Questions and answers

Question reference: S4W-18444

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Monday, 18 November 2013
Current Status: Answered by Alex Neil on 28 November 2013

To ask the Scottish Government how many cancer clusters were identified in (a) 2004, (b) 2005, (c) 2006, (d) 2007, (e) 2008, (f) 2009, (g) 2010, (h) 2011 and (i) 2012 and have been identified in 2013; what criteria must be met for a group of cancers to be considered to be a cluster; where and how these were identified; what causes have been suggested; what action has been taken; what agencies are involved in identifying and explaining cancer clusters, and how the number of clusters in Scotland compares with other countries.

Prospectively looking for cancer clusters is not regarded as a useful method of cancer prevention. A study by the International Agency for Research on Cancer demonstrated that clusters found by scanning methods may be caused by localised exposure to environmental or occupational carcinogens, infectious processes or random variation and that it is very difficult to distinguish between these.

Information Services Division investigate suspected cancer clusters when an organisation such as an NHS board or member of the public believe that cancer incidence or mortality is higher than normal in a particular area. ISD also investigate suspected cancer clusters where there is a concern about a possible source of carcinogens in a particular area.

When investigating suspected cancer clusters, ISD works with health boards, the Scottish Government and other groups such as the Committee on Medical Aspects of Radiation in the Environment.

The usual method of investigation is to calculate standardised incidence ratios (or standardised mortality ratios if mortality is being investigated). This compares the actual number of cases in an area with the number that would be expected if the rates from a reference population are applied to that area (the reference population is usually Scotland but other areas can be used).

Table 1 shows the number of initial investigations into suspected cancer clusters that ISD have carried out since 2004 and how many of these investigations found statistically significant increases in cancer incidence in the areas being investigated. It should be noted that a statistically significant difference alone does not indicate that there is a causal relationship and the potential exposure of concern. More in-depth investigation would normally be required for this to be determined.

Table 1: Number of investigations into suspected cancer clusters and the number that returned statistically significant results; 2004-2013

	Completed information requests on cancer clusters	Number of statistically significant results
2004	4	0
2005	1	0
2006	0	0
2007	2	1
2008	1	1
2009	2	0
2010	4	0
2011	7	0
2012	2	1
2013	3	2
Total	26	5

Source: ISD Scotland

Ref: IR2013-02039

ISD are not aware of any collection of data on cancer clusters that would enable comparison between Scotland and other countries.

Question reference: S4W-18383

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Monday, 18 November 2013
Current Status: Answered by Alex Neil on 28 November 2013

To ask the Scottish Government how many oncology specialists there have been in the NHS and specialising in which cancers in each of the last six years, broken down by NHS board.

Information on the total number of consultants in medical and clinical oncology and the number of clinical nurse specialists (CNS) in oncology by NHS board in headcount and whole time equivalent can be found in the following tables.

Information on the number of consultants by cancer site is not available.

Please note, the figures shown in the tables below may not reflect the true number of consultants who work in oncology as the recording of consultants specialties does not take into account the duel or multi specialisms which some consultants practice.

Information on the number of clinical nurse specialists by cancer site is available at:

https://isdscotland.scot.nhs.uk/Health-Topics/Workforce/Publications/2013-11-26/Clinical_Nurse_Specialists_S2013.xls?31631977

A change in the definition of a clinical nurse specialist in 2011 means that the numbers are not strictly comparable across the years, in addition due to the multidisciplinary nature of the CNS role a nurse may work in more than one specific specialty.

Table 1. The number of medical oncologist consultant staff in post in NHS Scotland from Sep 2008 to Sep 2013 (WTE and headcount):

Sep-08

Sep-09

Sep-10

Sep-11

Sep-12

Sep-13

	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count
NHS Scotland	33.0	38	8.9	12	11.1	13	9.9	13	7.7	9	8.7	9
NHS Ayrshire and Arran	-	-	-	-	2.0	2	1.0	1	-	-	-	-
NHS Grampian	1.0	1	1.0	1	1.0	1	1.0	1	-	-	1.0	1
NHS Greater Glasgow and Clyde	6.5	8	5.4	7	1.5	2	2.8	4	2.1	3	3.0	3
NHS Highland	-	-	-	-	1.0	1	1.0	1	1.0	1	1.0	1
NHS Lothian	24.3	27	1.3	2	4.4	5	2.9	4	2.9	3	3.0	3
NHS Tayside	1.2	2	1.2	2	1.2	2	1.2	2	1.7	2	0.7	1

Source: Scottish Workforce Information Standard System (SWISS), ISD Scotland

Ref: IR2013-02040

Table 2. The number of clinical oncologist consultant staff in post in NHS Scotland from Sep 2008 to Sep 2013 (WTE and headcount)

