Chamber and committees

The information requested is not available centrally.The majority of temporary closures to new admissions occur when a hospital is under particularly severe pressure, for example due to a substantial increase in emergency admissions during the winter months. Such closures are invariably of very short duration, and when they occur, arrangements are put in place to ensure that patients requiring urgent treatment are diverted to another hospital.

The information requested is not available centrally.The majority of temporary closures to new admissions occur when a hospital is under particularly severe pressure, for example due to a substantial increase in emergency admissions during the winter months. Such closures are invariably of very short duration, and when they occur, arrangements are put in place to ensure that urgent cases are diverted to another hospital and that elective admissions which have to be cancelled are re-scheduled as soon as possible.

The exact information requested is not available centrally. It is not possible to identify from the central records the number of new out-patients who go on to require treatment as an elective in-patient or day case.Table 1 shows the number of new out-patient attendances and the number of elective admissions during each year specified. Some of the patients admitted as an in-patient or a day case will have been admitted without a preceding out-patient attendance.Figures for new out-patient attendances in each year do not necessarily equate to the elective in-patient and day case figures for the same year because, for example, a patient seen as a new out-patient in year ending March 2000 may not become an elective in-patient or day case admission until the year ending March 2001.Table 1NHSScotland: New Out-patient Attendances in Acute Specialties^1,2,3,4,5 and Elective In-patients and Day Cases^6,7,8 by NHS Board of Residence Years Ending 31 March: 2000-02^P

NHS Board (Residence)		Financial Years
		1999-2000	2000-01	2001-02P
Scotland	New out-patient attendances during year	915,931	895,282	861,106
	Elective in-patients8 during year	209,876	201,764	190,919
	Day cases8 during year	396,952	406,093	381,529
Argyll and Clyde	New out-patient attendances during year	75,775	74,929	55,389
	Elective in-patients8 during year	20,275	19,767	19,255
	Day cases8 during year	30,164	31,200	32,720
Ayrshire and Arran	New out-patient attendances during year	66,600	64,027	62,367
	Elective in-patients8 during year	15,418	15,050	14,262
	Day cases8 during year	33,721	36,414	35,211
Borders	New out-patient attendances during year	19,093	18,650	19,629
	Elective in-patients8 during year	4,183	3,665	3,490
	Day cases8 during year	8,228	8,748	8,565
Dumfries and Galloway	New out-patient attendances during year	23,508	23,427	22,799
	Elective in-patients8 during year	6,296	6,119	5,187
	Day cases8 during year	11,998	12,322	10,677
Fife	New out-patient attendances during year	62,194	60,407	59,772
	Elective in-patients8 during year	12,814	13,350	11,690
	Day cases8 during year	35,124	36,865	34,107
Forth Valley	New out-patient attendances during year	46,550	45,597	45,480
	Elective in-patients8 during year	9,367	9,498	9,307
	Day cases8 during year	20,155	22,799	24,906
Grampian	New out-patient attendances during year	81,287	77,328	76,396
	Elective in-patients8 during year	24,923	22,681	21,732
	Day cases8 during year	28,059	28,911	24,851
Greater Glasgow	New out-patient attendances during year	180,270	182,644	175,717
	Elective in-patients8 during year	38,373	38,630	37,435
	Day cases8 during year	68,908	71,325	69,766
Highland	New out-patient attendances during year	39,249	37,474	37,769
	Elective in-patients8 during year	10,706	10,164	9,697
	Day cases8 during year	11,921	12,383	12,642
Lanarkshire	New out-patient attendances during year	97,020	95,182	88,429
	Elective in-patients8 during year	23,130	21,587	20,654
	Day cases8 during year	52,072	48,365	47,539
Lothian	New out-patient attendances during year	137,014	133,102	134,950
	Elective in-patients8 during year	23,535	21,584	19,988
	Day cases8 during year	62,342	61,253	52,813
Orkney	New out-patient attendances during year	2,679	2,607	2,037
	Elective in-patients8 during year	1,019	1,089	1,111
	Day cases8 during year	717	963	885
Shetland	New out-patient attendances during year	3,847	3,907	3,992
	Elective in-patients8 during year	1,412	1,322	1,332
	Day cases8 during year	1,281	1,219	1,400
Tayside	New out-patient attendances during year	76,015	71,229	71,317
	Elective in-patients8 during year	16,416	15,224	13,755
	Day cases8 during year	30,605	31,553	23,537
Western Isles	New out-patient attendances during year	4,830	4,772	5,063
	Elective in-patients8 during year	2,009	2,034	2,024
	Day cases8 during year	1,657	1,773	1,910

