Chamber and committees

The Executive does not collate that data. The Packaging (Essential Requirements) Regulations 2003 are regulations of the United Kingdom Government and relate to reserved matters.

The Scottish Executive’s main concern is that decisions made by Children’s Hearings result in positive outcomes for the child. Children’s Hearings need a range of disposals to meet the needs of individual children. Different disposals require different resources. Each disposal must be right for the child.

I refer the member to the answer given to question S2W-13791, answered on 8 February 2005. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.scottish.parliament/webapp/wa.search.

The Review of the Children’s Hearings system has identified the need to put robust monitoring and evaluation procedures in place, including procedures to evaluate the outcomes of different disposals. The Scottish Executive will therefore be considering with local partner agencies how we can best deliver monitoring and evaluation procedures. Consideration will be assisted by Scottish Executive commissioned research intended to inform decision-making about the most effective use of secure accommodation. The research aims to provide a clearer understanding of the purpose and effectiveness of secure care in meeting the needs of young people, their families and communities. The project’s two interimreports will be published on the Scottish Executive website within the next few weeks.

The Scottish Executive uses 23 indicators to monitor trends in health inequalities in Scotland. These indicators were set out in Improving Health in Scotland – The Challenge (2003) and are listed below for information:

Population Group	Indicator of Inequality
Children	1. Smoking during pregnancy 2. Breastfeeding 3. Dental health of children 4. Low birthweight babies 5. Accidents in children aged 0-9 (hospital admissions) 6. Infant mortality
Young People1	7. Accidents in children aged 10-14 (hospital admissions) 8. Teenage pregnancies (females aged 13-15) 9. Teenage pregnancies (females aged 13-19) 10. Suicides among young people aged 10-24
Adults2	11a. Diet – consumption of fresh fruit 11b. Diet – consumption of green vegetables 12. Adult smoking 13a. Self-reported general health in people aged 16-44 13b Self-reported general health in people aged 45-64 14. Self-reported limiting long-standing illness 15. Obesity 16. Mental health (GHQ12 scores) 17. All cause mortality rate among people under 75 18. Mortality rates from coronary heart disease among people under 75 19. Mortality rates from cancer among people under 75 20. Life expectancy at birth
Older People	21. All cause mortality rate among people over 75. 22. Mortality rates from coronary heart disease among people 75 and over 23. Mortality rates from cancer among people 75 and over

 

Trends on Health Inequalities within Scotland for all these indicators were published in March 2004, in a Scottish Executive report entitled: Inequalities in Health – Report of the Measuring Inequalities Working Group. A copy of this report is available at http://www.scotland.gov.uk/library5/health/hirnov03.pdf.

Health Inequalities in Scotland are measured by comparing outcomes of the 20% most deprived postcode sector areas with the 20% most affluent, defined by the Carstairs Index of Deprivation. (Work is underway to convert the health inequalities measure to the new Scottish Index of Multiple Deprivation).

The Scottish Executive uses five indicators to monitor trends of health inequalities within NHS boards. This is done by comparing outcomes of the 20% most deprived postcode sector areas within each NHS board with the 20% most affluent. The five indicators used for this purpose are listed below:

Population Group	Indicator of Inequality
Children	1. Smoking during pregnancy 2. Dental health of children
Adults	3. Adult smoking 4. Mortality rates from coronary heart disease among people under 75 5. Life expectancy at birth

 

Recent data and trends for each of these indicators, by NHS board, is available via the NHS Performance Assessment Framework (PAF) system, under section 1.14, at http://paf.isd.csa.scot.nhs.uk/pafn/.

Further information on health outcomes by NHS board is available via the PAF system or via the website of the Information and Statistics Division of the NHS at http://www.isdscotland.org/isd/.

The recommendations of the expert group and details of the actions taken in response to each are as follows:

Recommendation 1

The Scottish Executive should agree to make compensation payments as a matter of urgency to all people who can demonstrate, on the balance of probabilities, that they received blood, blood products or tissue from the NHS in Scotland before the dates when they were made HCV-safe and who were subsequently found to be infected with hepatitis C virus (HCV).

