Chamber and committees

Published in 2011, the TB Action Plan for Scotland contains a recommendation for the Scottish Microbiology and Virology Network (SMVN, formerly the Scottish Microbiology Forum) to consider the centralisation of mycobacterial diagnostic services into a small number of laboratories with higher throughput and defined quality standards in laboratories in Scotland.

This has now been achieved. It has occurred through a natural evolution process and via facilitation by the work of the SMVN sub-group on mycobacterial services. All board TB laboratories in Scotland are accredited by Clinical Pathology Accreditation and have achieved external quality assurance results for TB culture and microscopy of 100% in 2012. In addition, Scottish TB laboratories have exceeded the European Centre for Disease Prevention and Control target for 80% of all new pulmonary TB cases to be confirmed by culture.

An ‘exempt visitor’ is a person who is not ordinarily resident in the UK who is exempt from NHS charges under the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989, as amended.

Further information on people who may not be charged for conditions (including eye conditions) that occur during a visit to the UK can be found at:

http://www.scotland.gov.uk/Topics/Health/Services/Overseas-visitors

Free NHS eye examinations are available annually, where required, for children aged under 16 and adults aged 60 and over.

For children rapid growth may require them to attend for eye examinations annually. Cases where it is particularly important for annual eye examinations in children include the detection and up to date correction of refractive error and early and regular intervention to reduce visual loss due to squints.

For adults the incidence of eye disease increases dramatically with age and with poor general health. Cataract, glaucoma, and macular degeneration are common causes of visual loss in older people. Frequent refractive error changes, and the screening and monitoring of disease development and progression are vital to maintain optimal vision. Good vision does not rule out the possibility of sight threatening eye disease and regular eye examinations in older people are most important.

Less frequent examinations may be recommended by the optometrist where the likelihood of ocular disease and refractive change is low.

Supplementary eye examinations are available to all, free of charge, where required. Supplementary eye examinations are undertaken for a range of reasons including follow up or repeat tests or procedures to monitor an abnormality or suspect abnormality; referral refinement before deciding if a patient requires referral to secondary care; where a patient has a problem with their eyes before their next primary eye examination is due.

NHS eye examinations are free to all UK residents, irrespective of the place of residence, when provided in Scotland.

No assessment has been undertaken by the Scottish Government on the impact that free NHS eye examinations have had on sight threatening conditions.

There are a number of factors which impact on sight and increase the incidence of blindness, including an ageing population and poor general health.

The free NHS eye examination is one in a number of changes in how we deliver eye care services, with the emphasis now being on the screening and monitoring of eye disease in community optometric practices. The introduction of the supplementary examination has further supported practitioners in the early detection of sight-threatening disease. Early detection of sight threatening problems and appropriate and timely referrals from the optometrist to the ophthalmologist are key.

Changes to secondary care treatments, improvements to ophthalmic surgical techniques and increased patient care have also resulted in the ability to save the sight of more patients.

An unregulated person carrying out tooth whitening is considered to be unlawfully holding themself out as practising, or being prepared to practise dentistry, contrary to sections 38 (1) and (2) of the Dentists Act 1984. This legislation is a reserved matter, however the General Dental Council has provided the following information.

2014: five prosecutions, five convictions;

2013: three prosecutions, three convictions;

2012: two prosecutions, two convictions;

2011: two prosecutions, two convictions.

No information is available prior to 2011.

The costs of administering the registration process for the minor ailment service is approximately £96,000 per annum.

Some 1,559,000 patients have been registered at some point for the minor ailment service since prescription charges were abolished in April 2011. The total number of current registrations is 956,858.

It is for NHS boards to determine, based on local priorities and clinical need, the level of local ophthalmic service they provide in order to meet the needs of their population.

The Visual Impairment Network for Children and Young People (VINCYP) was designated a national managed clinical network on 1 April 2014. VINCYP aims to bring together health, education and social care agencies to improve the care for visually impaired children and young people. The network has been commissioned by NHS National Services Scotland and an official launch is scheduled for 30 May 2014.

The Scottish Government has invested £2 million to implement the recommendations in the ‘See Hear; A Strategic Framework for meeting the needs of people with a sensory impairment’ published on 24 April 2014 and will work with service providers, service users and relevant voluntary and statutory agencies to achieve this.

Midwives are recognised as a key group in promoting the benefits of pertussis vaccination and rubella screening.

The pertussis immunisation programme for pregnant women was introduced in October 2012 in response to a UK wide outbreak of pertussis. The programme aims to provide passive immunity to young infants in the first few weeks of life before they are old enough to start their immunisation schedule at eight weeks of age. Most pregnant women are vaccinated against pertussis in their GP practice.

Prior to the introduction of the programme, training materials were produced by NHS Education for Scotland for registered healthcare professionals and midwives and a revised version will be issued in May this year.

A leaflet explaining the benefits of vaccination is also provided to pregnant women by NHS Health Scotland.

A point of delivery audit was undertaken in the main maternity units in Scotland in January 2013, which estimated that uptake of the vaccine was high at 78.1%. HPS is currently working on a mechanism to obtain regular uptake data via general practices for the routine monitoring of this programme.

HPS monitors the incidence of pertussis and this includes collecting a dataset on all laboratory confirmed cases under one year of age, including whether the mother was vaccinated during pregnancy.

The number of laboratory confirmed cases in infants < 1 year, declined by over 85% from 140 cases in 2010 to 19 in 2013.

MMR vaccine is offered to women immediately after pregnancy if they have been identified as not immune to rubella during screening tests in pregnancy. Screening for rubella antibodies is one of the routine tests offered to all pregnant women at their first appointment with their midwife at around two to three months pregnant. Information about Rubella immunity is also included in the pregnancy screening guide which is issued to every pregnant woman in Scotland.

The MMR vaccine is the only licensed rubella vaccine in the UK. It is a live vaccine and should not be given to pregnant women. So although screening for rubella immunity happens during pregnancy, MMR vaccine can only be given after delivery and offers protection for future pregnancies.

Rubella screening services are commissioned by each NHS board and at this time there is no national system where screening and vaccination are recorded. However, a number of initiatives have been developed to monitor pregnancy and newborn screening programmes at the local (NHS board) level.

Clinical standards for pregnancy and newborn screening were developed by NHS Quality Improvement Scotland in 2005.

NHS National Services Division (who commission screening services in Scotland) developed quality indicators for pregnancy and newborn screening in 2011. These indicators included an indicator for uptake of MMR in rubella susceptible women within five days after delivery. NHS boards provided preliminary data against these indicators in 2011-2012 but the data was not robust enough to be reported.

NHS Healthcare Improvement Scotland published a series of indicators for pregnancy and newborn screening in 2013. There is no specific indicator for uptake of MMR. This can be found at:

http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal__child/programme_resources/pns_indicators.aspx

Rubella screening for pregnant women is a routine and well established part of pregnancy and newborn screening.