There are established referralarrangements with the private sector to meet the needs of NHS patients likely tobenefit from in-patient eating disorder care. In all cases quality and continuityof care are paramount for both the referring and receiving clinicians.

Plans are at an advanced stageof consideration for a new regional NHS specialist eating disorderservice and accommodation in the north of Scotland which will complement existing arrangements.

The Care Commission report refersto three fatal accident inquiries following the death of residents from septicaemiaassociated with an infected pressure ulcer. Of the inquiries, one found that deficienciesin the care home had contributed towards a resident’s death. No central informationis held on whether any compensation was paid by the home to the relatives of theresident. The home has subsequently closed.

the Scottish Government accepts the findings of the Care Commission’s report Pressure for Change, which includes important recommendations for care providers,NHS boards and local authorities.

We are keen to ensure a nationalapproach in responding to this issue. The Scottish Government is establishing aNational Programme Board, to be chaired by the Chief Nursing Officer, to overseeand quality assure a programme of work on pressure ulcers and skin care. The boardwill consider and advise on any necessary action. It will involve representativesfrom a wide range of relevant interests.

The National Screening Committee,which advises the UK health departments on issues related to screening programmes,has recommended the introduction of a population-wide vascular risk management programme.This is very much in keeping with the approach set out SIGN Guideline 97 on risk estimation and prevention of cardiovascular disease,which we are taking forward in part through our Keep Well pilots with their focuson cardiovascular disease.

The Quality and Outcomes Frameworkof the GMS contract uses estimated Glomerular Filtration Rate (eGFR) for the detectionof chronic kidney disease (CKD). This allows earlier detection of the conditionthan had been possible previously. CKD is an important risk factor for cardiovasculardisease, and using eGFR makes it easier to identify those who should be offeredtreatment to reduce the risk.

The Scottish Government currentlyhas no plans to establish a telephone helpline specifically for children and youngpeople with mental health and/or emotional problems.

Childline already provides afree, confidential 24-hour helpline across the UK for children and young people,who can talk to Childline’s trained volunteer counsellors about any problems theymay be experiencing, including abuse, bullying, family issues and teenage pregnancy.

A 24-hour helpline for peoplein emotional crisis is also well established across the UK through Samaritans.The Scottish Government supports Samaritans’ work in Scotland throughcore grant funding, and in addition Choose Life (the implementationteam for the Scottish Government’s strategy on suicide prevention) has providedfunding to enable Samaritans to develop a co-ordinated approach to suicide interventionin branches in Scotland.

The Scottish Government alsofunds the free BreathingSpace advice and signposting telephone line.It is aimed primarily (though not exclusively) at young men experiencing low moodor depression.

Local authorities are under astatutory duty to ensure that they provide and maintain for their area sufficientschool accommodation. It is therefore for them to decide how best to fulfil thatduty and ensure that supply of school places meets envisaged and changing demand.

There are currently no effectivetherapies to prevent type 1 diabetes.

Type 2 diabetes is associatedwith several factors, some of which are reversible and others, such as genetic associations,which cannot be influenced by lifestyle changes. Obesity is the single most importantpreventable predictor of type 2 diabetes, although smoking, lack of exercise, poordiet and excessive alcohol consumption are all associated with increased risk ofdiabetes.

The Better Health Better Care Action Plansets out the Scottish Government’s commitmentto tackle the rising problem of obesity. Over the next three years we will be investinga further £14.7 million, in addition to increased spending on healthy eating andphysical activity, to tackle obesity.

The Scottish Government fullysupports the principle of early diagnosis of long-term conditions such as diabetes,in order to improve quality of life and reduce the risk of complications. The NationalScreening Committee (NSC) advises that we should screen groups who are at high-riskof type 2 diabetes, for example those who are seriously overweight, who have a familyhistory of diabetes or who have symptoms such as sudden weight loss or extreme thirst.Further advice is needed from the NSC, however, on the most effective mechanismto screen for diabetes.

Many of those at risk of developingdiabetes can be identified as part of the care delivered by the general practiceteam, through the primary medical services contract. GP Practices are also incentivisedthrough the Quality and Outcomes Framework of the GMS contract and the ScottishEnhanced Services Programme to support early diagnosis and appropriate managementof patients with diabetes.

