Chamber and committees

It is for local authorities and NHS boards to determine and design services in response to local priorities and clinical need.

Under the Additional Support for Learning (Scotland) Act 2004 as amended, education authorities are required to identify, meet and keep under review additional support needs of all children for whose education they are responsible, including those with social, emotional and mental health difficulties, and to tailor provision according to individual needs. Appropriate agencies, which include NHS boards, are required to assist a local authority in the exercise of any of its functions under the act. In addition, under Curriculum for Excellence, all learners are entitled to support. Again, support should be tailored to individual needs and circumstances, and delivered in partnership with relevant agencies, rather than through one type of universal provision such as counselling.

We have been working with NHS boards to ensure that there is a mental health link worker or properly articulated link system between schools and child and adolescent mental health (CAMH) specialists and the development of a web-based toolkit (http://www.handsonscotland.co.uk) aimed at improving the confidence of teachers and others in responding to the mental health needs of children.

Under Curriculum for Excellence, every learner is entitled to support, from universal support which starts with ethos, climate and relationships within a learning environment which is inclusive and fair, to targeted support. Support and health and wellbeing are responsibilities for all staff. All learners should have frequent and regular opportunities to discuss learning with a key adult who has a holistic overview of progress and personal development and all staff are responsible for establishing open, positive and supportive relationships across whole school communities where learners feel listened to and secure in their ability to discuss sensitive aspects of their lives. Support depends upon personalised planning and knowledge of steps to be taken in any given situation, including appropriate referral and multi agency delivery where appropriate, to meet individual needs. This may include counselling in school if appropriate.

In support of identifying and referring on pupils with mental health needs, NHS boards should make available a named health link person to every school, or a properly articulated link system between schools and Child and Adolescent Mental Health (CAMH) specialists.

Integrated care pathways seek to ensure that local multi-agency agreements are in place to join up all the available help. NHS Quality Improvement Scotland have developed standards for doing this in Scotland which are currently out for consultation across all agencies.

Extensive human papilloma virus (HPV) type-specific testing is a relatively recent development. As yet there is no data to allow any changes over the past five years to be evaluated. However, in many countries, including Scotland, the normal prevalence of HPV in unvaccinated populations has been estimated and published within the scientific literature.

The prevalence of HPV varies by age and the prevalence and distribution of genotypes varies by severity of HPV-related disease.

In a study of cervical cancers diagnosed in Scotland, HPV was detected in 88% of invasive cervical cancers tested. Of these: 64% were type 16; 20% type 18; 6.5% type 45; 5% type 31; 3% type 33. All other specific types were detected in less than 1% of samples, aside from type 6 which was detected in 1.2%, but in all cases was as a co-infection with another High Risk HPV type. Overall 10% of HPV infections detected were within a multiple infection.

In unvaccinated populations of women with normal cervical cytology overall prevalence of HPV varies according to age. In a large study in the North of England HPV prevalence with High Risk (oncogenic) types of HPV varied from 22.3% in 20 to 29 year olds to 5.8% in 50 to 64 year olds.

With respect to HPV genotypes - a meta-analysis of studies from around the world compared HPV types in 1 million women with normal cytological findings. This included 21 studies from northern Europe, eight of which were from the UK. The findings showed that overall prevalence of HPV among 97,242 Northern European women of all ages was 10%. Within Europe the most prevalent subtypes were 16; 31, 18, 39, (33,66), 6, (45, 52, 51,58). (Brackets indicate HPV types with equal prevalence.)

Within Scotland a study of 3,444 women attending screening in one NHS board found that among 3089 women of all ages (<25 to >55) with normal cytology 12.7% were positive for HPV. 8.3% had a High Risk type identified; 6.5% a Low Risk type. 4.5% of women with normal cervical cytology were infected with multiple HPV types. The most prevalent HPV types among these women with normal cytology were: 16; (18,51), 31, 52, 45, 73, 59, 56, 33, 58, 39 with other types each identified in less than 1% of samples. (Brackets indicate HPV types with equal prevalence).

The HPV Immunisation Programme in Scotland started on 1 September 2008.

The latest statistics showing uptake rates for girls eligible for vaccination in year one (September 2008 to August 2009) and year two (September 2009 to August 2010) of the programme are published on the ISD Scotland website at http://www.isdscotland.org/isd/5921.html. Information is broken down by school year of those vaccinated and by NHS board area.

