Chamber and committees

VAT is not payable on fees for safeguarders.

There are some 180 serving safeguarders in Scotland. The Scottish Government is aware of representations from two safeguarders on the issue of the payment of VAT. Both enquires were received in January 2014, with a follow-up from one individual in April 2014. The position was checked with the relevant officials, and written responses were provided explaining that VAT was not payable.

The payment of safeguarders prior to the 2011 Act was a matter for local authorities. It is understood that the method and range of payments varied between local authorities as well as in respect of individual safeguarders. Prior to the 2011 Act and associated regulations coming into force on 24 June 2013, the Scottish Government undertook a consultation on fees applicable to the new arrangements with all safeguarders. A revised set of nationally consistent fees, expenses and allowances, with levels set on a ‘no detriment’ basis was published by the Scottish Government. From 24 June 2013, Children 1st have been responsible for the payment of fees and expenses to safeguarders - VAT is not payable on these fees.

Fees payable to safeguarders by Children 1st are not subject to VAT. No direct discussions have been held with HM Revenue and Customs, as the position on VAT applicability is in line with HM Revenue and Customs guidance and the Scottish Public Finance Manual.

The Scottish Government cannot pay VAT on fees for safeguarders, reflecting the positions set out in HM Revenue and Customs and Scottish Public Finance Manual guidance.

Table 1 shows European age-sex standardised mortality rates for heart failure, cancer and stroke from 2008 to 2012, as published by Information Services Division Scotland. Further information is available on the ISD website at the following web addresses:

Cancer: http://www.isdscotland.org/Health-Topics/Cancer/

Heart Disease (including heart failure): http://www.isdscotland.org/Health-Topics/Heart-Disease/

Stroke: http://www.isdscotland.org/Health-Topics/Stroke/

Table 1: European age-sex standardised mortality rates per 100,000 population per

year for heart failure, cancer and stroke; Scotland, all ages and both sexes; 2008-

2012.

Notes: 1. International Classifications of Diseases, 10^th revision (ICD-10) codes used:

Heart Failure – I50.

Cancer – C00-C97 excluding C44.

Stroke – I61, I63-I64.

2. Rates are directly standardised to the 1976 European Standard Population

Source: National Records of Scotland (NRS), death registrations and population estimates. Reference: IR2014-01155.

The first year of lung cancer quality performance indicators data analysis (for patients diagnosed from 1 April 2013 to 31 March 2014) is scheduled for submission to ISD on 13 November 2014. The national comparative report is due to be published May 2015.

Smoking, including passive smoking, increases the risk of developing lung cancer. The Scottish Government has introduced a legislative programme on smoke-free public places and on tobacco sales. This includes the Tobacco and Primary Medical (Scotland) Act 2010, which is designed to discourage people becoming addicted at an early stage.

In March 2013, the Scottish Government published its new Tobacco Control Strategy - Creating a Tobacco-Free Generation. The new strategy sets out the Scottish Government's ambition for a smoke-free Scotland (less than 5% smoking population) by 2034. A key action within the strategy charged NHS Health Scotland with leading a review of smoking cessation services in Scotland. In addition, the current HEAT target for smoking cessation focuses on addressing health inequalities.

The Scottish Government is also committed to improving survival rates from lung cancer. Our 'Detect Cancer Early' initiative, which was launched in February 2012 with £30 million of investment, focuses on raising public awareness and encouraging people with early symptoms of cancer to see their GP.

Our lung cancer social marketing campaign, led by Sir Alex Ferguson as spokesperson, has been running from November 2013, with the aim of building belief that something can be done for lung cancer if detected earlier, reinforcing that people can live well after lung cancer if it’s detected earlier, and impressing on people that it is worthwhile seeing their GP as soon as possible.

The revised Scottish Referral Guidelines for Suspected Cancer were published in October 2013 and updated May 2014. This version updates referral guidelines for lung cancer, and takes account of new research evidence and the findings of audits undertaken since the last revision. The aim of these updated guidelines is to facilitate appropriate referral between primary and secondary care for patients whom a GP suspects may have cancer. The guidelines should help GPs, the wider primary care team, other clinicians and patients and carers to identify those patients who are most likely to have cancer and who therefore require urgent assessment by a specialist. Work is also being undertaken to support the effective dissemination and implementation of the revised guidelines when they are published by August 2014.

The quality performance indicators programme also aims to drive up the standard of cancer services available in NHS Scotland. This programme contains specific indicators for prostate cancer. These indicators will be used to monitor and drive quality improvement in prostate cancer care across the NHS in Scotland and ensure that people have access to timely, safe and effective services.

The Scottish Cancer Taskforce discussed the possibility of a cancer patient experience survey in Scotland in their meeting on 27 June 2014. The taskforce agreed that further investigation should take place, including examination of the methodology behind the surveys which have taken place in other parts of the UK.

The Scottish Government gathers the experiences of a range of health care users via the biennial Inpatient Patient Experience survey and the biennial Health and Care Experience survey (formerly the GP Patient Experience survey). This includes cancer patients.

A national cancer quality performance indicators (QPI) programme is being taken forward to drive continuous quality improvement in cancer care across NHS Scotland, and QPIs will be developed for all main cancers by October 2014. As part of the wider QPI work programme, Patient Experience QPIs were published in April 2014. The aim is to foster a culture of continuous quality improvement at a local level supported by a programme of regional and national comparative reporting and review. This will allow for identification of common themes and best practice for improvement in patient experience.

Heart failure services are covered by the Scottish Government 18 weeks to referral to treatment waiting time standard. To deliver this standard all parts of the patient pathway, outpatient consultation, diagnostic test and treatment, must be as short as possible. If a patient goes on to inpatient and day case treatment they will also be covered by the 12 weeks legal treatment time guarantee. However, within the standard and guarantee we would expect that the more urgent patients will be seen much quicker.

There are no waiting time targets for follow up appointments as the timing of such appointments need to reflect each individual patients condition and treatment. We would expect clinicians to keep patients fully informed of their care and the frequency of any follow-up care.