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Operational decisions about local engagement are a matter for Police Scotland.

Reform is strengthening the connection between the services and the communities they serve. This is supported by the statutory principle that the police service should seek to achieve its main purpose of improving safety and well-being by being accessible to and engaged with local communities. Ministers have also set strategic priorities for the service to be visible, responsive and focused on protecting frontline delivery.

There are local commanders for each of Police Scotland’s 14 divisions, and they work with the community and other partners to shape and deliver local policing. The 353 local policing plans provide a key way for the service to engage with local communities about progress being made to address their priorities.

The Scottish Centre for Healthy Working Lives was established in 2005 as a Directorate of NHS Health Scotland to promote good health and wellbeing in Scottish workplaces.

The Centre operates a website with a wide range of information on workplace health, safety and wellbeing good practice. It has a free and confidential advice line that is currently receiving additional funding from the Department for Work and Pensions (DWP) as part of a pilot to improve access to advice for managers in small and micro-enterprises (<50 employees). The advice line can offer advice to employers on a wide range of conditions around workplace adjustments to support workers with health conditions or disabilities and supporting workers with sickness absence issues.

The Centre runs the Healthy Working Lives Award programme which recognises and rewards organisations that meet a range of criteria for the promotion of workplace health, safety and wellbeing. The Centre also has a network of advisers based in the territorial health boards who provide site visits, deliver the award programme and organise events for employers.

Advice on work is also available through the Musculoskeletal Zone on the NHS Inform website at the following link: http://www.nhsinform.co.uk/msk

In addition the DWP’s Work Programme and Access to Work service provide additional support for people who have been out of work for some time and provide help for people overcome barriers to starting or keeping a job.

The Scottish Government have commissioned the production of a minimum standard framework for musculoskeletal (MSK) Services which encompasses pathways for diagnosis, investigation, timely management and onward referral of individuals who have, or are suspected to have, an inflammatory disease such as ankylosing spondylitis. The framework is currently subject to consultation.

The framework will ensure the awareness and documentation of the relevant indicators for inflammatory conditions, service access to investigations as clinically indicated and local processes for onward referral to other clinical specialisms, including rheumatology. The Framework emphasises that NHS boards should clearly define and disseminate referrals pathways from primary care right through to tertiary services.

There are a number of diagnostic tests which can be used to determine a diagnosis of ankylosing spondylitis (AS). Initial tests such as blood tests can provide an indication of inflammation. Where inflammation is indicated a referral to a rheumatologist would be expected for further tests.

The rheumatologist will carry out imaging tests to examine the appearance of the spine and pelvis which may include x-ray, ultrasound scan and magnetic resonance imaging (MRI). It is recognised that an MRI scan can highlight changes in the sacroiliac joints (at the base of the spine) that might not show up on an X-ray and can also show any inflammation of ligaments in the spinal region. MRI scans are increasingly being used to detect ankylosing spondylitis early.

In developing appropriate pathways to improve diagnosis and patient outcomes, NHS boards are encouraged to take into account clinical guidance, research findings and quality standards as well as relevant guidance produced by organisations such as the National Ankylosing Spondylitis Association.

Where a potential diagnosis of an inflammatory condition such as ankylosing spondylitis is suspected we would expect people to be referred to a Rheumatologist for diagnosis, treatment and on-going management, as required. Rheumatologists are specialists in the care and treatment of a number of inflammatory conditions which also include rheumatoid arthritis and psoriatic arthritis.

In 2012 the Scottish Public Health Network (SPHN) published the Health Care Needs Assessment (HCNA) on rheumatoid arthritis (RA). The report, commissioned by the Scottish Government, outlines RA service provision across Scotland, taking account of recent advances in understanding, treatment and care of people living with RA.

The purpose of the HCNA was to identify gaps in service provision, highlight priority areas for change and make recommendations that aim to assist NHS boards to plan and develop services for people living with RA and support them to become more person centred, safe and effective.

Although the needs assessment focussed on RA many of the issues are raised are similar for other inflammatory conditions including AS and a number of the recommendations in the report are equally relevant to other inflammatory conditions including AS, for example: raising awareness; early diagnosis/treatment; support to self-manage; management of flare ups; and support to remain in work.

We are currently considering how we can best support boards in implementing the recommendations contained within the HCNA for RA, which will also be of benefit to people living with AS. We will seek opportunities to ensure that positive outcomes from this work are maximised across the range of inflammatory conditions including AS.

The accurate and effective use of clinical data is an essential component of high quality care. NHS boards must ensure that clinicians have appropriate access to systems to enable them to capture the data needed to support patient care.

The Scottish Government have commissioned the production of a minimum standard framework for musculoskeletal (MSK) services which encompasses pathways for diagnosis, investigation, timely management and onward referral of individuals who have, or are suspected to have, an inflammatory disease such as ankylosing spondylitis (AS). The Framework is currently subject to consultation.

