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Advice on the issue is being formulated by the Chief Executive of the NHS in Scotland and the Chief Medical Officer, based on work already carried out by National Services Division of the Common Services Agency and jointly by Greater Glasgow and Lothian Health Boards. The NSD work canvassed a broad range of opinion, including users of the service. To ensure that their advice is based on the clearest possible understanding of all the issues, the Chief Executive and CMO have recently met senior representatives of both Trusts and the Medical Schools in Edinburgh and Glasgow, as well as the 2 Health Boards.I expect to receive a report on this matter shortly and will announce my decision at that time.

It is important to emphasise that outcome indicators are not intended to be used as 'league tables'. As the report itself stresses, no direct conclusions should be drawn from any of the comparisons in this report about the quality or effectiveness of the services or treatment provided for patients of different Trusts or populations of different Health Boards. Such differences may exist, but they cannot be identified solely on the basis of these comparisons. The outcome indicator reports should rather be seen as part of a range of initiatives geared to the creation of a more quality-oriented and patient-centred NHS in Scotland.

The most likely explanation of any variations will be case mix (i.e. how ill the patients were then they were admitted), but this cannot be confirmed without further detailed analysis, which is the responsibility of the Trusts and Health Boards concerned. Both Boards, in conjunction with the Trusts concerned, are specifically investigating the stroke survival variations shown by the latest Clinical Outcome Indicators report. This gives added impetus to the work already being undertaken by these and all other local health services to translate into local practice the Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the management of patients who have had a stroke. In addition, both Boards are also investing in stroke services. In Lothian, £350 000 is being made available to develop an 11 bed stroke unit at St John's, while in Fife, £86 000 will be invested to provide a dedicated stroke rehabilitation unit at Cameron Hospital.In future, one of the roles of the Clinical Standards Board for Scotland will be to oversee the development and monitoring of standards for specific services, and it is in that context that the clinical outcomes indictors are likely to be of greatest value.

The Scottish Prison Service has its own Suicide Prevention Strategy and a research report on the Strategy was published in 1997. The Service's revised Suicide Risk Management Strategy is to be the subject of an evaluation, with research to commence early in 2000.

In addition, legislation has been introduced governing the pack sizes of some paracetamol and aspirin products available over the counter, following evidence that many people who intentionally overdose use products that are readily available in their homes. The new measures are designed so that customers can still have easy access and sufficient quantities to treat short episodes of minor illness without leaving large residual amounts in the home.

We are also funding a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The study is examining health records of all individuals who committed suicide or homicide and had been in contact with mental health services in the period leading up to the suicide or homicide. The aim is to identify common patterns of behaviour, symptoms etc, and to use this information to provide guidance to medical practitioners to enable them to identify at an early stage symptoms which indicate that an individual's mental state has the potential to lead to their committing suicide or homicide. Early identification may lead to timely intervention and diagnosis, and it is hoped that this may result in a reduction in the rates of suicide and homicide.Further, the Scottish Prison Service (SPS) has had a Suicide Prevention Strategy in place for some years, with a revised strategy introduced as recently as 1998. Key features include reducing isolation to a minimum, providing a safe social environment and engaging families in the care process.