A UK ex-gratia payment scheme has been established. The Skipton Fund, which administers the scheme and started operations on 5 July 2004, has to date settled over 400 Scottish claims amounting to around £8.5 million. Details of the scheme are available at www.skiptonfund.org.

Recommendation 2

The Scottish Executive should consider how it could fund and develop other mechanisms for supporting people who suffer from HCV including services delivered by voluntary organisations. In particular, additional support in the following areas should be considered:

(a) Access to understandable information on HCV

(b) Counselling Services

(c) Access to information on benefits available

(d) Advice and assistance in securing appropriate and adequate assurance and insurance

(e) Setting up a pro-active publicity campaign spearheaded by the Health Education Board for Scotland.

(f) Improved access to palliative care and symptom management services when appropriate.

Since 2002, the Executive has also funded the establishment and ongoing activities of the UK Hepatitis C Resource Centre in Scotland which is based in Glasgow and offers advice on testing and treatment to those affected by hepatitis C. The services provided by Hepatitis C Resource Centre are in addition to those provided by individual NHS boards.

The Scottish Executive has commissioned Health Protection Scotland to estimate the current and future burden of HCV-related disease in Scotland over the next two decades. Further work is also being commissioned to identify how much it will cost NHSScotland to care for individuals infected with hepatitis C and how cost-effective different approaches to hepatitis C case finding and treatment would be.

The Executive is also developing an action plan, in consultation with stakeholders, for issue in spring 2005. The main objectives of the plan are to set out the actions that will (a) reduce the transmission of HCV and (b) manage the burden of disease among those individuals who know they are infected and those who do not. Key areas of the plan will cover treatment and care and education and training.

The Health Department is working with clinicians to develop Managed Clinical Networks for Hepatitis C. A further meeting in February is proposed.

Recommendation 3

The Scottish Executive should invite the Scottish Legal Aid Board (SLAB) to consider the following:

(a) Proceeding with the development of the template on Advice and Assistance as soon as possible;

(b) Including in the template provision for meeting/negotiation with the defender;

(c) Including in the template provision for class actions as well as individual clinical negligence cases;

(d) Updating the guidelines to the profession;

(e) Introducing an “interests of justice” test for civil legal aid applications in clinical negligence cases, and

(f) Proceeding towards the making of staged payments.

Reform of Civil Advice and Assistance is the subject of recent SE consultation procedures- available from the Executive website at http://www.scotland.gov.uk/consultations/justice. This consultation deals with proposals for granting and providing civil advice and assistance, as well as remuneration of practitioners. Templates to deal with different types of cases following the Consultation procedures are to be drawn up as part of this process by SLAB.

Recommendation 4

(a) That the Scottish Executive should consider including the following in their revision of the NHS complaints procedure: better training for complaints/claims handling staff; more accessible information for complainants and claimants in clinical cases; more emphasis on face to face or telephone contact to clarify points not clearly expressed; increased support or advocacy for complainants and claimants in the early stages to prevent complaints escalating and to enable complaints to be dealt with appropriately.

(b) The Scottish Executive should consider encouraging NHS trusts and boards to use their power to make ex-gratia payments under the NHS complaints procedure in respect of “lesser injuries”.

The Executive has taken all of these points into consideration in devising the new procedure, which it is hoped will be issued within the next few months. The new complaints procedure will place more emphasis on early resolution of complaints with more face to face contacts where appropriate. The Health Rights Information Scotland project (part of the Scottish Consumer Council) will provide a leaflet with information that they consider patients need and will consider in what ways this should be made accessible.

The power to make ex-gratia payments remains an option for consideration by individual NHS boards on completion of investigations under the complaints procedure. Details can be found at:

http://www.show.scot.nhs.uk/publications/me/complaints/CHS/Section2/020_180CompletionOfTheComplaintsProcedure.htm.

