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The Scottish Government has welcomed the Scottish Public Health Network’s (ScotPHN) Health Care Needs Assessment of Services for Adults with Rheumatoid Arthritis.

The recommendations of the ScotPHN report were recently discussed as part of a meeting between key stakeholders and officials, as to how improvement work on rheumatology may be taken forward in Scotland. The Scottish Government is currently engaging with these stakeholders as to how proposals may be progressed and it looks forward to working with them in developing work in this area.

The Scottish Government has not assessed the economic impact of rheumatoid arthritis.

The Scottish Public Health Network report (August 2013) on the Health Care Needs Assessment of Services for Adults with Rheumatoid Arthritis assessed the cost implications for NHS Rheumatoid Arthritis Services in Scotland. The report is available at:

http://www.scotphn.net/pdf/2013_08_27_RA_HCNA_Part_D.pdf

Table 1 summarises the influenza B vaccine strains and circulating influenza B virus types for each of the previous three seasons: 2011-2012, 2012-2013 and 2013-2014. Information has been provided for all ages due to the small numbers of samples in two out of three seasons. Caution is required when interpreting these results due to the low level of influenza B detected and hence samples processed in 2011-12 and 2013-14. Please note that 2012-13 was characterised by a higher than usual influenza B activity and a decision was made to type all influenza B positive samples.

Due to the small number of samples tested for influenza B type in the 2011-12 and 2013-14 seasons, it is not possible to provide figures broken down by health board to avoid deductive disclosure. Whilst the number of samples typed for influenza B for the 2012-13 season are greater we are only able to provide a breakdown by circulating vaccine strain by region due to small numbers of samples tested in some boards (table 2)

Table 1: Flu B vaccine and circulating strains for the last three influenza seasons in Scotland

Table 2: Regional breakdown of circulating Influenza B types in Scotland in 2012-13

* Whilst the number of samples available for analysis from season 2012-13 was 667 amplification to allow lineage was only possible on 546 of these samples

Unlike influenza A viruses, there are only two lineages of influenza B virus, Yamagata and Victoria. Due to an increasing number of influenza B circulating strains being of the Yamagata lineage (type) in recent years, the World Health organization (WHO) changed the influenza B vaccine strain component of the annual trivalent seasonal influenza vaccine from Victoria to Yamagata in 2012-13.

A ‘mismatch’ is where the flu viruses in the vaccine are significantly different from those circulating in the community. In years when the vaccine strains are not well matched to circulating strains, vaccine effectiveness may be reduced. However, even when the viruses in the vaccine and circulating viruses are not well matched, a vaccine may still offer some protection against circulating viruses. For example, B/Yamagata/Wisconsin strain in the 2012-13 trivalent vaccine provided some protection against B/Yamagata/Massachussetts (contained in the 2013-14 vaccine). However, B/Yamagata strains will not provide protection against B/Victoria. Vaccines containing one influenza B lineage would not be expected to give a significant level of protection against the other lineage. Hence the WHO recommendation for development of quadrivalent vaccines with both B lineages.

The arrangements for the ordering and reimbursing of generic flu vaccine for the 2014-15 flu season were advised in NHS Circular PCA (P)(2014)1/PCA (M)(2014)6 issued on 11 February 2014.

Health boards are responsible for the healthcare of the population in their areas, including prisoners. Prisoners who are ‘at-risk’ or are over the age of 65 would receive the flu vaccine in prison from their local NHS board.

The Scottish Prison Service (SPS) offers flu vaccinations to all employees free of charge. The SPS and its national partners strongly encourage employees to take full advantage of this offer. The SPS arranges on-site vaccinations and clinics, at no cost to employees which are held in each establishment. Employees wishing to receive the seasonal flu vaccination in their place of work are asked to register their interest with their local human resource department and the programme is delivered by SPS’s occupational health provider.

The responses to the consultation ‘Promoting responsible dog ownership in Scotland: microchipping and other measures’ are currently being independently analysed and it is expected that an analysis report will be published soon. The views offered in response to the consultation will inform decisions by the Scottish Government about next steps in relation to measures to promote responsible dog ownership.

NHS Grampian is working to develop their systems to help inform service development in line with demand. NHS Grampian also continues to make efforts to increase staffing capacity.

All mental health teams in NHS Grampian have undertaken a review of their patient pathway, with a view to making improvements. In addition, workloads have been shared across teams as appropriate.

Discussions are planned between the Scottish Government’s Quality and Efficiency Support Team and NHS Grampian to review other options for support in meeting the target as quickly as possible.

The Scottish Government provides support to NHS boards through its Quality and Efficiency Support Team (QuEST), who have developed a number of resources to support service improvement. This includes a toolkit to help services understand demand, capacity, activity and queue. QuEST support is designed to be sustainable and focussed on meeting the needs of people using the services.

Discussions are ongoing between QuEST and each individual NHS board to review options for tailored improvement support in meeting the targets.

We will continue to monitor NHS boards’ progress against the psychological therapies and Child and Adolescent Mental Health Services HEAT targets, through monthly submissions of data to Information Services Division, which also give boards the opportunity to set out any issues they are facing in meeting the target, for example, with data collection or systems.

We have provided guidance to boards on the scope of the psychological therapies HEAT target, and through NHS Education for Scotland (NES) have produced ‘The Matrix’, a guide to delivering evidence based therapies. Also through NES, we are working to assess and develop workforce capacity to ensure that a range of staff are equipped to deliver therapies.

The current psychological therapies and Child and Adolescent Mental Health Services (CAMHS) Heat targets are to be met from December 2014. A decision has not yet been taken on the next steps for these targets. However, any future steps would take into account the integration of health and social care.

Data on waiting times for both psychological therapies and CAMHS will continue to be collected by Information Services Division.