In light of the significant circulation of measles in Wales and England, it was announced on 25 April 2013 that children aged 10–17 years will be offered a further opportunity to be vaccinated over the next few weeks. This will complement the continuation of the current activity by NHS boards of offering MMR vaccine to unimmunised and partially immunised children in the appointments given to them for receiving other immunisations.

We will be supporting this activity with a communications campaign and will be encouraging parents to take up vaccination if their children are not protected.

NHS Health Scotland’s Choose Life programme produces a range of resources for local areas and organisations to use, either internally with their work force or for their work force to give to people who are vulnerable to suicide or their family and friends. For example, the new Police Scotland is planning to issue the Choose Life key message card to all its staff so that they can refer to them and give them to members of the public as and when appropriate.

The resources are regularly updated and research undertaken to ensure that they are relevant and accessible to their intended audiences. Materials are distributed free in Scotland on request.

These include the following resources - the numbers give the monthly average distribution:

Choose Life – Don’t Hide It Pocket Card – 800

Choose Life “Read Between the Lines” Key Message Card – 1,200

Choose Life Card – 170

Read Between the Lines Posters, 4 types – 3,000

After a Suicide Mental Health Booklet – 120

The Art of Conversation, full A4 document – 400

The Art of Conversation Summary – 3,300

As part of its awareness-raising activity, the Breathing Space telephone advice line for people experiencing low mood, depression or anxiety, has distributed postcards (“Help a friend stay in the game”) developed by Choose Life, at various Scottish Premier League football games.

Breathing Space pocket cards and other ambient materials are distributed throughout the country, both direct by Breathing Space and via its various partner organisations such as Choose Life, Scottish Huntington’s Association; Veterans 1^st point; Royal National Institute for the Blind; Deafblind Scotland; and MacMillan Cancer Support – this information is specific to Breathing Space as a phone and web based service for people experiencing low mood, depression or anxiety.

Choose Life materials signpost people to help available from Samaritans and Breathing Space. Samaritans use text messages – among other methods - to support people who contact them.

Under the new Future programme at NHS24 there are plans to introduce a text messaging service – at a time to be confirmed - to support people experiencing low mood, depression or anxiety. NHS24 also have plans for an email service to complement this, again at a time to be confirmed.

As part of the childhood immunisation programme, two doses of MMR vaccine are routinely offered to children by five years of age (one dose at around 12 to 13 months of age, and a second dose from three years four months of age). Table 1 shows the number and percentage of children by doses received by five years of age. MMR vaccine uptake rates by five years of age have been monitored since 2006. Uptake rates by six years of age are also published and the available information is shown in Table 2. Information is not centrally available on the number and percentage of children vaccinated separately against measles, mumps or rubella.

Table 1: Uptake rates of MMR vaccine by five years of age in Scotland

Source: SIRS, ISD Scotland.

Ref: IR2013-00677.

Table 2: Uptake rates of MMR vaccine by six years of age in Scotland

Not available. Uptake rates of the first dose of MMR vaccine by six years of age have been monitored since 2006.

Source: SIRS, ISD Scotland.

Ref: IR2013-00677.

Currently, MMR vaccination uptake rates in Scotland are very high, with rates reaching 97.1% in children up to the age of five years. This figure exceeds the World Health Organisation target of 95%.

Since the introduction of the MMR vaccination in 1988 the uptake rates in Scotland on average did not drop below around 85%. Although the risk level is significantly lower in Scotland than in Wales or England, Health Protection Scotland (HPS) has further assessed the risks in Scotland including an analysis of work already carried out by NHS boards over the last 18 months. An HPS risk assessment at that time recognised the need for some action to target 10-17 year olds and NHS Boards were asked to vaccinate on an opportunistic basis when visiting secondary schools to deliver the existing S3 booster. This action, along with our childhood immunisation uptake rates, have placed us in a better position than other parts of the UK.

