Chamber and committees

It is estimated that in thefirst year of national rollout (2004-05) the EMA programme will cost £16.5million. On full national rollout (2007-08) the programme will costapproximately £43 million. Estimates are not available centrally for individuallocal authorities.

All local authorities willreceive annual administration costs of £25,000 plus £15.00 per EMA student.

The Scottish Executive will take a two phased approach.

Phase 1 will involve acombination of evidence-gathering through commissioned research (e.g. intointernational experience of the health benefits/economic impact of statutorycontrols) and an awareness raising campaign to inform the general public andthe business sector of the risks associated with second-hand smoke (e.g. thenew passive smoking advertisements by NHS Health Scotland).

Phase 2 will take place thissummer, with the launch of a set piece consultation using innovative means togather views; regional events and a Scottish conference with invitedinternational speakers with experience of different approaches to reducing theharm associated with passive smoking.

We will make decisions onthe future development of the central heating programme later this year when wehave had the opportunity to consider the Scottish House Condition Survey 2002topic report on fuel poverty.

A range ofpolicies and initiatives are being progressed at local and national level aimedat improving care, services and support for older people with mental health problems.These include implementingthe joint future agenda for single shared assessments and our work with theagencies to reduce delayed discharges from hospital. We are also working withAlzheimer Scotland-Action on dementia on guidance to help remove any blockagesto joined up care that may occur in the organisation of dementia services.

Following the May 2003 Election, the First Minister established a ministerial group on European strategy with the remit to map out a clear framework for the Scottish Executive’s work on EU issues over the next four years. One of the outcomes of this work has been the production of the Scottish Executive’s European Strategy, which has been published today. The strategy has been developed in close consultation with the UK Government.

The strategy states the strategic goals for our engagement in Europe, outlines our key priorities, and identifies how we plan to set about achieving our goals. The strategy is ambitious and demanding and applies to the whole Executive, as well as its agencies and non-departmental public bodies.

A copy of the strategy has been placed in the Parliament’s Reference Centre (Bib. number 30570). I shall be sending a copy to all Scotland’s MEPs, to other members of the European Elected Members’ Information Liaison and Exchange group, and to members of the Consular Corps. Copies are also being sent to key stakeholders and delivery partners. The document will also be available on the Scottish Executive internet site.

Following the failure of theintergovernmental conference on 12-13 December 2003 to agree a new EUConstitutional Treaty, the European Council has asked the Irish Presidency tomake an assessment of the prospects for progress and to report to the European Councilin March 2004.

The Scottish Executive will continue to work with the UK Government and the Group of Regionswith Legislative Powers to promote the role of the legislative regions and theeffective application of the principle of subsidiarity, as was embodied in thedraft treaty language on the role of the regions and the protocol onsubsidiarity.

The Executive is participatingin the UK-wide risk sharing scheme, which makes available disease-modifyingdrugs MS to patients assessed as suitable for treatment. There has been goodprogress in implementing this scheme. We are also funding the development of aManaged Care Network in Forth Valley for people with MS, which includes standards forservices in primary care and in hospital, endorsed by NHS Quality ImprovementScotland. We wish to see these MS networks developed across Scotland.

Naltrexone hydrochloride is licensedas an adjunct to prevent relapse in detoxified, formerly opiate dependentaddicts. It is not licensed for the treatment of multiple sclerosis (MS) andthere is no information held centrally on its effectiveness when used in the treatmentof MS. Anecdotal evidence would suggest that Low Dose Naltrexone is not beingused by MS specialists in Scotland. However, a clinician can use a medicine outwith itslicensed indications if it is considered to be an appropriate treatment for anindividual patient. In these circumstances the clinician bears a greater degreeof responsibility for the use of the medicine.The Executive does not holdinformation on the use of Low Dose Naltrexone in Ireland or America. Someinformation on the use of Low Dose Naltrexone in multiple sclerosis, includingin America, can be found on the Multiple Sclerosis Research Centre website at www.msrc.co.uk.

The Executive supports therisk-sharing scheme, which allows patients meeting criteria by the Associationof British Neurologists to receive treatment with beta interferon or glatirameracetate, another drug used in the treatment of multiple sclerosis. Thepharmaceutical companies participating in the scheme have agreed terms for thesupply of their products under the scheme.

The drug costs per patientper year of the beta interferons included in the scheme are: Avonex - £8,502;Betaferon - £7,259; Rebif - £7,513 lower dose, £8,942 higher dose. Patients inthe scheme will be monitored at regular intervals and the prices paid byNHSScotland for the drugs will be adjusted according to whether expectedpatient benefits are realised.

The scheme is explained inHealth Department Letter (2002) 6, a copy of which has been placed in the Parliament’s Reference Centre (Bib. number 20653).

Naltrexone hydrochloride is aprescription only medicine licensed as an adjunct to prevent relapse indetoxified, formerly opiate dependent addicts. Naltrexone hydrochloride is notlicensed for the treatment of multiple sclerosis.

The British NationalFormulary, which contains up-to-date information about medicines, includingcost, states that Nalorex tablets (Naltrexone hydrochloride 50mg) cost £42.51for a 28-tablet pack. The cost is that before the addition of any pharmacy feesand deduction of any pharmacy discount or patient charges.

The estimated annual costfor any patient prescribed Low Dose Naltexone will depend on the dosageprescribed and duration of treatment.