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The use of fittings and fixtures that reduce ligature risks is not clinically appropriate in many general hospital rooms, e.g. x-ray, consulting exam and patient toilets and showers, as they would compromise the hospital’s ability to deliver appropriate care to patients who have the freedom to leave at any time. So it would not be appropriate for the whole of the Queen Elizabeth University Hospital Glasgow to be constructed to a full anti-ligature specification.

Scottish Government policy and NHS guidance requires local risk management of patients and their environment. The board should use their appropriate multi-disciplinary skills and expertise to assess the likelihood and impact of all safety risks, including clinical, infection and self-harm, whilst ensuring an accessible, therapeutic environment that promotes care and recovery for all.

Fittings and fixtures that reduce ligature risks, are used only as required following a risk assessment which shows a patient vulnerable to self-harm may be left unattended or unobserved for a period of time. For patients assessed as ‘high risk’ of self-harm, local management plans should be agreed, such as keeping a patient under observation.

The Scottish Government is fully committed to ensuring that the NHS in Scotland delivers high quality, safe, effective and person-centred care to all patients every-time they access health services.

Healthcare Improvement Scotland is responsible for the scrutiny and inspection of healthcare, which drives improvements in patient care, in line with a plan agreed by Scottish Ministers.

NHS boards are responsible for complying with all relevant statutory obligations, including the Health and Safety at Work etc Act 1974. The Scottish Government requires all NHS boards to have assurance mechanisms in place as part of their corporate governance mechanisms.

The Health and Safety Executive is responsible for the enforcement of the Health and Safety at Work etc Act 1974 in NHSScotland and, together with local authorities, the social care sector in Scotland as well as throughout the UK.

<>The 2011 census shows that there were 9,825 young carers and young adult carers (aged 16 to 24) in further or higher education.

The Scottish Government is working with colleges, universities, and other bodies to better identify students who also have caring responsibilities.

This government is committed to undertake a review to determine whether people with learning difficulties and autism should be removed from the definition of ‘mental disorder’ under the provisions of the Mental Health (Care & Treatment) (Scotland) Act 2003.

During the progress of the Mental Health Bill (now the Mental Health (Scotland) 2015 Act), Mr Hepburn made clear that he was open to a stakeholder event to help move the process forward. He also stated that the review will be participative and that stakeholders would be involved in shaping its remit.

The Mental Welfare Commission in partnership with the Scottish Commission for Learning Difficulties are currently undertaking a scoping exercise on behalf of the Scottish Government to gauge opinion from service users as well as representative bodies which will help shape the remit of the official review. This will in turn ensure that the design of the official review acknowledges the complexities, includes the full range of stakeholders and leads to practical proposals with as much consensus as can reasonably be achieved.

Part of the official review process will be to hear the views of the people of Scotland and once the scope and engagement strategy has been agreed it will be made public.

The Scottish Government is acting on the recommendations made in the Child Death Review Reports of 2014 and 2016 and is at the early stage of establishing a national child death review system in Scotland.

Child death reviews in Scotland will consider modifiable and preventable factors, and will incorporate local and national data collection, to learn lessons with the aim of reducing avoidable mortality in children and young people.

As at March 2016, there were 918.9 Whole Time Equivalent (WTE) staff working in Paediatrics Specialties in NHS Scotland – a 30.4 per cent increase under this government. This includes a 78.9 per cent increase in paediatric consultants.

Information on the number of WTE medical staff (all grades) working within paediatrics specialties, broken down by NHS Scotland board as at March 2016, is published by Information Services Division Scotland and included in the following table:

Scotland	918.9
NHS Ayrshire and Arran	38.3
NHS Borders	13.5
NHS Dumfries and Galloway	19.6
NHS Fife	44.1
NHS Forth Valley	38.4
NHS Greater Glasgow and Clyde	314.6
NHS Grampian	86.9
NHS Highland	25.3
NHS Lanarkshire	60.4
NHS Lothian	198.9
NHS Orkney	-
NHS Shetland	0.3
NHS Tayside	76.9
NHS Western Isles	1.0
NHS Education for Scotland	0.6

Source: Scottish Workforce Information Standard System.

NOTE:

Paediatrics specialties included are: paediatrics, paediatric cardiology, paediatric surgery and paediatric dentistry.

In October 2015, Information Services Division (ISD) Scotland published analysis of individuals on methadone based on those prescriptions with a valid Community Health Index (CHI) number. This analysis was published on the ScotPHO website, and can be accessed here, with the caveat that due to sub-optimal CHI capture rates, the estimates should be regarded as a minimum count of individuals on methadone hydrochloride in Scotland. The results of this analysis were:

In 2014-15, methadone 1mg/ml solution was prescribed at least once to 25,170 individuals (based on prescriptions with a valid CHI).

The number of individuals prescribed methadone 1mg/ml solution appears to have reduced from 26,202 individuals in 2011-12.

In 2014-15, 117,578 (or 27%) of prescriptions did not have a valid CHI number. It is not possible to determine how many additional individuals prescribed methadone 1mg/ml solution would have been identified had these data been complete.

