Chamber and committees

Treatment and rehabilitation needs vary greatly and our strategy is to ensure that a range of services is provided. The planning and provision of these services are the responsibility of local statutory and non-statutory agencies. Local Alcohol Misuse Co-ordinating Committees (AMCCs) and Drug Action Teams (DATs), who are best placed to assess local needs have a key role to play in ensuring a strategic and co-ordinated approach for their areas.The drugs strategy Tackling Drugs in Scotland: Action in Partnership sets out a comprehensive programme of action in the form of objectives and action priorities. Treatment is one of the four strategic aims of the strategy. Specific action priorities include the provision of shared care arrangements and integrated drug misuse services; improvements in service provision for young people, particularly the under-16s; and the provision of measures to prevent the spread of blood borne viruses.The Scottish Advisory Committee on Alcohol Misuse established in April 1999 to develop a national strategy for tackling alcohol misuse in Scotland will be advising on the development of further guidance on effective local strategies within the context of national strategic objectives and priorities.

The latest figures available as at 30 September 1999, indicate that nine acute NHS Trusts are forecasting a year end deficit. It is not possible to present the information on a hospital by hospital basis as NHS Trusts are managed on an overall Trust basis and information on individual hospital units is not routinely collected.Those Trusts forecasting a deficit are being closely monitored and have been asked to consider how their financial position can be rectified as soon as possible.

Trust	Year End
	forecast deficit
	As at 30.09.99
	£000
Argyll and Clyde Acute Hospitals NHS Trust	(2,123)
Borders General Hospital NHS Trust	(413)
Fife Acute Hospitals NHS Trust	(399)
Grampian University Hospitals NHS Trust	(141)
North Glasgow University Hospitals NHS Trust	(8,798)
South Glasgow University Hospitals NHS Trust	(2,649)
The Yorkhill NHS Trust	(912)
Highland Acute Hospitals NHS Trust	(400)
Tayside University Hospitals NHS Trust	(3,821)

Since 1 April 1999, Health Boards and local authorities are for the first time working to the same definition of delayed discharge from NHS care. The information that will flow from this initiative will inform what impact, delayed discharge has on the organisation of NHS hospital care.

The Access to Health Records Act 1990 gives individuals the right of access, subject to certain specific exemptions, to health records containing information about themselves. Parents may also be entitled to access to their children's health records. The Act makes no distinction between parents who may be living together or separated. In the case of a child under the age of 16, an application for access to a record may be made by either the patient, a person authorised by the patient or by the child's parent or guardian. The child's right to confidentiality, however, must also be considered. A child who, in the opinion of the health professional with overall responsibility for their clinical care, possesses sufficient understanding to give or withhold consent to disclosure of their information enjoys the same rights to confidentiality as any other person.

It is generally believed that CHD in Scotland is a mass disease, which affects some 500,000 people. As far as mortality is concerned, the most recent figure for Scotland is that in 1998 there were 13,419 deaths from CHD. The latest year for which the information is available for England is 1997. There were 140,559 deaths from CHD that year.As the report of the Acute Services Review (June 1998) noted, however, there is a shortage of data on coronary heart disease, especially in relation to morbidity in the community. Better data are essential so that we can assess whether we are meeting all the needs of those with CHD. The Scottish Executive's CHD Task Force is therefore giving priority to setting up a national CHD database founded on the routine management of patients in primary care.In the meantime, the most recently published information on the prevalence and mortality from CHD, although categorised as Ischaemic Heart Disease, occurs in The Scottish Health Survey 1995, published by the former Scottish Office Department of Health and Regional Trends based on data provided by General Register Office (Scotland) and the Office for National Statistics. Those data are summarised below.The Scottish Health Survey, which is based on respondants in the 16-24age group, states:"Ischaemic heart disease - The prevalence of IHD was higher in Scotland than in England with the difference being greatest among older informants. Among men, the overall prevalence was 4.0% in Scotland and 2.5% in England. The difference in prevalence was greatest among those aged 45-54 (6.0% vs. 3.0%) and those aged 55-64 (17.0% vs. 10.3%). Among women, the overall prevalence was 2.9% in Scotland and 1.5% in England. The corresponding figures in the 45-54 years and 55-64 years were 3.4% vs. 2.3% and 11.4% vs. 5.9% respectively".The table below shows age-adjusted mortality rates for Ischaemic Heart DiseaseAge-adjusted mortality rates: Ischaemic Heart Disease(rate per 100,000 population)

Year
	Males		Females		both sexes
	England	Scotland	England	Scotland	England	Scotland
1994	285	349	230	288	257	315
1995	271	329	218	278	246	302
1996	261	325	211	266	237	294
1997	245	299	200	261	224	279

Source: Regional Trends Data; Office of National Statistics, GRO (Scotland)We are of course taking forward a £15 million demonstration project under the White Paper Towards a Healthier Scotland which will build on international experience in the primary prevention of CHD. That White Paper also set a target of reducing by 50% between 1995 and 2010 the mortality associated with CHD.

It is for individual clinicians to decide whether to offer post-exposure prophylaxis taking account of the circumstances of each case.

Scottish Executive Health Department officials met with representatives of the Royal College of Radiologists and of the Scottish Council for Postgraduate Medical and Dental Education (SCPMDE) in May of this year to discuss planning for the radiology workforce. They recognised a need for an increase in the number of trainees in radiology in Scotland and therefore SCPMDE have increased the numbers of Specialist Registrars in this specialty by five per year from 71 to 76 and will consider further increases in the future.

A pilot exercise involving local authorities and health boards was announced in April, based on a national definition that a delay has occurred where two days have passed after the clinician has agreed that a transfer is appropriate.

On the basis of information currently available for 13 of the 15 health board areas, in the 35,524* average available staffed beds in Scotland, there are 2,015 patients whose discharge has been delayed by more than the two days referred to in the pilot definition.

Guidance has issued on the need to ensure that plans are in place locally to deal with peaks in demand for services and care throughout the year and over holiday periods in particular. All agencies are continuing to work together to keep the numbers and duration of delays to an absolute minimum.(* Source ISD Scotland, 1998-99 provisional figures-excluding joint user and contractual beds)

The policy on dental screening is that children in local education authority schools should have a minimum of three dental checks during their school career.Health visitors are not normally expected to visit schools, although they may have some involvement in relation to specific local projects.

I refer the Member to my answer to parliamentary question number S1W-1740.