(a) We endorse the recommendation made by the Royal Society of Edinburgh in their Report “Encouraging Resolution - Mediating patient/health service disputes in Scotland”, that the Scottish Executive should, in conjunction with the National Health Service Scotland Central Legal Office (CLO), undertake a fully researched mediation project mirroring that being undertaken by the National Health Service Litigation Authority (NHSLA) in England.

A working group with representation from the Executive’s Health and Justice Departments, Central Legal Office, an NHS Board Medical Director, the Medical and Dental Defence Union in Scotland and Edinburgh University was set up to take this recommendation forward and the group is currently finalising a specification for a fully researched project in resolving clinical negligence claims through mediation. The project is expected to run for a period of three years from 1 April 2005.

(b) The Scottish Executive should consider making initial funding available for Action against Medical Accidents (AvMA) to open a Scottish branch.

The Executive (Health Department) is currently working with AvMA on a funding proposal to develop AvMA's presence in Scotland.

(c) The Scottish Executive should invite the Law Society and the Scottish Legal Aid Board to consider increasing the level of fees to solicitors in civil business to enable them to pursue clinical negligence cases and also to enable increased expenditure to be available for payment of outlays in relation to reports, e.g. medical reports.

An interim 5% increase was made to fees in civil advice in June 2004. This would affect clinical negligence type cases as well as any other type of civil aid case that required to be legally funded subject to the usual tests of probable cause and appropriate to receive legal aid on eligibility grounds.

(d) The Scottish Executive should draw the attention of the Lord President of the Court of Session to the need for implementation of judicial management procedures for complex clinical negligence cases.

Enquiries are being made to establish the current position.

(e) The Scottish Executive should encourage the Central Legal Office to continue and develop its practice of offering structured settlements early in the negotiating process.

A number of settlements have been reached on a structured basis, and the Central Legal Office will continue to encourage this process in appropriate cases.

I will write to you separately when enquiries have been completed on 4(f) and will place a copy of my response in the Parliaments Reference Centre.

There are no plans to link the deprivation criteria in Arbuthnott to successful health outcomes in reducing health inequalities. The formula is about distributing resources on the basis of need by taking into account levels of deprivation across health boards.

We intend to propose an extension of the statutory nuisance provisions of the Environmental Protection Act 1990 to include light pollution when a suitable legislative opportunity arises.

Action on health inequalities is central to our health improvement strategy and we have set ambitious targets in Building a Better Scotland, and Closing the Opportunity Gap, to increase the rate of health improvement for the most deprived communities by 15% by 2008, measured across a range of key indicators.

NHSScotland has a key role to play in this and we are preparing guidance to support NHS boards in stepping up the rate of change. Community Health Partnerships, which will have tackling health inequalities as a central aim, offer a new opportunity for focused action at local level to make a difference. £15 million invested in Unmet Needs projects is helping to improve access to health care for those in Scotland’s most deprived communities and will inform and underpin future practice throughout NHS Scotland. The £1 million per annum support for the Glasgow Centre for Population Health will help create solutions and provide leadership for action to improve health and tackle health inequalities in Glasgow and the West of Scotland, and more widely. Our decisionto improve public health through the banning of smoking in public places presentsthe greatest opportunity in decades to reduce health inequalities and will makea major contribution, given the greatest burden of smoking and ill-health is amongst Scotland’s most deprived communities.

By 2 February 2005, only one local authority, the City of Edinburgh Council, had formally submitted a copy of their resolution to Scottish ministers to apply the noise control provisions to all of its area, as required under section 41(5)(b)(i) of the Antisocial Behaviour etc. (Scotland) Act 2004.

A total of twenty two local authorities have, however, applied to the Scottish Executive for funding to assist in the discharge of the noise provisions of the act. These provisions have not yet commenced as supporting regulations to the act – the Antisocial Behaviour (Noise control) Regulations 2005 – have still to come into force.