Chamber and committees

The decision by the Chief Dental Officer was based on a request by NHS Highland to recruit a fixed term vacant salaried dentist post. This decision has no bearing on the Scottish Government’s long term commitment to NHS dental services in Skye.

NHS Highland is currently formalising a strategy for primary care dental services. Recruitment to a fixed term post at this stage will provide flexibility in terms of planning.

Table 1 and 2 provide available data for liver-related deaths among those diagnosed with hepatitis C in Scotland, and by age group, for the period 2007 to 2012. Data on age-standardised deaths from hepatitis C, and by parliamentary constituency is not available. Data for 2012 are provisional as they are not yet published.

Table 1: Number of liver-related deaths* among those diagnosed with hepatitis C in Scotland each year 2007-2013

* Deaths were defined as related to liver disease if the underlying cause of death was either (a) viral hepatitis, (b) liver cancer, (c) alcoholic liver disease or (d) non-alcoholic liver disease, or the contributing cause of death was either (b), (c) or (d).

** Data for this year are provisional.

Table 2: Number of liver-related deaths* among those diagnosed with hepatitis C in Scotland each year 2007-2013, by age group

In relation to the NHS, the testing, diagnosis and treatment of people with hepatitis C has been a Government priority since the publication of the Hepatitis C Phase 2 Action Plan in 2008. This priority is maintained in the Sexual Health and Blood Borne Virus Framework, which specifically requires multi-agency partners in local areas to work together to deliver local strategies on early diagnosis and treatment of those infected.

As a result of the government’s investment in these activities the cumulative number of individuals diagnosed with hepatitis C, and not known to have died, has increased from 18,638 in 2007, to 29,952 in 2013. Likewise the number of people commencing hepatitis C therapy every year has more than doubled from fewer than 500 per year to over 1,000 per year.

In relation to alcohol and drug partnerships (ADPS) the Scottish Government has worked in partnership with ADPs to strengthen governance and accountability arrangements and to develop and agree a set of core ADP outcomes and indicators. One of the national indicators that ADPs are expected to report against on an annual basis is the prevalence of hepatitis C among people who inject drugs. It is expected that ADPs will already be providing this information to their local community planning partnerships.

A confidential blood borne virus service, incorporating hepatitis C, is available to all prisoners within the Scottish Prison Service. This service includes immunisations, testing and counselling, treatment and harm reduction awareness-raising. Around 580 prisoners have been tested for hepatitis C every year since 2010. The Sexual Health and Blood Borne Virus Framework highlights the importance of ensuring that around 10% of those initiated onto treatment every year are prisoners. This target has been met, with more than 10% of all treatment initiations in Scotland taking place in prison every year since 2009-10.

Data on the number of people in the prison setting who have received a test for hepatitis C and who were diagnosed is provided in Table 1 below, along with the annual total number of diagnoses in prison. The test data represent tests undertaken in NHS Greater Glasgow and Clyde, NHS Lothian, NHS Grampian and NHS Tayside.

The number of chronically infected people initiated on hepatitis C antiviral therapy within the prison setting is provided in Table 2. These data are available by financial year only. These data indicate an increase in provision of therapy in this setting.

Data on treatment completion and response to treatment are not available at this time for the prison setting

Table 1: Hepatitis C testing and diagnosis in the prison setting 2007-2013:

*HCV testing data currently only available for NHS Greater Glasgow and Clyde, NHS Lothian, NHS Tayside and NHS Grampian

Table 2: Number of chronically infected people initiated on hepatitis C antiviral therapy within the prison setting, Scotland 2007 -2013

* Data for this year are provisional.

The Scottish Government will publish an updated framework in 2015, as a successor to the current framework. The new framework will retain the current high level outcomes, but will reflect relevant major developments, including changes in the hepatitis C treatment landscape.

The Sexual Health and Blood Borne Virus Framework sets out five high level outcomes the government wishes to see delivered. To support monitoring of progress against these outcomes the frameworks includes a range of detailed data indicators. When the current framework comes to an end in 2015, the Scottish Government will produce a report evaluating the progress made under the framework, based on these key indicators as well as reports on progress from NHS boards and other partners.

The Scottish Government will continue to ensure that people who wish to have access to a NHS dentist, can do so. Over 4.4 million people across Scotland are now registered with a NHS dentist. This constitutes an increase of 1.8 million since March 2007.

We will also continue to prioritise child oral health through preventative programmes such as Childsmile. The latest report from the National Dental Inspection Programme showed that almost 70 per cent of P1 pupils have no obvious sign of tooth decay compared with only 44 per cent in 2003.

We are working with NHS boards to deliver commitment 12 of the Mental Health Strategy to reduce admissions of under 18s to adult wards, with a new commitment to reduce figures across Scotland to a figure linked to current performance in the South of Scotland area during delivery of the strategy timeframe 2012-15. To support this we have:

Made a significant investment (£13.5 million from 2009 to 2014) to deliver faster access to specialist child and adolescent mental health services in the community; and in the CAMHS workforce which has seen the overall clinical workforce increase by 44% since 2008.

We have with ISD and the CAMHS regional tier 4 network, developed a data set to track progress in developing intensive community treatment teams and how the adolescent inpatient units are working. We are continuing to work with the CAMHS regional tier 4 networks to ensure that tier 4 services for children and young people are operating effectively and safely.

To meet the needs of children and adolescents, the North of Scotland are building a new 12 bed inpatient unit to replace the current 6 bed unit. This will increase the national bed base from 42 to 48 beds, and improve the quality of the estate.

There are some reasons why it may not always be possible for a young person to be admitted to a specialist child and adolescent bed, for example, a crisis admission out of hours where there are concerns for the young person’s safety, or where a specialist facility might be a considerable distance from family support that could help recovery.

The Scottish Government notes the Mental Welfare Commission’s report on The care and treatment of Mrs CD.

In meeting commitment 19 of the Mental Health Strategy 2012-15 on improving how services respond to distress, a draft report on work to develop and test an approach which focuses on improving responses to distress will be published by NHS Tayside later this year.

Responding to people in distress is one of five themes in the recently published Suicide Prevention Strategy (2013–2016). In addressing commitment 1 under this theme and building on the work in relation to commitment 19 above, we have arranged three stakeholder events, the next one being on 24 June 2014 in Glasgow, to allow colleagues from a range of sectors to work through the challenge of improving responses to the underlying causes of distress in people for whom current practices are ineffective.

Commitment 30 of the Mental Health Strategy: 2012-15 builds on the work at HMP Cornton Vale testing the effectiveness of training prison staff in a 'mentalisation' approach to working with women with borderline personality disorder and women who have experienced trauma. We have provided funding to support a two-year pilot programme at HMP & YOI Cornton Vale and HMP Edinburgh with the aim of improving the care, treatment and support of women with personality disorders through the development of therapeutic relationships and environment. The Scottish Prison Service (SPS) is currently reviewing how best to incorporate the concept of ‘mentalisation’ into the development of the SPS Framework for the Management of Women Offenders in Custody and the Staff Training Strategy.

We have also committed to work with NHS Lothian to test an approach to working with women with borderline personality disorder in the community by extending the Willow Project in Edinburgh. We will use the learning from this to inform service development more widely across Scotland.

With access to NHS dental services improving it is appropriate for NHS Dumfries and Galloway to review their service provision in order to ensure routine dental care is provided by independent contractors where possible.

The proposed changes are about migrating patients in need of routine dental care from salaried General Dental Services (GDS) to independent contractor GDS with a consequential shift in resources.