The framework will ensure the awareness and documentation of the relevant indicators for inflammatory conditions, service access to investigations as clinically indicated and local processes for onward referral to other clinical specialisms, including rheumatology. The framework emphasises that NHS boards should clearly define and disseminate referrals pathways from primary care right through to tertiary services.

In addition to this work we are considering the recommendations made within the health care needs assessment on rheumatoid arthritis (RA). The report published by the Scottish Public Health Network was commissioned at the request of the Scottish Government and while it focusses on the provision of care and treatment of RA many of the recommendations are relevant to AS. In taking this work forward we will seek opportunities to encompass other inflammatory conditions including AS.

Where a potential diagnosis of an inflammatory condition such as Ankylosing Spondylitis is suspected we would expect people to be referred to a Rheumatologist for diagnosis, treatment and on going management, as required. Rheumatologists are specialists in the care and treatment of a number of inflammatory conditions which also include rheumatoid arthritis and psoriatic arthritis.

In 2012 the Scottish Public Health Network (SPHN) published the Health Care Needs Assessment (HCNA) on rheumatoid arthritis (RA). The report, commissioned by the Scottish Government, outlines RA service provision across Scotland, taking account of recent advances in understanding, treatment and care of people living with RA.

The purpose of the HCNA was to identify gaps in service provision, highlight priority areas for change and make recommendations that aim to assist NHS boards to plan and develop services for people living with RA and support them to become more person centred, safe and effective.

Although the needs assessment focussed on RA many of the issues are raised are similar for other inflammatory conditions including AS and a number of the recommendations in the report are equally relevant to other inflammatory conditions including AS, for example: raising awareness; early diagnosis/treatment; support to self-manage; management of flare ups; and support to remain in work.

We are currently considering how we can best support boards in implementing the recommendations contained within the HCNA for RA, which will also be of benefit to people living with AS. We will seek opportunities to ensure that positive outcomes from this work are maximised across the range of inflammatory conditions including AS.

Ankylosing spondylitis can develop slowly over a long period of time. The symptoms can include: back pain and stiffness; buttock pain; inflammation of the joints; painful inflammation where tendons or ligaments attach to bone (enthesitis); and fatigue and usually start in late teenage years or early adulthood. The symptoms can vary greatly and may come and go, improve or get worse. Damage to the spine may not be visible as the condition progresses, which can make it difficult to diagnose.

NHS Inform is the primary source of information for public and for healthcare professionals in Scotland. The website has a dedicated page for ankylosing spondylitis which provides advice on symptoms, diagnosis and treatment.

http://www.nhsinform.co.uk/health-library/articles/a/ankylosing-spondylitis/introduction.

GP’s as generalists are expected to be able to recognise the signs and symptoms of inflammatory conditions and the Royal College of General Practitioners (RCGP) UK curriculum for GP training includes a section on the care of people with Musculoskeletal problems, which encompasses inflammatory conditions such as AS.

Upon completion of training, GPs have a professional obligation to participate in continuous professional development (CPD) activities. A successful GP is considered to be one who masters the skills required to become a self-directed and needs-based learner, which involves learning whatever is required to competently perform the role of a GP. It is Scottish Government policy for GPs to participate in an annual appraisal process, which helps GPs to identify their learning needs to address the healthcare needs of their patients.

We would expect people with a diagnosis of ankylosing spondylitis to receive treatment and on-going management under the care of a rheumatologist for diagnosis, as required. Rheumatologists are specialists in the care and treatment of a number of inflammatory conditions which also include rheumatoid arthritis and psoriatic arthritis.

Examples of good practice in the management of flare ups exist across NHSScotland. An example of this is the telephone support service provided by Clinical Nurse Specialists in NHS Greater Glasgow and Clyde which provides support for people with a range of conditions including ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Similar services are available in a number of boards including NHS Ayrshire and Arran, NHS Borders and NHS Fife.

In 2012 the Scottish Public Health Network (SPHN) published the Health Care Needs Assessment (HCNA) on rheumatoid arthritis (RA). The report, commissioned by the Scottish Government, outlines RA service provision across Scotland, taking account of recent advances in understanding, treatment and care of people living with RA.

The purpose of the HCNA was to identify gaps in service provision, highlight priority areas for change and make recommendations that aim to assist NHS Boards to plan and develop services for people living with RA and support them to become more person centred, safe and effective.

Although the needs assessment focussed on RA many of the issues are raised are similar for other inflammatory conditions including AS and a number of the recommendations in the report are equally relevant to other inflammatory conditions including AS, for example: raising awareness; early diagnosis/treatment; support to self-manage; management of flare ups; and support to remain in work.

We are currently considering how we can best support boards in implementing the recommendations contained within the HCNA for RA, which will also be of benefit to people living with AS. We will seek opportunities to ensure that positive outcomes from this work are maximised across the range of inflammatory conditions including AS.