Sep-08

Sep-09

Sep-10

Sep-11

Sep-12

Sep-13

	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count
NHS Scotland	65.1	70	46.4	49	78.5	85	81.3	88	82.2	89	79.6	86
NHS Grampian	7.0	7	7.4	8	7.4	8	7.0	7	7.8	8	5.6	6
NHS Greater Glasgow and Clyde	25.8	28	26.4	28	41.8	46	39.8	44	40.2	44	39.8	43
NHS Highland	4.0	4	4.0	4	3.0	3	3.0	3	3.0	3	3.0	3
NHS Lothian	21.7	24	-	-	18.0	19	23.1	25	23.4	25	23.4	25
NHS Tayside	6.6	7	8.6	9	8.4	9	8.4	9	7.8	9	7.8	9

Source: Scottish Workforce Information Standard System (SWISS), ISD Scotland

Ref: IR2013-02040

Table 3. The number of oncology clinical nurse specialists staff in post in NHS Scotland from Sep 2008 to Sep 2013 (WTE and headcount

Sep-08

Sep-09

Sep-10

Sep-11

Sep-12

Sep-13

	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count	WTE	Head count
NHS Scotland	165.2	180	170.0	187	182.6	198	245.1	271	242.8	269	237.7	264
National Waiting Times Centre	-	-	-	-	-	-	-	-	1.0	1	1.0	1
NHS Ayrshire and Arran	14.4	15	12.6	14	13.0	14	13.0	14	13.4	15	13.8	15
NHS Borders	4.4	5	4.4	5	3.4	4	3.4	4	3.4	4	2.4	3
NHS Dumfries and Galloway	7.0	7	7.0	7	7.0	7	8.4	9	7.4	8	7.4	8
NHS Fife	8.8	9	9.5	10	8.0	8	8.0	8	7.8	8	7.7	8
NHS Forth Valley	11.8	13	10.8	12	10.8	12	10.8	12	9.8	11	9.6	11
NHS Grampian	10.7	13	20.4	24	19.6	22	21.4	24	22.4	25	26.9	30
NHS Greater Glasgow and Clyde	42.6	45	40.7	43	54.6	57	57.9	61	58.3	61	52.4	55
NHS Highland	11.5	13	11.3	13	11.5	13	11.5	13	11.3	13	10.5	12
NHS Lanarkshire	13.0	14	14.5	16	15.1	17	32.8	37	32.3	37	32.1	37
NHS Lothian	13.1	17	12.0	15	12.1	15	52.9	63	51.9	61	51.0	60
NHS Orkney	-	-	-	-	0.7	1	0.7	1	0.7	1	0.7	1
NHS Shetland	2.8	3	2.8	3	2.8	3	3.0	3	3.7	4	3.0	3
NHS Tayside	20.2	21	19.2	20	19.2	20	17.4	18	15.4	16	13.4	14
NHS Western Isles	4.8	5	4.8	5	4.6	5	3.8	4	3.8	4	5.6	6

Source: Scottish Workforce Information Standard System (SWISS), ISD Scotland

Ref: IR2013-02040

Question reference: S4O-02634

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Wednesday, 20 November 2013
Current Status: Taken in the Chamber on 27 November 2013

To ask the Scottish Government what criteria VisitScotland uses to determine whether a town is a suitable location for a visitor information centre.

Question reference: S4O-02601

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Wednesday, 13 November 2013
Current Status: Taken in the Chamber on 21 November 2013

To ask the Scottish Government for what reason there was a decrease in funding for the disabled students allowance in 2012-13.

Question reference: S4W-17951

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Tuesday, 29 October 2013
Current Status: Answered by Alex Neil on 12 November 2013

To ask the Scottish Government, further to the answer to question S4O-02492 by Alex Neil on 10 October 2013 (Official Report, c. 23561), whether it will provide an update on how many additional (a) accident and emergency consultants and (b) nurses each NHS board has recruited under the unscheduled care action plan.

The following tables provide updated data on the number of additional accident and emergency consultants and nurses that have been recruited under the unscheduled care action plan so far.

Consultants:

NHS Board	A&E Consultants (WTE)
Borders	1
Dumfries and Galloway	0.85
Forth Valley	2
Grampian	1.5
Greater Glasgow and Clyde	3
Highland	1
Lanarkshire	1
Lothian	5
Tayside	3
TOTAL	18.35

Nurses

NHS Board	A&E Nurses (WTE)
Ayrshire and Arran	20
Borders	6.1
Dumfries and Galloway	1
Fife	6
Grampian	5.3
Greater Glasgow and Clyde	3.2
Lanarkshire	5.24
TOTAL	46.84

Question reference: S4W-17953

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Tuesday, 29 October 2013
Current Status: Answered by Alex Neil on 12 November 2013

To ask the Scottish Government, further to the answer to question S4O-02492 by Alex Neil on 10 October 2013 (Official Report, c. 23561), whether it will provide a breakdown of the (a) date each consultant (i) was appointed and (ii) started employment and (b) hospital at which each consultant is based.