The mosquito vectors for the Zika virus are not able to survive in the Scottish climate, and therefore the risk to Scotland is very low because it would not be possible for the virus to spread easily here.

Health Protection Scotland regularly reviews their advice, taking into account available evidence, to ensure information given to people visiting, and returning from affected countries is up-to-date. This is done at cross-governmental level to ensure advice for the UK is consistent. Detailed information can be found on Health Protection Scotland’s website and the public-facing Fit for Travel website. As an example of the information provided, all travellers to affected areas are advised to seek travel advice from a health care provider at least six to eight weeks in advance of travel, which includes advice on risk of sexual transmission of Zika virus, and particularly, advice for those who are pregnant or planning a pregnancy.

The information is not held centrally.

The following table shows the number of people discharged with a diagnosis of post-traumatic stress disorder (PTSD) from hospitals in Scotland in each year between 1999 and 2014. Numbers are shown for the whole of Scotland and for individual NHS boards of treatment.

Table 1. Number of people¹ discharged² with a diagnosis of PTSD³ from Scottish hospitals⁴, by NHS board of treatment, 1999-00 to 2014-15⁵.

	1999- 00	2000- 01	2001- 02	2002- 03	2003- 04	2004- 05	2005 06	2006- 07
NHS Ayrshire and Arran	15	7	13	12	14	10	11	10
NHS Borders	*	*	0	0	*	7	*	*
NHS Dumfries and Galloway	6	*	5	*	16	5	6	7
NHS Fife	*	*	13	8	6	15	11	6
NHS Forth Valley	*	6	7	7	9	7	8	7
NHS Grampian	7	9	11	8	12	10	8	12
NHS Greater Glasgow and Clyde	17	17	21	32	31	39	46	29
NHS Highland	9	16	11	18	12	14	11	14
NHS Lanarkshire	*	6	7	*	13	8	6	6
NHS Lothian	23	21	36	30	19	27	28	24
NHS Orkney	0	0	0	0	0	0	0	0
NHS Shetland	0	0	0	0	*	*	*	0
NHS Tayside	5	13	6	8	20	9	7	13
NHS Western Isles	0	*	0	0	0	*	0	*
Other (National Facility, State Hospital)	0	0	0	*	0	0	0	0
Scotland	92	104	128	128	153	149	143	131
	2007 -08	2008 09	2009- 10	2010- 11	2011- 12	2012- 13	2013- 14	2014- 15
NHS Ayrshire and Arran	18	15	9	17	22	24	25	28
NHS Borders	*	5	*	*	*	6	*	5
NHS Dumfries and Galloway	*	*	*	8	8	8	6	9
NHS Fife	10	7	17	13	18	19	21	19
NHS Forth Valley	12	18	13	12	15	23	17	14
NHS Grampian	12	9	8	9	14	16	20	19
NHS Greater Glasgow and Clyde	44	33	55	64	59	68	55	62
NHS Highland	12	16	14	9	18	30	30	36
NHS Lanarkshire	9	7	8	12	16	16	22	27
NHS Lothian	30	26	27	36	31	33	41	74
NHS Orkney	0	0	0	0	0	*	0	0
NHS Shetland	*	*	0	*	*	*	*	*
NHS Tayside	9	10	15	19	26	23	18	33
NHS Western Isles	0	*	0	0	0	*	0	0
Other (National Facility, State Hospital)	0	*	*	*	0	0	*	*
Scotland	157	152	172	203	225	269	257	323

Denotes values which have been suppressed to prevent the disclosure of sensitive information.

1. Individuals counted once in each year and in each NHS board in which they were treated. Individuals may be counted against more than one board in a single year. The Scotland total is therefore potentially lower than the sum of the figures for the separate Boards.

2. Includes patients who were resident out with Scotland or whose residence was not known.

3. Up to six diagnoses can be recorded on a single inpatient record. Hospital stays for PTSD were identified based on the ICD10 code F43.1 having been recorded in any of these diagnostic positions.

4. Hospital inpatient activity is recorded on Scottish Morbidity Record 01 (acute hospitals) and Scottish Morbidity Record 04 (psychiatric hospitals).

5. Financial year (e.g. 1 April 1999 – 31 March 2000) based on date of discharge.

Source: ISD Scotland

The number of registered care home places there are, broken down by (a) NHS board area and (b) whether they are in the (i) private or (ii) public sector is set out in the following table:

REGISTERED CARE HOME PLACES Source: Scottish Care Home Census, snapshot at 31 March 2015 (table 4)

	Local authority / NHS Sector	Private Sector	Voluntary Sector
NHS Ayrshire and Arran	94	3,111	277
NHS Borders	159	524	121
NHS Dumfries and Galloway	3	973	267
NHS Fife	368	2,571	115
NHS Forth Valley	293	1,583	269
NHS Grampian	344	3,371	815
NHS Greater Glasgow and Clyde	1,048	6,623	1,734
NHS Highland	316	2,021	357
NHS Lanarkshire	399	3,950	430
NHS Lothian	934	3,526	905
NHS Orkney	114	0	4
NHS Shetland	142	0	16
NHS Tayside	328	3,273	431
NHS Western Isles	138	40	39
Scotland	4,680	31,566	5,780