Average susceptibility rates are also very low in Scotland. However, evidence has shown that there are likely to be some pockets of coterminous small areas, particularly in urban areas, where susceptibility in 10-17 year olds may be higher. The catch up campaign for the MMR vaccine announced on 25 April is therefore a precautionary measure.

The Scottish Antimicrobial Prescribing Group (SAPG) leads on a variety of programmes and work streams to deliver on the recommendations contained within the report on Antimicrobial Use and Resistance in Humans in 2011.

The report was discussed at the Group’s February 2013 meeting and it was agreed that SAPG would work in collaboration with its stakeholders to take the recommendations forward as part of its 2013-14 programme of work.

Further details on work around the recommendations contained in the report are provided in the annex to this letter.

The MedTech Health Innovation Partnership (HIP), the Medicines Strategic Engagement Group (the equivalent of a medicines HIP) and the Digital Health Innovation Partnership will all report to the Innovation Partnership Board (IPB).

We welcome the Royal College of Physicians report as it provides further context and information towards our understanding of the many factors that impact on the provision of high quality, safe and effective care in our health services.

We are determined to continue to build upon Scotland’s excellent record in delivering safe and effective care services, in line with the ambitions of the Healthcare Quality Strategy and the 2020 Vision. Effective partnership working is integral to the success of our ambitions and to this end, we have instigated a series of regular meetings with the Royal Colleges, and the Academy of Medical Royal Colleges in Scotland to ensure we address such issues collaboratively. This engagement includes meetings with Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh.

There is a great deal of activity already underway in Scotland to address the issues highlighted within this report. In March 2013, we announced £50 million will be invested over the next three years as part of our Unscheduled Care Action Plan to help meet the growing demand on accident and emergency and other unscheduled care services, and there will be further investment in frontline staff. An expert group is now making sure that the best medical, nursing and other advice is contributing to the delivery of the action plan, and each health board has been asked to produce its own local version of the action plan to deal with the pressure points each faces.

We are also aware that that there are difficulties in recruiting to some medical specialities and welcome the launch, on 1 May, of the Strategy for the Recruitment and Retention of Trainess in Scotland, as this will enable NHSScotland to better understand career choices that medical trainees make, and thus consider ways to tackle recruitment and retention issues in a more systematic way.

We acknowledge that doctors in training posts make a substantial and valuable contribution to the delivery of patient care, including within out of hours care. It is NHS Education for Scotland(NES) which has responsibility for ensuring that all training programmes are delivered in such a way as to meet GMC quality standards. The GMC surveys all doctors in training on an annual basis, and this survey includes the collection of information on working hours, workload and work intensity, and the impact on training. NES also collects a wide range of additional information on the quality of training, and undertakes regular visits to training units to meet with trainees and trainers. Where NES identifies concerns about the quality of training, it works with health boards to put in place action plans to address these. All of this work is reported annually to the GMC, which has responsibility for approving training programmes across the UK.

We also await the recommendations from Prof. David Greenaway’s independent Shape of Training review, due later this year, as that is likely to lead to fundamental changes in the future shape of medical training across the UK. This will require careful scrutiny to understand the impact on Scotland’s health services of any change to future medical training programmes.

All NHS boards are being asked to identify an executive lead for innovation, where one does not already exist. It is the decision of boards which senior colleague they appoint to the innovation role. There are no plans to ask Boards to seek input to the selection process from outside groups.

The equivalent group for medicines is the Medicines Strategic Engagement Group, the remit of which has been drafted and will be agreed at its 15 May meeting.

The Innovation Partnership Board (IPB) is expected to consider final proposals for the Digital Health Innovation Partnership at its next meeting in June 2013.

The first meeting of the MedTech Health Innovation Partnership (HIP) took place on 1 April 2013.

The Medicines Strategic Engagement Group (the equivalent of a medicines HIP) will meet on 15 May.

The Innovation Partnership Board (IPB) is expected to consider proposals for the Digital Health Innovation Partnership at its next meeting in June 2013.