The “Keep Well” pilots identifythose in the most deprived communities in Scotland at particular risk of preventable, serious ill health.The focus is on cardiovascular disease and its main risk factors, including diabetes.

The fruit and vegetable sectorhas historically been relatively unsupported. The 2007 reform of the EU fruit andvegetable regime will give growers greater flexibility as land used to grow fruitand vegetables will, from 15 May 2008, support Single Farm Payment Scheme claims. The ScottishGovernment is also committed to encouraging retailers and consumers to source andeat fresh, seasonal produce and this should have a positive effect on Scottish fruitand vegetable production.

The Scottish Ambulance Servicecompleted the roll-out of the priority-based dispatch system across mainland Scotland in March2004, so 2004-05 is the first year in which category A demand and performance canbe measured across Scotland. This information is collected by health board area andthe tables set out the figures for comparing 2004-05 with 2005-06, 2005-06 with2006-07 and 2006-07 with 2007 to 4 January 2008. The ambulance service does not operate priority-based dispatch on the islands,however, it is still possible to identify those calls which would have been classifiedas category A, life-threatening.

NHS Board	2004-05 Category A Incidents	2005-06 Category A Incidents	Percentage Change (%)
Argyll and Clyde	8,851	9,894	+11.78
Ayrshire and Arran	9,077	9,402	+3.58
Borders	2,240	2,625	+17.19
Dumfries and Galloway	3,137	3,294	+5.00
Fife	8,233	9,500	+15.39
Forth Valley	5,180	6,818	+31.62
Grampian	10,298	11,353	+10.24
Greater Glasgow	25,741	26,607	+3.36
Highland	4,081	4,663	+14.26
Lanarkshire	12,798	14,921	+16.59
Lothian	18,315	21,953	+19.86
Orkney	150	147	-2.00
Shetland	180	278	+54.44
Tayside	8,726	9,968	+14.23
Western Isles	550	621	+12.91

 

NHS Board	2005-06 Category A Incidents	2006-07 Category A Incidents	Percentage Change (%)
Argyll and Clyde	9,894	9,965	+0.72
Ayrshire and Arran	9,402	8,428	-10.36
Borders	2,625	2,212	-15.73
Dumfries and Galloway	3,294	2,697	-18.12
Fife	9,500	8,006	-15.73
Forth Valley	6,818	5,886	-13.67
Grampian	11,353	10,153	-10.57
Greater Glasgow	26,607	26,369	-0.89
Highland	4,663	4,558	-2.25
Lanarkshire	14,921	13,774	-7.69
Lothian	21,953	19,250	-12.31
Orkney	147	145	-1.36
Shetland	278	251	-9.71
Tayside	9,968	8,640	-13.32
Western Isles	621	560	-9.82

 

NHS Board	2006-07 Category A Incidents	2007 to 4 Jan 2008 Category A Incidents	Percentage Change to Date (%)
Argyll and Clyde	9,965	8,883	-10.86
Ayrshire and Arran	8,428	7,945	-5.73
Borders	2,212	2,178	-1.54
Dumfries and Galloway	2,697	2,728	+1.15
Fife	8,006	7,713	-3.66
Forth Valley	5,886	5,424	-7.85
Grampian	10,153	9,755	-3.92
Greater Glasgow	26,369	23,355	-11.43
Highland	4,558	4,550	-0.18
Lanarkshire	13,774	12,871	-6.56
Lothian	19,250	18,396	-4.44
Orkney	145	194	+33.79
Shetland	251	234	-6.77
Tayside	8,640	8,140	-5.79
Western Isles	560	462	-17.50

Note: *Information provided bythe Scottish Ambulance Service.

Direct year-on-year comparabilityis compromised as there was a re-classification of incident codes betweencategory A and category B in 2006-07 and again in 2007 to 4 January 2008.

The overall emergency demandon the Scottish Ambulance Service has increased every year over the requested periodand this table sets out the emergency demand and percentage change.

Year	Emergency Demand	Percentage Change on Previous Year
2004-05	332,474	+3%
2005-06	354,974	+7%
2006-07	397,553	+12%
2007 to 4 Jan 2008	308,107	-22% (to date)

Note: *Information provided bythe Scottish Ambulance Service.