The following table provides a breakdown of the date each consultant was appointed, started employment and hospital where each consultant is based.

NHS Board	Date of Appointment	Employment Start Date	Hospital Base
Borders	28 October 2013	1 April 2014	Borders General Hospital
Dumfries and Galloway	19 August 2013	16 September 2013	Dumfries and Galloway Royal Infirmary
Forth Valley	30 July 2013	4 November 2013 2 December 2013	Forth Valley Royal Hospital
Grampian	5 September 2013	9 September 2013 and February 2014	Both will be based at Aberdeen Royal Infirmary
Greater Glasgow and Clyde	July 2013 (x3)	August 2013 (x2) September 2013 (x1)	Royal Alexandra Hospital RHSC Victoria Infirmary
Highland	22 August 2013	25 November 2013	Raigmore Hospital
Lanarkshire	tbc	January 2014	Hairmyres
Lothian	22 October 2013	Between January – March 2014	St John’s Hospital (x3) Edinburgh Royal Infirmary (x2)
Tayside	31 July 2013 (x2) 24 October 2013 (x1)	1 November 2013 (x2) To be confirmed (x1)	Ninewells

Question reference: S4W-17952

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Tuesday, 29 October 2013
Current Status: Answered by Alex Neil on 12 November 2013

To ask the Scottish Government, further to the answer to question S4O-02492 by Alex Neil on 10 October 2013 (Official Report, c. 23561), whether its media office subsequently briefed reporters that there were more consultants in addition to the number given in the answer and, if so, (a) for what reason, (b) what the additional number in the briefing was and (c) whether the figure provided in the briefing for consultant doctors incorporated nurse recruitment numbers.

The Scottish Government media office subsequently released information in relation to more consultants in addition to the number given in answer to question S4O-02492 by Alex Neil on 10 October. The media release clarified the number of consultants recruited across Scotland at the time of answering the initial question was 13. The three consultants referred to in Alex Neil’s answer related specifically to NHS Greater Glasgow and Clyde and not Scotland wide. This figure did not include nurses. The original answer did not specify the number of consultants or nurses recruited Scotland wide; it did state that recruitment within health boards was fully underway.

Question reference: S4W-18006

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Wednesday, 30 October 2013
Current Status: Answered by Alex Neil on 12 November 2013

To ask the Scottish Government what discussions it has had with other governments that have introduced price controls for (a) alcohol and (b) other products in order to protect public health.

Scottish Government policies are formulated and developed using evidence-based information, and this includes policies relating to public health. Part of the process of understanding evidence-based information involves discussions with all relevant parties and this may well include other governments.

The Scottish Government is at the forefront of trying to introduce a pricing control such as minimum unit pricing in order to protect public health. Other European countries are becoming increasingly interested in our policy and we have had discussions with various countries.

We are well aware of the strong empirical evidence coming out of Canada that shows that minimum pricing of alcohol will reduce consumption and alcohol-related harm.

Question reference: S4W-18005

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Wednesday, 30 October 2013
Current Status: Answered by Alex Neil on 12 November 2013

To ask the Scottish Government, in light of the introduction of minimum unit pricing of alcohol, what its position is on introducing other price controls in order to protect public health.

Pricing controls can play a part in contributing to protect public health, and consideration will be given where there is evidence that a pricing control policy is likely to be effective.

As regards alcohol, there is strong evidence that pricing controls are effective in reducing alcohol consumption and alcohol-related harm. The Scottish Government firmly believes minimum unit pricing is the most effective price control mechanism to tackle alcohol misuse, and we will continue to press for its introduction at the earliest opportunity.

The Scottish Government introduced the alcohol quantity discount ban in October 2011 which is aimed at protecting public health. The quantity discount ban is designed to not encourage consumers to buy more alcohol than they had originally intended.

Question reference: S4W-18008

Asked by: Jim Hume, MSP for South Scotland, Scottish Liberal Democrats
Date lodged: Wednesday, 30 October 2013
Current Status: Answered by Alex Neil on 12 November 2013

To ask the Scottish Government what discussions the (a) Cabinet Secretary for Health and Wellbeing and (b) Minister for Public Health has had with other cabinet secretaries and ministers regarding price controls in order to protect public health.

Scottish Government policies are formulated and developed using evidence-based information, and this includes policies relating to public health. Where a policy raises major issues or involves primary legislation, which was the case for minimum unit pricing of alcohol, the policy will be discussed by the Scottish Cabinet. Ministers and Cabinet Secretaries regularly discuss current or new policies where there are shared portfolio interests.

Chamber and committees