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This study is expected to be completed by 31 January 2010.

NHS boards must ensure that local surveillance mechanisms are in place to identify any potential areas for improvement in infection control practice, and this includes surveillance to link cases of Clostridium difficile to specific hospitals, wards and beds. Whenever a patient is transferred to another area or discharged, the bed and clinical area they occupied undergoes a thorough terminal clean. If the patient was C. diff positive then this would additionally include the use of chlorine based cleaning agents, which are a proven method of killing C. diff spores, to ensure the bed is completely decontaminated and prepared for the next patient to occupy.

The Scottish Government is also making available £2 million to NHS boards in the current financial year to support the further development of robust local surveillance systems, and NHS board practice in this area is the subject of review by the HAI National Taskforce, chaired by the Chief Nursing Officer.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service (SPS) to respond. His response is as follows:

Social Enquiry Reports and Trial Judge Reports may make reference to learning difficulty/disability issues. The SPS receive both reports and will follow up this information providing the prisoner consents to information being requested from their GP or other community based providers. Additionally, the SPS relies on prisoners self disclosing diagnosis of learning difficulty.

Where a prisoner is subject to post-release supervision community service providers are involved in the multi-agency Integrated Case Management (ICM) Community Integration Planning (CIP) process. The involvement of community service providers to this planning process facilitates two way communications of relevant information regarding learning difficulties/disabilities between the community and the SPS, including post release information.

In addition discharge summaries are sent to the GP''s where prisoner''s GP information is known and the prisoner wishes such information to be shared. In specific cases of extreme learning difficulty/disability which could affect the prisoner''s return to the community, a Care Programme Approach as used by the NHS may be initiated prior to the prisoner''s release from prison.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service (SPS) to respond. His response is as follows:

All convicted prisoners receive an initial Core Screen interview as part of the Integrated Case Management (ICM) process within 72 hours of admission. This process can highlight specific needs including learning difficulties but relies on self disclosure by the prisoner. The initial Core Screening interview forms the start of the process which can lead to referrals to specialist service providers including education and health care within the prison.

In addition to the Core Screen interview convicted prisoners also complete a literacy alerting tool which can establish if a prisoner has potential literacy learning needs, this may also highlight potential learning difficulties.

In accordance with the SPS Health Care Standard 1, all prisoners have a physical, mental health, and addictions screening on admission to custody. There is no specific health care screening tool in place to identify learning difficulties.

Since my previous answer further progress has been made and at the end of November the number waiting for arrears had come down to 5,534.

To put this into context, the effective date of introduction of Agenda for Change was 1 October 2004. When the current administration took office in May 2007, 124,381 staff had been assimilated and 59% of these had been assessed for arrears with these paid where appropriate. By the end of November 2008, the number assimilated had increased to 175,004 and the percentage who had received payment of arrears had been increased to 93%.

Boards are currently working hard to try to have all substantive staff assimilated by the end of the year. Thereafter, I would expect boards to ensure payment of arrears are processed as early as possible in the new year. Progress will be monitored on a monthly basis.

National surveillance of Clostridium difficile is carried out at board level although hospitals undertake local surveillance. However, in future there will be a common reporting template used by all boards to capture HAI data at hospital/service level on a number of metrics, for example MRSA, C.diff, Hand Hygiene, cleaning standards and causes of adverse incidents. Prior to October 2006 cases were reported on a voluntary basis and the systems for doing so were unreliable. Therefore only the past seven quarters of data are available. It should also be noted that the first quarter (October 2006 to December 2006) of data collection was artificially low, due to a lack of full compliance with the surveillance protocol by some hospitals.

Table showing C.diff cases for the past seven quarters, broken down by health board:

	October 06 - December 06	January 07 - March 07	April 07 “ June 07	July 07 - September 07	October 07 - December 07	January 08 - March 08	April 08 “ June 08
Ayrshire and Arran	110	151	137	152	113	125	160
Borders	13	13	18	16	20	33	25
Dumfries and Galloway	34	44	53	26	31	47	41
Fife	48	108	73	72	123	134	98
Forth Valley	64	102	54	70	81	120	126
Grampian	119	151	116	103	149	247	226
Greater Glasgow and Clyde	268	472	444	416	421	463	402
Highland	50	64	58	86	81	35	47
Lanarkshire	140	226	194	170	198	251	189
Lothian	241	258	262	212	248	259	261
Orkney	3	0	5	0	5	1	5
Shetland	4	5	2	3	2	4	1
Tayside	108	172	169	131	135	139	145
Western Isles	11	9	3	2	1	3	6
Total	1,213	1,775	1,588	1,459	1,608	1,861	1,732

Source: Health Protection Scotland: www.hps.scot.nhs.uk.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service to respond. His response is as follows:

There are currently 16 registered learning disability nurses employed by the Scottish Prison Service.

All prison based social workers are qualified social workers. There is currently no specialist learning difficulties qualification for social workers. Training on learning difficulties is incorporated into the generic training for qualified social workers.

MMR uptake rates in Scotland have been higher than in many parts of England throughout the last decade. The quarterly childhood immunisation statistics published on 30 September indicate that uptake of the MMR vaccine by 24 months in Scotland was 91.7%, whereas the comparable figure for England in 2007-08 was 85%, and uptake in London was less than 80%.

The rate of measles is also much lower in Scotland relative to the population than in the rest of the UK. In 2008 there have been a total of 53 laboratory confirmed cases of measles in Scotland, compared to 1049 laboratory confirmed cases in England and Wales to the end of October 2008.

For these reasons there are no plans to extend the English MMR catch-up campaign to Scotland. But we are not being complacent and have a number of initiatives underway that aim to reduce risk of measles, mumps and rubella. The Never Too Late campaign, launched in 2006, aims to encourage vaccination of children who may be beyond the normal age for vaccination, emphasising that it is never too late to be vaccinated. Currently there is also a national initiative to focus invitations for the second dose of MMR pre-school vaccination at the lower end of the age range for vaccinations, thereby decreasing the period of time in which children are reliant on protection from only one dose of MMR.

Targeted incidence surveillance by NHS Scotland boards of C. difficile in those over 65 years was made mandatory from September 2006, and this approach will be extended to include patients aged 15 years and over from April 2009.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service (SPS) to respond. His response is as follows:

Each establishment has provision of a visiting psychiatry service from the NHS. The SPS meets the cost of these services. Additionally a forensic community psychiatric nurse attends HM Prison Inverness one day per week.

HMYOI Polmont is the only establishment known to have a routine speech and language therapy service. HM Prison Inverness has provision of an in reach service when required.