Interim statistics on uptake by girls eligible for vaccination in year three of the programme (Sept 2010 to August 2011) will be published on the ISD Scotland website shortly.

A range of information materials are available to support the human papilloma virus (HPV) vaccination programme. Consistent messages are provided across these materials that the vaccination will only protect against two strains of the virus and that girls should attend for cervical screening when they reach the appropriate age.

Every girl who attends for vaccination will be provided with a leaflet before she is vaccinated. These leaflets, which are also available on the vaccination programme website say:

http://www.fightcervicalcancer.org.uk.

 The HPV vaccine is designed to protect against the two types of HPV that can cause 70% of the cases of cervical cancer.

The vaccine does not protect you against all other types of HPV, so you will still need to start going for regular cervical screening when you''re 20 years old. The combination of immunisation and cervical screening offers the best possible protection against cervical cancer.

In addition to this, the information materials available to support the Cervical Cancer Screening Programme also make clear that girls who have had the HPV vaccination programme still need to attend for screening. These are available at:

http://www.healthscotland.com/topics/health-topics/screening/cervical.aspx.

Data on the number of cervical screening tests processed by the Scottish Cervical Screening Programme for each of the last five years can be found on the Information Services Division website at:

http://www.isdscotland.org/isd/servlet/FileBuffer?namedFile=Annual_workload_data.xls&pContentDispositionType=inline.  

The most recent year for which numbers are available is the year ending 31 March 2010.

Data on the percentage uptake of females who had a record of a previous cervical screening test taken within the last 3.3/5.5 years, broken down by age group can be found on the Information Services Division website at:

http://www.isdscotland.org/isd/servlet/FileBuffer?namedFile=Annual_uptake_data.xls&pContentDispositionType=inline.

The most recent year for which numbers are available is the financial year ending 31 March 2010.

There is no national strategy for equal access to counselling in schools as there is already a comprehensive framework in place to make sure learners with additional support needs including social, emotional or mental health needs, short or long-term, access appropriate support in partnership with relevant agencies, under the Additional Support for Learning (Scotland) Act 2004 as amended.

Under Curriculum for Excellence, every learner is entitled to support, from universal support which starts with ethos, climate and relationships within a learning environment which is inclusive and fair, to targeted support. Support and health and wellbeing are responsibilities for all staff. All learners should have frequent and regular opportunities to discuss learning with a key adult who has a holistic overview of progress and personal development and all staff are responsible for establishing open, positive and supportive relationships across whole school communities where learners feel listened to and secure in their ability to discuss sensitive aspects of their lives. Support depends upon personalised planning; an understanding of anti-discriminatory, anti bullying and child protection policies, and knowledge of steps to be taken in any given situation, including appropriate referral and multi agency delivery where appropriate, to meet individual needs. This may include counselling in school if appropriate.

Since The Mental Health of Children and Young People: A framework for Promotion, Prevention and Care was published, delivery partners in NHS boards, local authorities and the voluntary sector have made significant progress.

Awareness of child and adolescent mental health in schools has been improved by, amongst other things, a Scottish Government commitment encouraging the establishment of explicit links between schools and child and adolescent mental health specialists as well as the development of a web-based toolkit aimed at improving the confidence of teachers and others in responding to the mental health needs of children.

Our work with NHS boards and their partners in implementing the framework highlighted a need for further expansion of the workforce capacity and are addressing this. We are allocating £6.5 million over three years to increase the number of psychologists working in specialist Child and Adolescent Mental Health Services (CAMHS) with £1 million having been allocated in 2009-10, £2 million being allocated in 2010-11 and £3.5 million being allocated in 2011-12.

We are also making available £2 million each year to help NHS services enhance intensive community services (Tier 3 and 4) and to help reduce the need for children and young people to be admitted to hospital. This investment will also support our referral to treatment waiting time target for specialist CAMHS which means by March 2013 no one will wait longer 26 weeks from referral to treatment.

This project, which is included within Intervention 22 of the Strategic Transport Projects Review (STPR), will require many stages to be undertaken, including detailed design and development work before we can finalise the timescales for delivery.

A timetable for delivering the Nairn bypass will be set in the context of overall affordability and our commitments to other STPR proposals.

Early design work has commenced to identify preferred solutions for this project as part of our commitment to upgrade the A96.