Notes:1. SMR00 records (Scottish Morbidity Records 0) record all new out-patient appointments in consultant-led clinics. This analysis relates to referrals from doctors and dentists.2. Excludes patients who did not attend for their appointment (DNAs) and return attendances.3. Includes patients with a Guarantee Exception Code or Availability Status Code (GEC/ASC).4. Acute specialties exclude obstetrics and mental illness specialties.5. The same patient may have more than one new out-patient attendance in the course of a year or number of years and they will be counted each time in the table.6. SMR01 records (Scottish Morbidity Records 1) record all in-patient and day case discharges from non-obstetric and non-psychiatric specialties in NHS Hospitals in Scotland.7. The same person could have more than one elective in-patient episode or day case episode in the course of a year or number of years and they will be counted each time in the table.8. Elective admissions are based on true waiting list and deferred waiting list admissions only i.e. exclude admissions for repeat waiting list.

Over the ten years 1992-2001 there was an average (mean) of 1,240 new admissions per annum, to acute general NHS hospitals, in which a principal diagnosis of endometriosis was recorded. The crude rate per 1,000 female population aged 15 to 64 (which accounts for 99% of hospital in-patient and day case admissions) averaged (mean) 0.73 over this period.

It is the responsibility of each NHS board to deploy the resources available to it to address the health care needs of its local population. In 2003-04 every NHS board received an above inflation increase in unified budgets of between 7.4 and 8.9%.

The number of women for whom a diagnosis of endometriosis was recorded, discharged from general acute NHS hospitals in Scotland, in each of the financial years 1999-2000, 2000-01, and, provisionally, 2001-02 is recorded, by NHS board and NHS trust, as follows:Year end 31 March

NHS Board	NHS Trust	2000	2001	2002 (provisional)
Argyll and Clyde (A and C)	A and C Acute Hospital NHS Trust	275	245	203
Ayrshire and Arran (A and A)	A and A Acute Hospital NHS Trust	218	210	193
	A and A Primary Care Trust	0	1	0
Borders	Borders General Hospital NHS Trust	25	19	13
Dumfries and Galloway (D and G)	D and G Acute and Maternity Hospitals NHS Trust	81	63	59
Fife	Fife Acute Hospitals NHS Trust	226	281	226
	Fife Primary Care NHS Trust	2	0	0
Forth Valley	Forth Valley Acute Hospitals NHS Trust	100	94	115
Glasgow	North Glasgow University Hospitals Trust	286	268	230
	South Glasgow University Hospitals Trust	244	284	263
	Yorkhill NHS Trust	0	0	1
Grampian	Grampian University Hospitals NHS Trust	333	273	312
Highland	Highland Acute Hospitals Trust	137	138	119
Lanarkshire	Lanarkshire Acute Hospitals NHS Trust	151	181	165
Lothian	Lothian Primary Care NHS Trust	12	9	6
	Lothian University Hospitals NHS Trust	210	196	144
	West Lothian Healthcare NHS Trust	154	160	129
	Fairmile Marie Cure Centre	1	1	0
Orkney	Orkney Health Board Unit	1	4	3
Shetland	Shetland Hospitals and Community Services Unit	0	3	5
Tayside	Tayside University Hospitals NHS Trust	152	152	86
Western Isles	Western Isles Health Board Unit	3	0	1
Total		2,611	2,582	2,273

In NHS Scotland consultant gynaecologists deal with most cases of endometriosis. Consultants in acute general hospitals may refer severe cases to university or tertiary centres. In cases in which endometriosis is associated with infertility, women will usually be referred to one of the four tertiary centres for infertility treatment in Edinburgh, Aberdeen, Glasgow or Dundee. These arrangements ensure access to clinical expertise. It is the responsibility of each NHS board to deploy the resources available to it to address the health care needs of its local population.For details of Executive funding for research into endometriosis please refer to the response to S2W-1558 on .

