Chamber and committees

As there is no ICD-10 (International Classification of Diseases 10th Revision) code suitable to identify the diagnosis of lipoedema in the data supplied by NHS Boards, specific treatments cannot be linked to this diagnosis.

However, lipoedema is frequently treated with liposuction and brachioplasty procedures and it is possible to provide the total number of these procedures done for all conditions combined. Tables 1 and 2 show the number of liposuction and brachioplasty procedures that have been carried out by financial year, from 2006-07 to 2016-17. It is, however, important to note that it is not possible to identify which of these procedures were carried out to treat lipoedema.

Table 1. Number of liposuction procedures^1,2; by NHS Board; 2006-7 to 2016-17^p

Source: ISD Scotland SMR01 dataset as at 13th August 2017

Ref: IR2017-01400

^p- provisional

* Indicates values that have been suppressed due to the potential risk of disclosure and to help maintain patient confidentiality.

- Denotes zero

1. The data relates to the following OPCS Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) code:

S622 – Liposuction of subcutaneous tissue, not elsewhere classified

2. Any liposuction procedures that were carried out as part of another procedure have been excluded.

3. Since March 2008, the Golden Jubilee National Hospital (National Waiting Times Centre) moved to provide specialist services resulting in a case-mix of patients that differ substantially from the majority of other hospitals in Scotland.

Table 2. Number of brachioplasty procedures^1,2; Scotland; 2006-7 to 2016-17^p

Source: ISD Scotland SMR01 dataset as at 13th August 2017

Ref: IR2017-01400

^p- provisional

1. The data relates to the following OPCS Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) code:

S033 – Excision of redundant skin or fat of arm

2. Any brachioplasty procedures that were carried out as part of another procedure have been excluded.

The malware incident that affected NHS Lanarkshire on 25 August 2017 has been identified as a new variant of Bitpaymer ransomware. This malware incident is considered a zero day attack in that the new variant was released on the same day the actual attack takes place so no anti-virus software is available to protect against the attack.

In this financial year NHS Lanarkshire is projected to spend over £29.45 million on IT ( which includes security and resource investment).

Locally NHS Lanarkshire have invested themselves in a range of prioritised, mitigating IT security controls, such as better rollout of patches and anti-virus software which they have put in place and further actions are now being developed , such as replacing firewalls, which will increase the robustness of NHS Lanarkshire cyber security.

In additional NHS Lanarkshire has increased the number of skilled cyber security and IT resources by 8, including 3 additional security skilled staff.

The malware incident that affected NHS Lanarkshire on 25 August 2017 has been identified as a new variant of Bitpaymer ransomware. This malware incident is considered a zero day attack in that the new variant was released on the same day the actual attack takes place so no anti-virus software is available to protect against the attack.

The information requested is not held centrally by ISD as there is no ICD-10 (International Classification of Diseases 10th Revision) code suitable to identify the diagnosis of lipoedema in the data supplied by NHS Boards.

I have asked Colin McConnell, Chief Executive of the Scottish Prison Service, to respond. His response is as follows:

The reduction of violence within our prisons remains an ongoing priority for the Scottish Prison Service (SPS). However, the significant challenges presented in responding to an evolving prison population has meant that the SPS Policy for Reducing Violence in Prisons remains under development. Since the response to question S5W-01442, SPS has completed scoping work around existing Violence Reduction Strategies across the Scottish prison estate and categorised trends and causes. The revised Policy is currently in draft format, with further consolidation due to take place in the next quarter with implementation anticipated for 2018.

Staff and prisoner relationships within the SPS have consistently been assessed as positive (HMIPS 2015-16). Good communication and positive relationships continue to play a key role in ensuring that our prisons remain safe, with 85% of respondents to the latest SPS Prisoner Survey, reporting that they had not feared for their safety at any point during the last month in our care. However, challenges do remain and whilst the continued reduction in our prison population is to be welcomed, the result of this can be that prisons are rightly asked to house the highest risk and often most violent of offenders. SPS are a key partner in Scotland’s drive to tackle crime and the successful efforts of Police Scotland, and others, in tackling Serious Organised Crime Groups (SOCG) in our communities has led to a significant increase in the population of SOCG members now held within our prisons.

I can advise that the work to reduce prison violence identified previously in response to question S5W-01442, continues. However, SPS have also further progressed a number of new initiatives to reduce prison violence:

• SPS have undertaken a population mapping exercise to identify the locations of all SOCG members in our custody. SPS continually monitor and manage the locations in which these individuals are held in order to minimise the risk of violence. SPS are continuing to monitor and review all intelligence related to SOCG in order to proactively manage the threat presented;

• In March 2017, SPS established our Strategic Risk and Threat Group (SRTG). The SRTG allows SPS to consider operational risks and oversee emerging threats and trends across the prison estate. The SRTG provides a mechanism for the identification of risks and priorities on a national level and the deployment of resources and tactical response options;

• At a local level each SPS establishment has a Violence Reduction Group responsible for continuous monitoring, reviewing and reduction of violent threats and incidents. Prisoner Case management and multi organisational case conferencing is utilised to assess and manage risk, to counter predation and to offer specific targeted services towards those people who may present a particular propensity for violence; and

• SPS have recently revised the operating structure for our dog units. It is anticipated that the revised operating structure will reduce the volume of illicit articles being introduced to our prisons and subsequently reduce the resultant violence associated with the trading of these items.

The treatment options available are aimed at facilitation and enhancement of the patient’s ability to self-manage, optimisation of health and prevention of progression and management of symptoms. The options include advice on healthy eating, weight management and physical activity, skin care and protection, compression therapy (garments), manual lymphatic drainage, surgical management, management of pain and psychosocial support.

The recommendation of any particular treatment is a matter for discussion between a patient and their clinician. Any issues surrounding the provision of a treatment are a matter for the relevant NHS Board.

The Scottish Government has not met with NHS officials to specifically discuss Lipoedema however a Lymphoedema Short Life Working group was set up which aimed to improve patient care in Scotland. The group included representatives from the NHS and Talk Lipoedema.

Healthcare professionals and the public are a supported by the provision of information produced by different organisations e.g. the Royal College of General Practitioners’ (RCGP) e-learning course in partnership with Lipoedema UK (also endorsed by Royal College of Nursing and available free to healthcare professionals in the UK) and by organisations such as Lipoedema UK, Talk Lipoedema, British Lymphology Society and Lymphoedema Support Network. Specialists in the field support their colleagues, such as general practitioners, nurses and other healthcare professionals, by directing them to the RCGP course and the resources available from other organisations.

The Scottish Government recognises the importance of the third sector in providing valuable support to those with lipoedema. There have been no applications to date received from lipoedema charities under the National Health Service (Scotland) Act 1978, Section 16B Funding Scheme. Officials updated lipoedema charities about possible opportunities for grant applications in 2015-16 under the Section 16B scheme.

The Scottish Government recognises that lipoedema can be a distressing and painful condition. As with all long term conditions we want people living with lipoedema to be able to access the best possible care and support.

Lipoedema services are mainly provided by therapists including nurses and allied health professionals. Therapists are based within lymphoedema services and are available in every Health Board area of Scotland.