A TB Action Plan for Scotland

Foreword

Tuberculosis is an ancient disease that has been with mankind for centuries, probably millennia. Towards the end of the last century, it was commonly accepted that tuberculosis was a conquered disease, an infection of the old world which was well controlled by modern medicines and good clinical practice. In particular the work of Scottish physician Sir John Crofton played a significant part in the steps taken to control TB during this period. However we now know that our optimism that TB had been conquered was ill-founded. Tuberculosis has not survived for so long with mankind to be so easily eliminated. The introduction to this Action Plan reports that tuberculosis continues to kill an estimated 1.8 million people worldwide each year. Many of these deaths continue to be in developing countries where access to vaccines, antibiotics and health care can be limited. But it is wrong to assume that these parts of the world are the only places where tuberculosis can devastate lives. In the developed world tuberculosis continues to have a strong grip, particularly amongst those with other social and health related problems. Drug resistant strains of the disease are emerging and need to be carefully managed and the continued prevalence of HIV can lead to significant complications for those co-infected with tuberculosis. In a rapidly changing world with increased movement of people wealthier countries no longer have the luxury of thinking tuberculosis is not a problem. Tuberculosis is an issue of global concern affecting every country. It is also naïve and simplistic to think that tuberculosis is a problem whose cause is immigration alone. In recent years Scotland has had a relatively low and stable incidence of tuberculosis. Compared with other parts of the UK and Europe the disease has not been a significant problem. However, the recent epidemiological evidence suggests that the picture may be changing. While tuberculosis is still at lower levels than elsewhere in the UK, the numbers of cases we are now seeing are suggestive of an increasing incidence. We need to act now to reverse this trend in Scotland.

At the highest level, the intention of this Action Plan is to ensure that Scotland provides the best quality clinical, laboratory and public health services in relation to tuberculosis, and that these are underpinned by the best possible surveillance and epidemiology. Our ambition is not just to stabilise the incidence of tuberculosis in Scotland. We want to go further. We want to significantly reduce the burden of ill-health caused by this serious disease. I believe the recommendations that are contained within this Plan provide a firm steer on what is needed. I have accepted these recommendations and the NHS Boards and other partners, including the Scottish Government, now need to deliver them.

I am grateful to all those who gave their time to the Working Group or Sub-Groups that developed this Action Plan. This commitment to improving services across the country, and the shared ambition to significantly reduce the impact of tuberculosis on the people of Scotland, reflects the very best that the NHS can be. It carries on the very good work that Sir John Crofton took forward in Scotland half a century ago.

Shona Robison
Minister for Public Health and Sport