Chamber and committees

The draft report was previously circulated to NHS chief executives for their comments and discussed with NHS chief executives on 21 April 2010. The working group will now reconvene to produce a final version of the report.

The care needs assessment provided by local authorities should identify the nutritional requirements of those cared for at home. The National Care Standards require care at home providers to develop a personal plan with each person who is using the service which sets out how their care needs will be met. Where the service includes the preparation of food the plan will include details of any special dietary requirements. It is for the Care Commission, as the national regulator, to ensure through its inspections that care at home services are complying with this aspect of the National Care Standards.

Local authorities undertake care needs assessments for older people receiving care in their own homes. A care needs assessment should identify any issues relating to malnutrition. It is likely to involve more than one agency in contributing to a holistic assessment of needs, including specialist input from a GP and/ or Dietician where there are health concerns around malnutrition.

NHS Dumfries and Galloway, NHS Shetland and NHS Orkney do not provide an epidural service, although arrangements can be made for intrapartum care at another health board. All other NHS boards do provide a 24 hour epidural service at their principal hospital as this clinical intervention can only be carried out by an anaesthetist.

Provision of services for people with learning difficulties and learning disability is increasingly based on the principle of improving access to mainstream services. Lip-reading courses are provided by a range of different community agencies, such as health, social work, and further education. The providers of the courses are responsible for making their services accessible to their local communities and classes across Scotland are locally determined and are variable.

Individuals with learning difficulties or learning disability may join local lip-reading classes, but maybe more likely to have one to one sessions as part of an individual support package. Lip-reading is a difficult skill for adults who lose their hearing in later life to acquire. It will be even more difficult for those with learning difficulties and for learning disabled people, especially if they do not have an established language base. Speech and language therapists will often be involved in the assessment of the communication skills of a learning disabled person and would recommend strategies to improve these which would involve their carers.

I understand that NHS Quality Improvement Scotland (NHS QIS) has no plans at present to develop clinical standards for services for adults with asthma, to complement those for children and young people with asthma which it published in March 2007.

In 2008, the Scottish Intercollegiate Guidelines Network (SIGN) published jointly with the British Thoracic Society SIGN Guideline 101, British Guideline on the Management of Asthma, covering adult as well as paediatric treatment and care.

Through our encouragement, each NHS board now has a respiratory managed clinical network (MCN). It is one of the core principles of all MCNs that they should use a documented evidence base, such as SIGN Guidelines. Accordingly, SIGN Guideline 101 forms part of the respiratory MCNs'' evidence base and this will inform standards of care for adults with asthma.

The asthma guideline is updated annually, and work is presently under way on the revision of the 2009 version.

The SIGN guideline Management of Obesity, which was published on 24 February 2010 provides evidence based recommendations for clinical practice in the management of adults and children with obesity, including the use of bariatric surgery.

It is a matter for NHS boards to plan for and provide services to meet the assessed needs of their resident population, including access to specialist services not provided locally.

FSA recommendations for milk consumption for children under five formed the basis of the Nutritional Guidance for Early Years for children aged one to five years in early education and childcare settings published in 2006.

The Nutritional Guidance for Early Years advises that plain drinking milk should be available as an option every day. For one-year-olds, who are not still being breastfed, whole cow''s milk should be the main milk drink until the child is at least two years old. From age two, semi-skimmed milk may be introduced as long as the child is eating well and getting enough energy and nutrients from a varied diet. The guidance states that fully skimmed milk is not suitable for children under five years.

The guidance states that where only one type of milk is available (e.g. in the nursery setting) whole milk should be provided and that flavoured milks are unsuitable because of their high sugar content.

I refer the member to the answers to questions S3W-32206 on 16 March 2010 and S3W-32784 on 20 April 2010. 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/Apps2/Business/PQA/Default.aspx.

The Scottish Government is developing a National Musculoskeletal Programme to improve the delivery of musculoskeletal and chronic pain services. A national programme board, chaired by an NHS board chief executive, is being established to drive implementation.

We have also highlighted to the Scottish Society for Rheumatology the benefits of a managed clinical network (MCN) for rheumatoid arthritis (RA), as this would help promote multi-disciplinary working and develop standards of care. MCNs require an evidence base, and SIGN Guideline 48 on RA provides this. They are also required to participate in audit, and CARA would satisfy this core principle. We have also highlighted the benefits of an MCN approach to Arthritis Care Scotland, the Arthritis and Musculoskeletal Alliance and the National Rheumatoid Arthritis Society, since the voluntary sector must be involved in all MCN developments.

This work is being undertaken in the context of our Long Term Conditions Action Plan, issued as CEL 23 (2009) on 16 June 2009, which forms a key part of our new Quality Strategy. The Action Plan sets out a shared vision: that throughout Scotland, those with long term conditions and those who support them feel valued, confident and able to enjoy full and positive lives. Robust reporting arrangements have been put in place to enable monitoring of implementation of the Action Plan by the geographical and special NHS boards

In light of this ongoing work, we do not believe there is any need for a ministerial statement.

A National Audit Office Report on services for people with rheumatoid arthritis (RA), published on 15 July 2009, suggests that RA costs the UK economy an estimated £1.8 billion a year as a result of sick leave and work-related disability.

Funding has been provided through the Delivery Framework for Adult Rehabilitation for a national lead to support the rollout of the National Musculoskeletal Programme. It is developing integrated multi-disciplinary teams to: improve access to diagnosis and treatment; reduce waiting times; enable self management, and, where appropriate, facilitate early return to work and avoid long-term absence and long-term dependency on social security benefits.

The Scottish Centre for Healthy Working Lives provides a wide range of support to employers in order to promote health and wellbeing in the working age population. As part of the Health Works Strategy, we will emphasise in the Scottish Offer the importance of the role health services can play in achieving patients'' employment goals.