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Scottish Government officials met recently with the lead investigator of this study who presented some early findings in confidence. However, the results of the study have yet to be published in the peer-reviewed scientific literature. Once the full results have been published, it is expected that the UK National Screening Committee will consider the data as a matter of course.

The Scottish Government has a clear commitment to increase early detection rates of lung cancer and a number of pieces of work are underway to ensure Scotland contributes to the emerging evidence base. While there are some potentially exciting developments for lung cancer in the pipeline, it’s imperative that the time is taken now to carefully explore the best option(s) that match our unique circumstances in Scotland, to avoid creating further health disparities.

The Fracture Liaison Service Database (FLS-DB) is a clinically led web based national audit of secondary prevention in England and Wales and forms part of their wider work programme - the Falls and Fragility Fracture Audit Programme (FFFAP). As this has been developed as part of this work stream it is not clear what the benefits for Scotland would be.

All health boards in Scotland have protocols and pathways in place for patients over 50 years who sustain a fracture to be referred for the appropriate diagnostic tests and treatment.

In Scotland we have a well-established process via the Clinical Outcomes and Measures for Quality Improvement Committee (COMQI) to assess the benefits of clinical audits and reviews, including databases. COMQI was established in 2014 and ensures a clear focus on the collection and use of clinical data to continue to drive quality improvement across NHSScotland whilst ensuring that appropriate governance and assurance processes are in place.

The Scottish Clinical Audit Programme (CAP) has been established as a sub group of COMQI to provide consistent, transparent and strategic oversight to the Scottish clinical audit process, including the participation in new audits.

CAP reviews proposals of participation in new clinical audits against a set of standard agreed criteria to ensure that the proposals align with Government and clinical priorities and demonstrate clear improvement benefits and value for money. To date there have been no approaches from the clinical community to these groups to support the FLS-DB.

The Scottish Government recognises that, with an ageing population, harm caused by falls continues to be a serious and growing concern for the people of Scotland and for our healthcare, social care and housing providers; that is why we are working with colleagues across a range of sectors to make the most of a broad range of opportunities to reduce harm from falls

We have a Programme for Government commitment to develop a National Falls and Fracture Prevention Strategy. In doing so, we look to create a culture of partnership in which we take collective action, maximising and respecting the contribution of all partners. Development of the Strategy provides an opportunity to present an achievable vision of a joined up, whole system approach to falls and fracture prevention and management which will help to deliver on strategic objectives to support people to age well. Consultation on the Strategy opened on 8 July.

Reducing the use of and harm caused by tobacco products is one of Scotland’s public health priorities. Given that smoking is more prevalent in our most deprived communities, we have set specific smoking cessation targets for our cessation services which are focussed entirely on these communities. Cancer Research UK commended this approach at the end of last year, recognising that the Scottish approach is reducing health inequalities. CRUK also recommended that the rest of the UK adopted the Scottish approach to engaging and supporting people in the most deprived communities. The rate of decline in smoking in these communities now matches, and in some areas exceeds, the rate of decline traditionally seen in our least deprived communities. As part of our recent approach we have also improved the consistency of service across boards and re-branded the service to a national identity - Quit Your Way - with the emphasis on individual smokers being able to choose their way to quit. This included the Get Through 72 campaign in summer 2018 which, as well as national television and radio broadcasts, included field marketing initiatives which took the campaign message on services directly to more deprived communities. Banning smoking in Scotland’s prisons will have higher impact and greater benefit in these communities as people give up their habit and, on release, return home non-smokers.

Increasing public awareness of the symptoms of Lyme disease is an ongoing priority for the Lyme Borreliosis Group which is part of the Scottish Health Protection Network. The group has produced a number of educational resources for the public which can be accessed at: The group meets on a regular basis to discuss and take forward projects on raising awareness of Lyme disease.

Our commitment to early detection is reflected in our £42 million Detect Cancer Early (DCE) Programme that aims to increase the proportion of breast, bowel and lung cancers diagnosed early in Scotland. The Programme also aims to reduce the inequality gap as those from more deprived areas are less likely to take part in screening and are more likely to present at a later stage, when the chance of survival is lower.

Social marketing has a key role to play in the early detection of lung cancer, targeting those from areas of deprivation. Sir Alex Ferguson has fronted DCE’s marketing activity since 2013 to raise awareness of the benefits of early detection, while reminding people that lung cancer is no longer a death sentence. This has contributed to the 31.0% increase in stage one lung diagnoses in the most deprived areas of Scotland since DCE began. A new social marketing approach is now being explored with key stakeholders and leading clinicians to ensure those at higher risk of lung cancer remain alert to possible signs and symptoms of lung cancer and feel empowered to act early. A new DCE roadshow will also be targeting areas of high deprivation across Scotland this summer, to reinforce messages around lung cancer survival direct to the public.

To support primary care clinicians in diagnosing cancer early, DCE funded a clinical refresh of the Scottish Referral Guidelines for Suspected Cancer, with updated evidence published January 2019. Eight pathways were included in the refresh, including lung. In collaboration with Cancer Research UK and Macmillan Cancer Support, work continues across NHSScotland to ensure the guidance is fully disseminated and adopted.

Meanwhile, the Scottish Government is currently exploring what opportunities exist for Scotland to contribute to the emerging evidence base of lung cancer screening for high risk individuals. Officials have recently met with academics, the Chair of the UK National Screening Committee, and the Scottish Screening Committee to discuss ongoing studies and trials, to identify where Scotland can best add value. These discussions are ongoing and any recommendations will be carefully considered.

The Design Manual for Roads and Bridges (DMRB) sets the national standards and guidance for the design of new capital road schemes and maintenance works on the trunk road network. The DMRB is kept under continual review and standards are regularly updated. The age of the A77 varies and improvement and maintenance of the route is always undertaken to the relevant national standards applying at the time. The DMRB does not specifically define any measure of acceptability with respect to road condition.