Chamber and committees

Targeted incidence surveillance by NHS Scotland boards of C. difficile in those over 65 years was made mandatory from September 2006, and this approach will be extended to include patients aged 15 years and over from April 2009.

MMR uptake rates in Scotland have been higher than in many parts of England throughout the last decade. The quarterly childhood immunisation statistics published on 30 September indicate that uptake of the MMR vaccine by 24 months in Scotland was 91.7%, whereas the comparable figure for England in 2007-08 was 85%, and uptake in London was less than 80%.

The rate of measles is also much lower in Scotland relative to the population than in the rest of the UK. In 2008 there have been a total of 53 laboratory confirmed cases of measles in Scotland, compared to 1049 laboratory confirmed cases in England and Wales to the end of October 2008.

For these reasons there are no plans to extend the English MMR catch-up campaign to Scotland. But we are not being complacent and have a number of initiatives underway that aim to reduce risk of measles, mumps and rubella. The Never Too Late campaign, launched in 2006, aims to encourage vaccination of children who may be beyond the normal age for vaccination, emphasising that it is never too late to be vaccinated. Currently there is also a national initiative to focus invitations for the second dose of MMR pre-school vaccination at the lower end of the age range for vaccinations, thereby decreasing the period of time in which children are reliant on protection from only one dose of MMR.

National surveillance of Clostridium difficile is carried out at board level although hospitals undertake local surveillance. However, in future there will be a common reporting template used by all boards to capture HAI data at hospital/service level on a number of metrics, for example MRSA, C.diff, Hand Hygiene, cleaning standards and causes of adverse incidents. Prior to October 2006 cases were reported on a voluntary basis and the systems for doing so were unreliable. Therefore only the past seven quarters of data are available. It should also be noted that the first quarter (October 2006 to December 2006) of data collection was artificially low, due to a lack of full compliance with the surveillance protocol by some hospitals.

Table showing C.diff cases for the past seven quarters, broken down by health board:

	October 06 - December 06	January 07 - March 07	April 07 “ June 07	July 07 - September 07	October 07 - December 07	January 08 - March 08	April 08 “ June 08
Ayrshire and Arran	110	151	137	152	113	125	160
Borders	13	13	18	16	20	33	25
Dumfries and Galloway	34	44	53	26	31	47	41
Fife	48	108	73	72	123	134	98
Forth Valley	64	102	54	70	81	120	126
Grampian	119	151	116	103	149	247	226
Greater Glasgow and Clyde	268	472	444	416	421	463	402
Highland	50	64	58	86	81	35	47
Lanarkshire	140	226	194	170	198	251	189
Lothian	241	258	262	212	248	259	261
Orkney	3	0	5	0	5	1	5
Shetland	4	5	2	3	2	4	1
Tayside	108	172	169	131	135	139	145
Western Isles	11	9	3	2	1	3	6
Total	1,213	1,775	1,588	1,459	1,608	1,861	1,732

Source: Health Protection Scotland: www.hps.scot.nhs.uk.

Yes. The 18 weeks referral-to-treatment standard will cover a patient''s journey from referral to treatment, including any necessary diagnostic tests.

The Better Health, Better Care: Action Plan sets out how the Scottish Government intends to achieve a patient centred NHS for the people of Scotland, which is safe, effective, efficient and equitable. It also includes a challenging target that no patient should wait more than 18 weeks for treatment following referral.

To achieve this target NHS boards will need to improve access to hospital services by increasing the effectiveness of clinical care through faster access to outpatients, diagnosis and treatment to meet the needs of their local population. NHSScotland are currently reviewing and redesigning services in each board area to provide patients with swift access to services, including where appropriate GP direct access to scans, as part of their plans to deliver the 18 weeks referral-to-treatment waiting time standard by the end of 2011.

This information is not held centrally. It is the responsibility of Alcohol and Drug Action Teams, with their local partners, to consider and put in place services which best meet local needs and priorities.

Arrest-referral schemes, to which the Scottish Government provides contributory funding, operate in the following areas:

Edinburgh and Midlothian. Action on Alcohol and Drugs in Edinburgh; Midlothian (DAAT).

Tayside: Dundee (DAAAT); Perth and Kinross (DAAT); Angus (DAAAT).

Renfrewshire: Greater Glasgow and Clyde (DAT).

Lanarkshire: Lanarkshire (ADAT).

Dumfries and Galloway: Dumfries and Galloway (ADAT).

Glasgow: Greater Glasgow and Clyde (AAT).

Aberdeen: Aberdeen City (JADAT).

The action being taken to mitigate against cross infection from these devices is to ensure regular and effective cleaning. All NHS boards have decontamination policies for patient equipment detailing when and how items should be cleaned, and more specifically that patient equipment should be cleaned prior to use on another patient. The implementation of policies relating to the decontamination/cleaning of patient equipment is monitored by the charge nurse who will ensure staff in her/his area are aware of procedures and how these should be applied.

On 8 December 2008 there were 163 patients cared for at the State Hospital. The planned capacity for the redeveloped facility will be to accommodate up to 140 patients.

Only those for whom a transfer is assessed as appropriate and safe will move to other services. Medium secure accommodation and other relevant services will deliver the forecast numbers by the 2011 commissioning date.

Exercise Cauld Craw will take place in late April and May of 2009. This exercise, based on a pandemic influenza scenario, will practice generic capabilities, (such as crisis decision making and the maintenance of essential services) that apply to any major emergency. It will also evaluate the ability to respond to challenges (such as the provision of high volumes of personal protective equipment for use by NHS staff) which are specific to a human health emergency.

Exercise Cauld Craw is aimed primarily at the Scottish Government itself. It will also involve several multi-agency Strategic Co-ordinating Groups (SCGs) and NHS boards. It will take lessons from Exercise Winter Willow which was led by the UK Government in 2007 and which also involved a number of SCGs and NHS boards.

The scheduling of future exercises involving a pandemic scenario is dependent on the relative risk from a pandemic as opposed to other potential emergencies.