal depression. The EPDS should be used at approximately six weeks and three months following delivery and should be administered by trained health visitors or other health professionals. This guideline applies to all health boards in Scotland.

Guidance issued to health boards in 1999 and 2004 on postnatal depression provides a template for the best organisation of care and support in the community and hospital settings, including the importance of early identification and screening, safe care environments, and continuity of care.