Self referral to physiotherapy services are promoted by physiotherapists, community teams and through GP practices. However, we recognise that it is important that there should be a systematic approach to self-referral for physiotherapy services and work is in hand to develop this further. The centralised system, using the technologies of NHS 24, currently being piloted by NHS Lothian is considering how people access e-health and other services and work to implement the Framework for Adult Rehabilitation is also developing pathways to enable patients to access the services that they need.

This information is not held by the Scottish Government.

The Care Commission''s role is to regulate for improvement. Where a care service is not providing care which meets the requirements set out in the National Care Standards, the Care Commission works with the provider to ensure that improvements are made. Closure of any care service with the consequent disruption to service users is a last resort.

The Care Commission''s overarching aim is to regulate for improvement in the quality of care in Scotland. It therefore prefers to work with service providers to improve poor quality care services rather than to close them, with the consequent disruption to the lives of those who use the services.

The Care Commission can provide information about care home registrations which have been cancelled. The contact details for the Care Commission are:

Ms Jacquie Roberts

Chief Executive

Scottish Commission for the Regulation of Care

Compass House

11 Riverside Drive

DUNDEE

DD1 4NY

T: 01382 207100

E: [email protected].

At present, there are no waiting times targets for access to physiotherapy services.

The NHS in Scotland is working to achieve the Scottish Government''s target of a maximum waiting time of 18 weeks from referral to treatment by the end of 2011. Earlier this year, we published the 18 Weeks: The Referral to Treatment Standard “ Principles and Definitions which was issued to NHS Boards. This guidance publication makes it clear that if a Consultant refers a patient to physiotherapy as an interim treatment, for example to alleviate pain, it will form part of that patient''s 18-weeks pathway. The guidance also states that whilst the 18-weeks standard does not cover community/GP referrals within the extended primary care team, NHS boards should ensure that all patients have rapid access to the most appropriate health care practitioners.

Physiotherapists and other Allied Health Professionals are involved in delivering patient care and treatment which has helped to cut waiting times for patients across Scotland. Treatments can include triage, assessment and therapeutic interventions in both hospital and community settings, sometimes avoiding the need for consultant referrals. Allied Health Professionals therefore have an important role to play in delivering better, faster care in a variety of roles and settings.

Let''s make Scotland More Active: A strategy for physical activity (2003) acknowledges that physical activity is a general term which encompasses active living, recreational activity, sport, exercise, play and dance. This will be reflected in the material which will support Curriculum for Excellence and in particular the physical education, physical activity and sport strands of the health and wellbeing experiences and outcomes.

The support material will include definitions and advice on particular experiences and outcomes. This includes the definition of moderate activity as being of sufficient intensity to raise heart and respiration rates characterised by being slightly out of breath and having a raised body temperature. Vigorous activity is defined as being of an intensity to significantly raise the heart and respiration rate characterised by being breathless and perspiring.

Access to infertility services has not historically been included in waiting time targets because there were concerns about breaching patient confidentiality. However, we are aware of disparities in waiting times and access criteria and wrote to NHS boards recently asking for information on implementation of the 2007 updated criteria, and we are currently considering how best to ensure equity of access across Scotland.

We know that individual NHS boards have invested in this service to reduce waiting times in their area.

The Tobacco and Primary Medical Services (Scotland) Bill includes a number of measures to reduce the attractiveness and availability of tobacco to under-18s, such as the ban of the display of tobacco products and tobacco vending machines. These measures are based on international evidence and extensive consultation with stakeholders. The Scottish Government also raised the minimum age of purchase of tobacco from 16 to 18 in 2007. Whilst I have not been made aware of an appetite to extend the legislation in this way, I would be happy to meet with the member to discuss this matter further.

The full range of issues relating to the Modern Apprenticeship programme and the current economic climate will be explored at the Apprenticeship Summit on Tuesday 28 April.

CITB (ConstructionSkills) are already sending their displaced construction apprentices back to college for six weeks and paying those 75% of their wage for the same period to allow additional time for an alternative employer within the sector to be found.

The additional 7,800 modern apprenticeships, agreed as part of the budget, will increase apprenticeship opportunities next financial year.

The full range of issues relating to apprentices and the current economic climate will be explored at the Apprenticeship Summit on Tuesday 28 April.

The Scottish Government''s priority is to ensure that as many apprentices as possible can complete their apprenticeship training with an employer. Therefore, where an apprentice is made redundant, public agencies will make every effort to work with the relevant Sector Skills Council and the training provider to secure alternative employment to enable apprentices to complete their training in work. This is already happening for construction.

The current contract for the provision of air ambulance services is due to expire on 31 March 2013. The Scottish Ambulance Service will begin the process of re-procuring this service in the second half of this year, 2009, with the outcome being a new contract beginning on 1 April 2013.

The Medicines and Healthcare Products Regulatory Agency (MHRA) is the government agency which is responsible for monitoring the safety of medicines and vaccines, including the HPV vaccines. The MHRA and the Commission on Human Medicines (CHM) run the UK''s suspected adverse reaction reporting scheme, called the Yellow Card Scheme. As of 19 March 2009, 158 reports of suspected adverse reactions following Cervarix, or brand unspecified HPV vaccine,have been received by the MHRA from Scotland. out of a total of 1,454 reports of suspected adverse reactions received across the UK. This follows administration of more than 700,000 doses of vaccine across the UK.

An updated summary of these reports is published on the MHRA website each week at (www.mhra.gov.uk/HPVvaccine). These reports relate to adverse medical events which the reporter considered could have been caused by the vaccine (i.e. if there was merely a suspicion of causality). Therefore, reports may be true side-effects or they may have been purely coincidental events, due to underlying or undiagnosed illness, that would have occurred anyway in the absence of vaccination.

The MHRA has reported that, to date, the majority of adverse reactions have related to the signs and symptoms of recognised side effects, or were due to the injection process (e.g. due to a fear of the needle). CHM has advised that no serious risks have been identified and the balance of risks and benefits of Cervarix remains positive.