Chamber and committees

Rises in confirmed notifications of meningococcal infection over the winter of 1999-2000 were associated with the unusually large outbreak of influenza, a well-recognised association. On 14 January the Executive issued a press release, SE0059/2000, confirming this and urging vigilance to identify early signs of meningococcal infection and urging parents to bring their children forward when invited to receive vaccination against meningococcal group C infection.

The Executive is meeting the costs of the meningococcal C immunisation programme which began in November last year, and which is aimed at reducing numbers of cases of group C meningococcal infection. The cost of the programme is £31 million over the three years to 2001-02.

The Scottish Centre for Infection and Environmental Health (SCIEH) has recently implemented an enhanced surveillance programme, in liaison with the Scottish Meningococcal and Pneumococcal Reference Laboratory (Stobhill), to study in detail the effects of the vaccination programme and to allow targeting of other interventions as appropriate or which may be available in the future.

Reported levels of infection have now declined to low levels in accordance with what would normally be expected at this time of year.

Coronary stents are already used in Scotland for the treatment of coronary heart disease, based on the indications set out in SIGN Guideline 32, Coronary Revascularisation in the management of stable angina.

The National Health Service is obliged to ensure equity of access to all services for everyone irrespective of their ethnic background or if English is not their first language. General principles and specific recommendations for language, communication and information needs are set out in the 1994 Department of Health booklet, Access to Health Care by the Ethnic Minority Communities: A Guide to Good Practice.

The Scottish Executive has funded a stocktake of policy statements and action plans on race equality and access to services, the results of which will provide the basis for best practice guidance for the NHS in Scotland.

The Scottish Health Survey is the major national survey of the health of the Scottish population within the 2-74 age group. It involves the gathering of health-related data from almost 13,000 members of the Scottish public.

The fieldwork for the 1998 survey, which commenced in April 1998, was completed in May 1999 and took the form of individual interviews and separate nurse visits for the purpose of blood pressure and other measurements and collection of blood and saliva samples. The resultant extensive and complex data have been subject to rigorous evaluation and analysis to ensure the validity and quality of the survey outcome and report, a task which is essential to set within an appropriate time frame.

The exact number is not yet known. In preparing their plans, health boards and Trusts have been asked to take account of the work of the short-life group which the Chief Medical Officer has established to look at ITU and HDU issues. Its report is expected in the early autumn.

Currently, flu vaccine is ordered by community pharmacists in anticipation of demand from general practice. Information is collected centrally about the vaccines dispensed but not the orders placed.

I announced on 23 May an extension of the flu vaccine immunisation programme to everyone aged 65 and over. Community pharmacists have been advised to take this into account when ordering supplies.

This question had been referred to officials, became lost in the system, and came to light when a comprehensive trawl was made of all unanswered questions. I first received a suggested reply from officials on 26 June and the question was answered by me on 7 July.

The latest data available is from the annual notification of vacancies at 30 September 1999, which is collected by ISD Scotland. Only consultant and staff grade vacancies are recorded. At 30 September 1999, 8.2% of established consultant or staff grade posts in radiology were unfilled.

We are committed to increasing the number of doctors working in the NHS in Scotland, particularly in the area of cancer treatment. Figures show that the whole time equivalent figure for consultants in radiology has increased by 8.5% from 1996 to 1999 and the headcount has increased by 11% over the same period.

I have recently announced a package of additional investment in the workforce which includes provision for 100 extra junior doctors and 10 extra consultants. Half of the additional junior doctor posts will be flexible posts, to recognise the increasing role of women in the medical workforce. The distribution of posts across various specialties is currently being determined.

The following table shows public expenditure on health as a proportion of GDP in Scotland and in countries within the European Community in 1997 - the latest year for which comparable data are available.

Public Expenditure on Health as Percentage of GDP
Country	%
Germany	8.3
Sweden	7.2
France	7.1
Belgium	6.7
Denmark	6.7
Luxembourg	6.4
Netherlands	6.2
Austria	6.0
United Kingdom	5.8
Finland	5.7
Spain	5.6
Italy	5.3
Greece	5.0
Ireland	4.9
Portugal	4.7
EU Average	6.5
Scotland	6.4

Notes:

1. The source of the data for European countries is the OECD healthcare database 1999. The estimate for Scotland is based on total NHS expenditure and an estimate of GDP at market prices.

2. OECD estimates of health expenditure as a percentage of GDP use GDP at market prices. Although this figure is available for the UK, separate estimates are not made of GDP at market prices for regions within the UK. To obtain a figure for GDP at market prices in Scotland the following method has been used: it has been assumed that the Scottish share of UK GDP at market prices (Including North Sea oil output) is the same as the share of GDP at factor cost. It should be noted that estimates of UK GDP at market prices may be subject to revision and this would affect the estimate of Scottish GDP at market prices.

3. The EU average has been estimated by weighting together the figures for individual European countries, with each country's GDP used as the relative weight.

4. Private expenditure on healthcare is excluded from these figures.

Expenditure on the NHS in Scotland in 1997 was about the same percentage as the EU average although comparisons of health expenditure between countries should be treated with considerable caution. There are differences between countries in methods of organising and delivering healthcare as well as differences in funding arrangements. There may also be differences in methods of recording expenditure on healthcare and, as the OECD point out, "the very definition of healthcare...differs from country to country". All of these factors may distort comparisons between countries.

The Scottish Executive is committed to making substantial increases in health spending for the duration of this Parliament. As tangible evidence of this, health spending in the current year has been increased by almost £500 million on last year's planned level of funding and is due to increase by a further £2.095 billion by 2002-03. This represents a significant investment in the NHS in Scotland and the Executive is now working with the service to ensure that the resources are invested effectively in a way that will deliver sustainable improvements for patients across Scotland.

There are no formal guidelines specifically targeted at malnutrition in the community. In 1999 by the Scottish Executive Health Department set out an action plan for nursing homes to assess the nutritional status of residents and provide for their dietary needs in line with UK Department of Health Dietary Reference Values. The plan was also to be applied by health boards and Trusts in all NHS facilities.

The Scottish Executive is also pursuing a range of initiatives to encourage and support people to make the lifestyle changes necessary to improve their health.