Chamber and committees

On 21 February 2007,the Scottish Executive issued guidance, HDL (2007)13 (http://www.show.scot.nhs.uk/sehd/mels/HDL2007_13.pdf) which asks NHS boards and Community Health Partnerships to have acombined falls and bone health strategy in place. The consultation on theproposed Scottish enhanced service programme for primary and community careseeks to build on this by including falls prevention and bone health as one ofthose enhanced services.

NHS Quality ImprovementScotland will published advice on the recommendations of the multipletechnology appraisal by the National Institute for health and ClinicalExcellence of drugs for the primary prevention of osteoporosis inpost-menopausal women. NHSScotland should take account of this advice in itsplanning, funding and provision of services, to ensure that recommended drugsor treatments are made available to meet clinical need.

We are aware that this is anissue which NICE is considering in the context of its multiple technology appraisalof drugs used in the primary prevention of osteoporotic fragility fractures inpost-menopausal women. The process relating to these appraisals is set out inthe question to S3W-1937 answered on 23 July 2007.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/wa.search.

SIGN Guideline 71 on themanagement of osteoporosis, and a number of other SIGN Guidelines which referto osteoporosis, set out the appropriate pharmacological management of thecondition.

As indicated inthe answers to questions S3W-1938 and S3W-1939, both answered on 23 July 2007, NHS Quality Improvement Scotland will consider theNICE multiple technology appraisal on drugs for the primary prevention ofosteoporosis in post-menopausal women.

All answers to written parliamentaryquestions are available on the Parliament’s website, the search facility forwhich can be found at:

http://www.scottish.parliament.uk/webapp/wa.search.

We are aware that this is anissue which NICE is considering in the context of its multiple technologyappraisal of drugs used in the primary prevention of osteoporotic fragilityfractures in post-menopausal women.

For women who cannot take orhave withdrawn from treatment with alendronate, alternative treatment optionswill be outlined in the NICE Osteoporosis guideline, which is due later thisyear. The Osteoporosis guideline cannot be published until both the primary andsecondary prevention of osteoporosis technology appraisals have been finalised.The recommendations from the technology appraisals on initiation of therapywill then be incorporated into the full guideline. This will ensure that acomprehensive care pathway is agreed for postmenopausal women withosteoporosis.

Until the guideline ispublished, the existing NICE guidance TA87 (published in 2005) onsecondary prevention of osteoporosis in post-menopausal women will apply, whichrecommends alternative treatment options for those women who cannot take or whohave withdrawn from alendronate.

Once a diagnosis ofcoeliac disease has been confirmed, the only treatment is strict avoidance of glutenin the diet. This will be made very clear by the person’s GP, specialists and anyother health care professionals involved.

The British NationalFormulary, which is made available to all GPs, includes information about the appropriate prescribing of gluten freeproducts.

Initiatives regardingfood labelling help people to access the right diet to suit their needs. Breastfeeding can help prevent the development of the condition for some years.

I commend the workof voluntary organisations such as Coeliac UK,who have an important role to play in raising public awareness of the condition,through events such as Coeliac Awareness Week.

In May 2006 the PrimaryCare Society for Gastroenterology produced an updated version of its guideline onthe management of adults with coeliac disease in primary care. This covers recentdevelopments in the areas of the epidemiology, clinical features, diagnosis andmanagement of the disease, and I commend it to all members of the primary care team.

NHS24 includes a detailedentry on the symptoms, diagnosis and treatment of the disease.

Early diagnosis isessential, to ensure the condition can be managed and to avoid serious complications.

Once coeliac diseaseis suspected, the person’s GP can arrange for a blood test to be carried out, butdefinitive diagnosis depends on a biopsy of the small intestine, carried out throughendoscopy by a gastroenterologist.

We are exploring withthe National Screening Committee the possibility of population screening for coeliacdisease.

I refer the memberto the answer to question S3W-901 on 26 June 2007. All answers to written parliamentary questions are availableon the Parliament’s website; the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

Followinga meeting on 15 June 2007 of the West of Scotland Transport Leads, group discussionsare beginning with Glasgow Community Transport, SPT and the west of Scotland NHSboards on how to create improved community transport in Ayrshire specifically focusedon improving access to health care. These discussions are at a very early stage.There are no details at the moment on what may be possible from such a communitytransport initiative, as a full business case would have to be developed with GlasgowCommunity Transport, SPT and local Ayrshire community transport groups.

The creationof the extended Stagecoach route 24 would directly benefit residents travellingfrom South Carrick as it would reduce the numberof bus changes required for residents from these areas to access the main Ayrshiregeneral hospitals i.e. Ayrand Crosshouse Hospital. This will result in reduced travel timeand cost for passengers.