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The Director General of Health and Chief Executive of NHS Scotland wrote to NHS board chief executives in May asking them to undertake an urgent review of their current local policies and indentify the actions required to ensure information on additional needs and the necessary support services are recorded and transmitted across the NHS, particularly between primary and secondary care. It also asked that they must ensure that additional support, including different types of documentation/communication formats are in place to ensure that patients'' with additional needs, including visually impaired people, have no delay in accessing health care. Officials continue to monitor the implementation of NHS boards planned actions.

http://www.scottish.parliament.uk/Apps2/Business/PQA/Default.aspx

This level of detail is more likely to be addressed in a local authority area service plan.

There is limited national Scottish evidence on differences in health risk behaviours for ethnic minority groups - the respective populations are quite small “ for example, the Pakistani population being around 0.63% and the Bangladeshi population 0.04% of the Scottish population at the 2001 census. However, the Scottish Executive report High Level Summary of Equality Statistics: Key Trends for Scotland 2006 noted that smoking prevalence was lower among minority ethnic groups, as a whole than among white ethnic groups, although percentages were based on small sample sizes.

In addition, the Dimensions of Diversity report published by the Scottish Public Health Observatory in January 2010, notes that a series of studies in Glasgow has found that among members of ethnic minority groups, with the exception of Pakistani men, smoking rates are much lower than among the general population, with particularly low rates among ethnic minority women (4 to 5%). Other studies have shown a high prevalence of use of other tobacco products, particularly in the Pakistani and Bangladeshi communities. The use of certain types of non-smoked and chewing tobacco may be more widespread than in the general population.

There has been targeted support for minority ethnic communities through local tobacco alliances and national pilot smoking cessation projects under the Partnership Action on Tobacco and Health (PATH) initiative, which is funded by the Scottish Government. PATH, NHS Lothian and the Minority Health Inclusion Project have produced a DVD resource for discussing the use of various tobacco products with those in minority ethnic groups. The resource was presented to the Ministerial Working Group on Tobacco Control in May 2010 and a Scottish Government official has since met with the stakeholder organisations to explore how to maximise the impact of this resource.

The Guide to Smoking Cessation in Scotland 2010 “ Planning and Providing specialist smoking cessation services, published by NHS Health Scotland and ASH Scotland, includes guidance on how evidence-informed specialist stop smoking services should operate. This includes recommendations for working with target groups, including minority ethnic groups, and a recommendation to provide services in the language chosen by clients, wherever possible. The national telephone helpline smoke line has the Language Line translation facility available.

Information is not held centrally that would enable analysis by local authority or deprivation category.

To coincide with the introduction of the smoke-free legislation in 2006, which banned smoking in most work places, the Scottish Government supported RNIB Scotland to raise awareness around the health risks associated with smoking and loss of sight through a series of road shows across the country. RNIB Scotland continue to raise awareness of such issues through their website.

We will, of course, continue to look for opportunities to raise awareness of the issue through social marketing activity undertaken by the Scottish Government and our key partners such as NHS Health Scotland, ASH Scotland and RNIB Scotland.

In addition, work is also ongoing to increase the number of brief interventions and referrals for specialist smoking cessation support made by all health professionals. Included in this is the range of professions involved in the assessment and treatment of patients where there may be a risk of sight loss.

Notes:

1. Additional to the funding outlined above £2 million per annum is contained in NHS board baselines from the smoking kills and health improvement fund.

2. In addition a smoking cessation service was introduced as part of the community pharmacy contract at end August 2008. The following figures represent payments to community pharmacies providing a smoking cessation service.

2008-09: September 2008 “ March 2009

(part year service began end of August 2008) = £3,461,230*

2009-10 = £3,746,096

2010-11 = two months fees for April and May 2010 = £677,523. It is estimated that the costs for the full year will be similar to 2009-10.

*The 2008-09 figure includes one-off readiness and administration payments to each pharmacy providing a smoking cessation service to cover set-up and training costs.

Total revenue resource limit (RRL) figures are not available for 2010-11 as in-year board allocations have yet to be confirmed for all programmes.  To maintain consistency with prior year figures, smoking cessation funding as a % of total RRL has not been calculated for 2010-11.

All figures are rounded to the nearest £1,000.

In 2009, 14,431 successful one month quits were recorded in the two most deprived within board Scottish Index of Multiple Deprivation quintiles, equating to 54.5% of all successful quits recorded in NHS stop smoking services. The Scottish Government is considering how to build upon this as part of the work which is currently ongoing to review and update NHS Scotland HEAT targets.

In March 2010, following extensive consultation with key stakeholders, we announced that new guidance would be prepared to help mental health residential service providers move towards establishing smoke-free environments. The aim of this guidance, which is being developed by NHS Health Scotland in consultation with key stakeholders and service users, will be to drive change at a pace which is acceptable to individual services, and, most importantly, to the service users themselves. The guidance will draw on best practice from residential mental health services which have already successfully implemented completely smoke-free policies. The guidance is expected to be published by the end of March 2011.

It is recognised, of course, that a key component of achieving smoke-free services is to ensure that appropriate stop smoking support and advice is available. With this in mind the Scottish Government is continuing to invest in NHS stop smoking services, over £40 million in this spending review period to enable NHS boards to provide high-quality and accessible services across their areas.

Moreover the Guide to Smoking Cessation in Scotland 2010 - Planning and Providing Specialist Smoking Cessation Services, published by NHS Health Scotland and ASH Scotland, includes guidance on how evidence-informed specialist stop smoking services should operate. This includes a recommendation that when working with people with mental health problems tailored smoking cessation advice should be provided and timely access to an intensive smoking cessation service, with fast tracking, should be offered where possible.

We do not currently have formal arrangements in place for national-level monitoring of smoking levels in mental health inpatient units but we are exploring the scope for updating a mapping report on smoking policies in residential psychiatric services which was undertaken by ASH Scotland''s tobacco and inequalities project. This may inform a baseline against which progress could be monitored towards achieving a reduction in smoking levels following the issuing of the guidance material.