Chamber and committees

More than two million people in Scotland have long term conditions.

Multimorbidity (two or more long term conditions) is the norm in Scottish people aged over 50 years however most people with multimorbidity in Scotland are under 65 years. Multimorbidity occurs 10-15 years earlier in deprived areas compared to affluent areas and in this situation the most common co-morbidity is a mental health problem.

Clinical research, guidelines, care pathways and board managed clinical networks have traditionally focused on improving care and outcomes for single conditions. One of the 12 priorities in the 2020 route map is to improve the care and support for people with multiple chronic illnesses, particularly those with concurrent physical and mental health conditions.

We have developed and will soon publish our action plan for multimorbidity which builds on the actions in CEL 23 (2009) Improving the Health and Wellbeing of People with Long Term Conditions in Scotland: A National Action Plan. The multimorbidity action plan includes an action to work with Healthcare Improvement Scotland and Scottish Intercollegiate Guidelines Network to develop prompts for clinicians to consider multimorbidity at key points in guidelines and pathways for all common conditions. We are engaging with NHS Education for Scotland to develop units of learning on multimorbidity for delivery within undergraduate and postgraduate continuing professional development programmes for all professionals.

A copy of this action plan will be made available on SPICe in due course (Bib Number 55589).

Local authorities are responsible for the provision of school education within their areas.

As indicated in the answer to question S4W-18318, SCHOLAR, a programme of Heriot-Watt university, provides interactive online learning resources for SQA courses to Scottish secondary schools. Each of the 32 local authorities have now signed three year contracts with SCHOLAR from August 2013 ensuring that all learners in Scotland’s secondary schools studying towards Scottish higher and advanced qualifications in science, technology, engineering and mathematics subjects (STEM), business Subjects and languages have access to these study support materials.

The SCHOLAR materials supplement and complement teaching in the class. They are not a replacement for teaching. The Scottish Government will continue to encourage schools and local authorities to work together, and with colleges, to deliver as wide a range of courses to learners as possible.

There is no fixed amount.

Payments are made up of two elements: remuneration, paid for each prescription written plus an on-cost payment, and; reimbursement, in respect of the items dispensed.

Full details are set out in Section 18 of the General Medical Services Statement of Financial Entitlements for GPs in Scotland, which is published annually. The current version, for 2013-2014, is available on the Scotland’s Health on the Web (SHOW) website at: www.sehd.scot.nhs.uk/pca/PCA2013(M)09letter.pdf

Smoking cessation support for people with mental health issues is available throughout Scotland via local stop smoking services.

Individual treatment plans for all patients, including patients with mental health conditions, should be developed taking into account current smoking cessation guidance and recommendations. Current guidance identifies people with mental health issues as a priority group.

Smoking cessation services receive £11 million per annum (allocated directly to NHS Health Boards) from the Scottish Government to provide this service. A review of smoking cessation services is currently underway and will include specific recommendations on delivering services that are person centred and supports the needs of the individual no matter their personal circumstances. The review will report in 2014.

The Scottish Government funds NHS boards and their partners to provide high quality health care that meets the needs of their local populations.

The Scottish Government has prioritised mental health and continues to work to give it parity with other health conditions. The Mental Health Strategy (2012 – 2015) is fully consistent with the NHS 2020 Vision for all health care, including physical health issues, that everyone is able to live longer healthier lives.

In relation to ensuring we have the same level of NHS care and treatment for people with mental health issues as for physical health issues, the Scottish Government works closely with NHS partners to implement improvement that is based on a shared understanding of the goal that is to be achieved, that uses data to understand what is happening at national and local level, that identifies early gains to create momentum and confidence, and that builds in improvement support to share and develop learning and that puts in place a clear performance and accountability framework.

Some people can experience more difficulty than others in accessing mental health services to meet their needs. This can be because some groups are less likely to try to access services, for example due to stigma, or because there are gaps or lack of capacity in some services. We are committed to combatting the stigma and discrimination that can be associated with mental health problems. The Scottish Government is committed to work with NHS boards and partners to improve monitoring information about who is accessing services, such as ethnicity, is consistently available to inform decisions about service design and to remove barriers to services. (Commitment 14)

We introduced the HEAT targets for access to Child and Adolescent Mental Health Services (CAMHS) and psychological therapies. Across Scotland we delivered the 2008-11 targets to improve diagnosis of dementia, which has been replaced by a HEAT standard. To build on this, the first national target on post-diagnostic support began in 2013. This is underpinned by a commitment that everyone diagnosed with dementia from 1 April 2013 should receive a minimum of a year's worth of post-diagnostic support, coordinated by a named link worker.

We have worked with the management group of see me, with the Scottish Association for Mental Health and the Mental Health Foundation who host see me and with other partners to develop the strategic direction for see me for the period from 2013 onwards.

The Scottish Government’s approach to supporting service improvement includes having a focus on information to tell us how well our system works and where the opportunities are for improvement. We continue to develop the Mental Health Benchmarking Toolkit and the CAMHS Balanced Scorecard as tools to support service improvement, by using a range of comparative information to identify gaps and opportunities for improvement and to monitor progress. We also introduced the HEAT targets for access to CAMHS and psychological therapies.

NHS boards are also responsible for monitoring information about who is accessing services so they can ensure that local services are meeting the needs of their local communities.

All patients in psychiatric hospitals will have access to support from dedicated NHS smoking cessation services.

While existing smoke-free legislation includes an exemption for designated rooms in psychiatric hospitals and psychiatric units, national guidance was issued in 2011 to help service providers move towards a smoke free mental health service. This guidance stresses the importance of effective smoking cessation support and lays out detailed recommendations on service delivery.

Our latest strategy builds upon the aspiration for smoke free mental health facilities by setting a target that mental health services should ensure that indoor facilities are smoke-free by 2015.

The minor ailment service and the chronic medication service are additional pharmaceutical services, and by statute may only be offered by community pharmacy contractors on the pharmaceutical list of an NHS board.

The level of staffing of a GP practice is a matter for the practice itself.