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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.

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.

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 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.

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.

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.

Actions in the Mental Health Strategy 2017 – 2027 are aimed at ensuring that young people have good mental health and that agencies act early enough when issues such as grief and bereavement emerge and impact young lives. The £150m supports delivery of the overall strategy which in turn will drive change and improvement across a range of local services to enable people to get the right help at the right time.

The Scottish Government has also begun the process to appoint a national
co-ordinator for child bereavement services. In doing so we have written to the child health commissioners group seeking their professional advice and guidance on which organisations would be best placed to either co-ordinate, or take on a Child Bereavement Co-ordinator. Once we receive their views we will look to appoint a national co-ordinator as soon as possible.

The Scottish Government's view is that homework, when provided at the appropriate level and in an appropriate way, can help to reinforce and support learning, and can help to involve parents with their child’s progress.

A school's approach to homework should be considered in the context of the research and guidance available, the school's wider strategies to improve attainment, learning in the home and family learning. School work assigned to pupils to take home should take account of the individual needs of the child, the views of parents and the need for all children to have a healthy balance of play, activity and learning opportunities. Schools should take an evidence-based approach to the setting of homework and broader efforts to support learning at home. Decisions should be based on teachers' professional judgement and knowledge of their own pupils' learning needs and parents should be fully consulted about any major changes to homework policy across the school.

The Scottish Schools (Parental Involvement) Act 2006 recognises the vital role that parents and other carers play in their child’s learning and development. The statutory guidance accompanying the Act states that parents should receive information and support to help develop their child’s learning at home and in the community. This should include appropriate information and support in relation to homework.

As part of the Scottish Attainment Challenge the Scottish Government is providing funding to the Education Endowment Foundation to develop a learning and teaching toolkit adapted for the Scottish context. The toolkit presents accessible summaries of the global educational research on 34 different educational approaches, and is available at:

https://scot.educationendowmentfoundation.org.uk/

The toolkit includes summaries on the cost and impact of homework in both primary and secondary.

The Scottish Government recognises the importance of supporting low income families and ensuring that all children get the best start in life to achieve their full potential in school and beyond.

That is why the Government has announced plans to introduce a new Best Start Grant, as part of its new social security powers. This new grant will be introduced in summer 2019 for lower income families with children, including offering a payment of £250 before a child starts school. This will assist families with the many of the costs associated with starting school. As of this summer, parents of all new born children now receive a Baby Box. All children, regardless of their parents’ circumstances, deserve the best possible start in life and Scotland’s Baby Box is designed to support families in the crucial first few months of a child’s life.

Local authorities are responsible for the school uniform policy in schools, as part of their responsibilities for school rules. In addition to its plans to introduce the Best Start Grant, the Scottish Government provides funding to local authorities to help low income parents afford the basic costs associated with school, such as providing suitable clothing.

Supporting families is integral to the policies of the Scottish Government and Scottish Ministers continue to engage with COSLA and local authorities on how best to support low income families.