Seòmar agus comataidhean

The Scottish Government is raising awareness amongst prescribers about the relative effectiveness of varenicline compared to traditional nicotine replacement therapies. The percentage of smoking cessation service users being prescribed varenicline rose to 19% in 2017-18. The Scottish Government expects this percentage to rise further in future years.

NHS Public Health teams are working within Health Boards to improve clinical confidence in varenicline, which has now been cleared for use by the Medicines and Healthcare products Regulatory Agency.

People are offered a wide range of approaches and products for smoking cessation. The level of varenicline use will reflect in part that people are currently preferring other methods, such as nicotine replacement. Public Health teams are working within the Boards to improve clinical confidence in varenicline, which had been associated with potential harm by the Medicines Health Regulatory Association in 2008. Subsequent clinical research has demonstrated that varenicline is safe to use for many people wanting to stop smoking. It is anticipated that the use of varenicline will continue to increase.

Health Environmental Services (HES) provides clinical waste management services to 18 Health Boards that covers collection through to disposal of waste.

We do not hold details of the contracts which individual NHS Boards have with HES, including value of the contract.

A National Once for Scotland tender is currently underway and being managed by NHS National Services Scotland.

There is a strong existing evidence base around coexisting psychosis and substance misuse. NICE clinical guidance CG120 contains detailed information about assessment and management: https://www.nice.org.uk/guidance/cg120

SIGN 131 guidelines cover the management of schizophrenia, and include a dedicated section on dual diagnosis:  https://www.sign.ac.uk/assets/sign131.pdf

We are not aware of any current plans to update this guidance.

Some local services across NHS Scotland have their own specific policy and guidance to ensure that local service delivery is matched to need.

Additionally, the Scottish Government will publish a new alcohol and drug strategy this autumn. It will challenge alcohol and drug treatment services to adapt the ways in which they work, in order to better meet the wide range of complex health and social care needs.

Clinical waste collection continues as normal for NHS Scotland and we are not aware of any issues regarding the disposal of this waste in Scotland.

The Scottish Government is monitoring the situation and receiving regular updates from Health Boards.

In the event of disruption to clinical waste management services at NHS sites across Scotland, all NHS Scotland Boards have contingency plans ready to put into place. The plans ensure that there is sufficient storage capacity for clinical waste to be stored safely on site for a period of 72 hours.

Haematologists within each NHS board are expected to take account of any relevant guidance, such as the guidelines published by the British Committee for Haematology Standards 2014 and the National Institute for Health and Care Excellence Clinical Knowledge Summary on Anaemia, B12 and foliate deficiency.

A range of specialist support is available depending on the type, severity and symptoms of the syndrome.

Most people with Ehlers-Danlos syndrome (EDS) in Scotland are managed by consultant rheumatologist or physiotherapy services in their local hospital. Depending on the type of EDS and the severity of their symptoms, some people are managed by or receive additional input from a range of clinical speciality areas such as dermatology, paediatrics, vascular surgery, gastroenterology and neurology.

People with rarer types of EDS will normally be referred to regional genetics for confirmation of diagnosis. There are also specialist EDS diagnostic services based in Sheffield and London available on referral for people in Scotland with complex symptoms.

People with EDS may also require specialist pain management advice, for which there is a national service for Scotland provided by NHS Greater Glasgow and Clyde. Very complex cases can be referred for a residential programme to the Royal National Hospital for Rheumatic Diseases in Bath.

Authorities in England alerted Scottish Government to issues regarding the company’s management of clinical waste at its sites in England in August.

Since then Scottish Government have been working with Scottish Environment Protection Agency (SEPA) and NHS National Services Scotland (NSS) to monitor the situation and have sought assurances with NHS Boards that they have contingency plans in place.

NHS Scotland, working with SEPA , have developed contingency plans which firmly maintain environmental protections. SEPA is clear that compliance is non-negotiable and is robustly monitoring sites in Scotland.

Scottish Government continues to monitor the situation in England and any potential impact on services in Scotland.

The Scottish Government will continue to advance the case for Scotland to remain in the European Union, or failing that within the single market and customs union.

That notwithstanding, the principles of equal treatment and non-discrimination apply to procurement exercises not only as a matter of European law, but also apply to the award of regulated public contracts as a matter of domestic law, by virtue of the Procurement Reform (Scotland) Act 2014.

The Scottish Government is also committed to equal treatment and non-discrimination in the awarding of its grants and is required to comply with domestic equality law in the Equality Act 2010 and the Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012.

NHS whistleblowers who have concerns should raise them locally in the first instance. Staff can also contact the Whistleblowing Alert and Advice Line for independent, confidential advice from legally trained staff on whistleblowing matters. This also provides a route, where appropriate, for staff to have their whistleblowing concerns passed to the appropriate regulatory or scrutiny body.

I announced on 8 October that I will personally appoint Health Board`s non-executive Whistleblowing Champions, and that this will now be a dedicated role. If any of the Whistleblowing Champions feel they, or staff within their area are not being heard by their Board, they will be able to contact me directly. More detail on the process for appointments will be provided in due course.

Significantly reducing health inequalities is a top priority.

We are addressing root causes through a wide range of action to tackle deep-seated poverty and inequalities in wider society. This includes investment of over £125m in 2018-19 on welfare mitigation and measures to protect those on low incomes in the face of the UK Government’s cuts and continued austerity.

We are making progress against our public health priorities and taking action to ensure this continues. For example, the Tobacco Action Plan published in June focusses on health inequalities and targeting smoking rates in communities where people find it most difficult to quit. The introduction of minimum pricing at 50 pence per unit on 1 May 2018 is a key milestone on our journey to tackle alcohol misuse in Scotland. Our diet and healthy weight delivery plan sets out our vision for everyone in Scotland to eat well and have a healthy weight, and our ambition to halve childhood obesity by 2030 and significantly reduce diet-related health inequalities. We are currently consulting on world-leading measures to restrict promotions of junk food.

And with CosLA, in 2019, we will establish a new public health body, Public Health Scotland, building on the work of NHS Health Scotland and the Scottish Public Health Observatory to focus the whole system on factors which reduce inequalities and have the greatest impact on healthy life expectancy.