The safety of medicines is reserved and is the responsibility of the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA has advised that research into the risks associated with synthetic progestins is conducted in the UK and worldwide on a continuous basis by a variety of research bodies, including pharmaceutical companies, hospitals, universities and other independent researchers.The National Research Register (NRR), a UK wide database of all publicly funded research of relevance to the NHS, records that there are currently seven projects on-going in the UK on the effects of synthetic progestins.Details of these projects are available from the NRR, a copy of which is in the Parliament's Reference Centre (Bib. number 17404).In the UK, a study (The Million Women Study) involving around one million UK women aged 50 and over is on-going and aims to answer many outstanding questions about the factors affecting womens' health in this age group. In particular, the study is looking at how hormone replacement therapy (HRT) affects a woman's health. This study was set up in 1996 by Cancer Research UK, the National Health Service Breast Screening Programme and the Medical Research Council. Over one in four women in the UK in the target age group are now participating in the study which means that the Million Women Study is the largest study of its kind in the world.In 2001, a European-wide review of all the available evidence regarding HRT use was initiated in order to produce consistent information for health professionals and women throughout Europe. The UK has had significant involvement in these discussions and has provided advice from the Committee on Safety of Medicines (CSM) Expert Working Group (EWG) on HRT. In July 2002, the combined (oestrogen and progestogen) HRT arm of the Women's Health Initiative (WHI) trial, a study that was set up to investigate the long-term effects of HRT in healthy post-menopausal women in the USA, was prematurely stopped because a pre-defined threshold of harm was reached. In the UK, the WISDOM trial, which was similarly designed to assess the balance of risks and benefits of long term HRT, was subsequently stopped as it was considered unlikely to provide substantial evidence to influence clinical practice in the next ten years. When the findings of the WHI trial were published, they were immediately considered by the CSM. Preliminary urgent advice was issued to all UK health professionals later that same day, together with a fact-sheet to help advise women who may have been concerned about the implications of these findings.The EWG on HRT has met three times since July 2002 to examine in detail these trial findings together with other recent data on the long-term risks associated with HRT and their implications for the safety of HRT in the UK. Their conclusion was that these data confirm what is already known about the small increase in risk of breast cancer and venous thromboembolism (VTE) and the lack of protection from coronary heart disease. Importantly, they also confirm protection against hip fracture and reduced incidence of colorectal cancer but provide new evidence for a small increase in the risk of stroke and ovarian cancer.In light of these data, the CSM advises that the benefits of taking HRT in the short-term outweigh the risks for the majority of women who use it. However, the risks of HRT increase with long-term use and so treatment should only continue as long as the benefit in alleviating symptoms continue to outweigh the possible risk. For women with osteoporosis, the risks and benefits of HRT should be considered alongside those of alternative treatment options and each patient's treatment should be reviewed at least yearly.The CSM advises that HRT continues to have a useful role in alleviating menopausal symptoms and helping prevent osteoporosis. However, in an effort to maximise the safe and judicious use of HRT, women are encouraged to make the decision to take HRT jointly with their doctor, taking into consideration her personal and family history, their general health, concomitant medication and personal preferences and, importantly, to review the need for continuing therapy at least annually.The new advice has recently been published in the MHRA's safety bulletin, "Current Problems in Pharmacovigilance", which is distributed to all GPs, pharmacists, dentists and coroners in the UK. This information, together with an article specifically for women, has been posted on the MHRA/CSM website (www.mhra.gov.uk).These important messages have also been included in the British National Formulary (BNF) and are being added to the information for prescribers and the patient information leaflet that should be included with each pack of HRT.

I refer the member to the answer given to question S2W-1236 today. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.scottish.parliament.uk/webapp/search_wa.

The constitution and proceedings of fatal accident inquiries are governed by the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976. The findings of the sheriff at the conclusion of a fatal accident inquiry have the same status in law as findings of fact in any other civil proceedings. The sheriff does not determine legal liability for the death, either in the criminal or civil sense, and the determination cannot be founded upon in any other judicial proceedings.The purpose of a fatal accident inquiry is to determine certain specific matters relating to the death with which it is concerned, and certain of the circumstances surrounding that death. These matters include the time, place and causes of the death and of any accident resulting in the death, any reasonable precautions which might have prevented the death, and any defects in any system of working which contributed to the death or the accident which caused it. The findings of the inquiry should inform changes to working practices or safety procedures, where defects in these have contributed to the death. The responsibility for learning any lessons which come out of the inquiry, and for implementing its findings by remedying any defects in practices or procedures which the sheriff identifies, lie with those who have responsibility for managing the systems in question. Examples would include employers, in the case of a death at work, or hospital managers in the case of a death due to medical mishap. The Executive looks to the responsible bodies to have regard to, and to apply as appropriate, any recommendations for change which emerge from a fatal accident enquiry.