Chamber and committees

VAT is not payable on fees for safeguarders.

The Scottish Government cannot pay VAT on fees for safeguarders, reflecting the positions set out in HM Revenue and Customs and Scottish Public Finance Manual guidance.

The payment of safeguarders prior to the 2011 Act was a matter for local authorities. It is understood that the method and range of payments varied between local authorities as well as in respect of individual safeguarders. Prior to the 2011 Act and associated regulations coming into force on 24 June 2013, the Scottish Government undertook a consultation on fees applicable to the new arrangements with all safeguarders. A revised set of nationally consistent fees, expenses and allowances, with levels set on a ‘no detriment’ basis was published by the Scottish Government. From 24 June 2013, Children 1st have been responsible for the payment of fees and expenses to safeguarders - VAT is not payable on these fees.

The first year of lung cancer quality performance indicators data analysis (for patients diagnosed from 1 April 2013 to 31 March 2014) is scheduled for submission to ISD on 13 November 2014. The national comparative report is due to be published May 2015.

Smoking, including passive smoking, increases the risk of developing lung cancer. The Scottish Government has introduced a legislative programme on smoke-free public places and on tobacco sales. This includes the Tobacco and Primary Medical (Scotland) Act 2010, which is designed to discourage people becoming addicted at an early stage.

In March 2013, the Scottish Government published its new Tobacco Control Strategy - Creating a Tobacco-Free Generation. The new strategy sets out the Scottish Government's ambition for a smoke-free Scotland (less than 5% smoking population) by 2034. A key action within the strategy charged NHS Health Scotland with leading a review of smoking cessation services in Scotland. In addition, the current HEAT target for smoking cessation focuses on addressing health inequalities.

The Scottish Government is also committed to improving survival rates from lung cancer. Our 'Detect Cancer Early' initiative, which was launched in February 2012 with £30 million of investment, focuses on raising public awareness and encouraging people with early symptoms of cancer to see their GP.

Our lung cancer social marketing campaign, led by Sir Alex Ferguson as spokesperson, has been running from November 2013, with the aim of building belief that something can be done for lung cancer if detected earlier, reinforcing that people can live well after lung cancer if it’s detected earlier, and impressing on people that it is worthwhile seeing their GP as soon as possible.

The revised Scottish Referral Guidelines for Suspected Cancer were published in October 2013 and updated May 2014. This version updates referral guidelines for lung cancer, and takes account of new research evidence and the findings of audits undertaken since the last revision. The aim of these updated guidelines is to facilitate appropriate referral between primary and secondary care for patients whom a GP suspects may have cancer. The guidelines should help GPs, the wider primary care team, other clinicians and patients and carers to identify those patients who are most likely to have cancer and who therefore require urgent assessment by a specialist. Work is also being undertaken to support the effective dissemination and implementation of the revised guidelines when they are published by August 2014.

The quality performance indicators programme also aims to drive up the standard of cancer services available in NHS Scotland. This programme contains specific indicators for prostate cancer. These indicators will be used to monitor and drive quality improvement in prostate cancer care across the NHS in Scotland and ensure that people have access to timely, safe and effective services.

The Scottish Cancer Taskforce discussed the possibility of a cancer patient experience survey in Scotland in their meeting on 27 June 2014. The taskforce agreed that further investigation should take place, including examination of the methodology behind the surveys which have taken place in other parts of the UK.

The Scottish Government gathers the experiences of a range of health care users via the biennial Inpatient Patient Experience survey and the biennial Health and Care Experience survey (formerly the GP Patient Experience survey). This includes cancer patients.

A national cancer quality performance indicators (QPI) programme is being taken forward to drive continuous quality improvement in cancer care across NHS Scotland, and QPIs will be developed for all main cancers by October 2014. As part of the wider QPI work programme, Patient Experience QPIs were published in April 2014. The aim is to foster a culture of continuous quality improvement at a local level supported by a programme of regional and national comparative reporting and review. This will allow for identification of common themes and best practice for improvement in patient experience.

Table 1 shows European age-sex standardised mortality rates for heart failure, cancer and stroke from 2008 to 2012, as published by Information Services Division Scotland. Further information is available on the ISD website at the following web addresses:

Cancer: http://www.isdscotland.org/Health-Topics/Cancer/

Heart Disease (including heart failure): http://www.isdscotland.org/Health-Topics/Heart-Disease/

Stroke: http://www.isdscotland.org/Health-Topics/Stroke/

Table 1: European age-sex standardised mortality rates per 100,000 population per

year for heart failure, cancer and stroke; Scotland, all ages and both sexes; 2008-

2012.

Notes: 1. International Classifications of Diseases, 10^th revision (ICD-10) codes used:

Heart Failure – I50.

Cancer – C00-C97 excluding C44.

Stroke – I61, I63-I64.

2. Rates are directly standardised to the 1976 European Standard Population

Source: National Records of Scotland (NRS), death registrations and population estimates. Reference: IR2014-01155.

The Detect Cancer Early (DCE) Programme aims to increase the proportion of Scots diagnosed in the first stage of cancer, initially focusing on breast, colorectal and lung cancer. Survival rates from cancer are often poorest in those living in the most deprived communities and uptake of the cancer screening programmes is lowest in these areas.

The DCE social marketing campaigns are targeted to the most hard to reach groups and include targeted TV, radio and press adverts, translated materials as well as extensive field marketing and road shows. Indeed, over 75% of this target audience have reported high levels of awareness of the DCE social marketing campaigns through an independent evaluation.

In addition we have introduced a two year primary care initiative to support informed uptake of the national bowel screening programme in areas of poorest uptake and have recently launched a targeted breast screening campaign aimed at women over 50 who do not currently take up the offer to screen.

The Detect Cancer Early Programme has an associated HEAT target to increase the proportion of people with stage 1 disease at diagnosis by 25% (as a proxy indictor of survival outcome) for the three most common cancers in Scotland, lung, breast and colorectal cancer and is due to be met by end December 2015.

The social marketing campaigns are continually being reviewed and are evaluated through an independent research agency. In addition the impact on the uptake of the national bowel and breast screening programme is being assessed. The initial evaluations of the social marketing campaigns have been encouraging however the direct impact of public awareness campaigns and other components of the Detect Cancer Early Programme will not be fully apparent until the cancer staging data for 2013-2014 is available.

To support GPs in Scotland to refer patients with suspected cancer as early as possible, the Scottish Government published referral guidance in 2007, called the ‘Scottish Executive Health Department Letter (2007) 9: Scottish Referral Guidelines for Suspected Cancer’.

Healthcare Improvement Scotland have been leading on a review of these Scottish Referral Guidelines for Suspected Cancer. Review groups have been established for each tumour group, with membership of each including clinicians from secondary and primary care, members of the Scottish Cancer Coalition and patient representatives. The lung cancer review group produced draft guidelines for suspected lung cancers, which were sent out for wide clinical, patient and public consultation prior to being published in October 2013.

To support effective communication and implementation of the revised guidelines a series of primary care education session were held in autumn 2014 in partnership with Roy Castle Lung Cancer Foundation. These sessions are now available for primary care professionals to view online.

The remaining guidelines are under review and all guidelines will be published by late summer 2014.

A further sub-group has being convened to support the effective dissemination and implementation of the revised guidelines with support from Macmillan Cancer Support.