Under the Regulation of Care(Scotland) Act 2001 the Care Commission has a wide range of measures available toit where it sees the need for a care home to make improvements. It can make recommendations,place requirements on the care home or serve an improvement notice which detailsthe required improvements that need to be made and the timescales for this. If thecare home fails to make the improvements then, ultimately, the Care Commission cantake steps to cancel the service’s registration.

Decisions on what action to takeif a service is not meeting the National Care Standards or the Regulations are anoperational matter for the Care Commission. Any decisions made by thecommission take account of all the relevant circumstances and are proportionate

You can contact the Chief Executiveat the following address:

Ms Jacquie Roberts

Chief Executive

Scottish Commission for the Regulationof Care

Compass House

Riverside Drive

Dundee

DD1 4NY

T: 01382 207100

E: [email protected].

The National Care Standards forCare Homes for Older People require providers to have in place comprehensive policies,procedures and systems for ordering medication and for its safe storage and administration,and for the safe disposal of unused medicines. The standards also require a carehome’s staff to be fully aware of the systems,and to be fully trained in how to manage each resident’s medication safely and inthe way which suits them best.

Providers are also required underthe Regulation of Care (Requirements as to Care Services) (Scotland) Regulations2002 to keep a record of any medicines for the use of residents which are kept onthe care service premises, and details of any instances in which medication hasbeen administered to a resident without the resident’s or their representative’sconsent.

The Care Commission is responsiblefor regulating providers against these requirements and has a wide range of sanctionsavailable to it should a provider fail to meet any of the requirements.

Assessment and treatment of obesityis included in the training of health professionals. However, the Scottish Governmentis aware that there may be a need for further training opportunities for healthprofessionals in this priority area, particularly in managing unhealthy weight inchildren. We shall publish further details of planned activities to tackle obesitythrough both treatment and preventative means in spring 2008.

The most commonly used methodof assessing obesity is body mass index (BMI). The GP Quality and Outcomes Framework(QOF) specifies using BMI to identify patients for practice obesity registers.

BMI is calculated by dividingan individual’s weight in kilograms by their height in metres squared. In adults, obesity is defined as a BMI greater than orequal to 30. As children have different growth patterns at different stages of childhood,obesity in children is defined as having a BMI within the top 5% of the 1990 UKreference range for their age and sex.

Treatment needs are assessedand managed on a case by case basis, including through discussion between the individual,their family and health professionals.

Boththe NICE and the SIGN obesity guidelines provide advice for GPs and healthboards to assess the suitability of interventions.

the Scottish Government will publish guidance on the appropriate treatment and referralpathways for patients with unhealthy weight and on the provision of weight lossservices by the end of 2008.

We shall publish further detailsof planned activities to tackle obesity through both treatment and preventativemeans in spring 2008.

We are currently examining howbest to design these health checks to ensure the maximum benefits for patients,building on the success of the Keep Well programme. We shall announce decisionson implementation in due course.

On the basis of the reforms proposedin Firm Foundations: theFuture of Housing in Scotland, the ScottishGovernment expects that the increased budget for affordable housing of £1.5 billionin 2008-11 will deliver more new affordable homes – including social rented housesand houses for low cost home ownership – than planned for 2005-08.

The LIFT initiative – our Low-costInitiative for First-Time buyers – is a key part of the package of measures to revitaliseScotland’s housing set out in the Firm Foundations document.Through the Firm Foundationsconsultation process, we are seeking viewson potential measures which could be incorporated within LIFT. The components ofLIFT, alongside work to establish a Scottish Housing Support Fund to expand sharedequity provision, will influence the future numbers of households which thegovernment assists into low-cost home ownership.

We remain on target for deliveryby the end of 2008. In some areas Primary Mental Health Care workers are alreadyperforming this role, while others are considering how best to fulfil the commitmentobjectives. A national event is planned for March this year to further aid and informthese local considerations.

A training programme has beendesigned and implemented with over 500 people graduates so far. Attention continueson this important agenda.

Information on the percentagechange in the number of people presenting to Accident and Emergency departmentsin each of the last five years by NHS board area is shown in table 1.

Table 1: Accident and EmergencyAttendances; Percentage Change from Previous Year; Years Ending 31 March2003-07

	2002-03	2003-04	2004-051	2005-062	2006-072,3
Scotland	-1.8	0.1	-2.3	0.3	3.1
Ayrshire and Arran	-1.9	2.7	0.6	-0.6	2.5
Borders	1.2	-2.2	-4.1	4.8	-25.4
Dumfries and Galloway	0.5	1.4	3.9	10.5	13.9
Fife	-4.4	4.2	-0.9	0.1	5.4
Forth Valley	-2.6	-0.3	3.0	-5.2	7.9
Grampian	-4.0	-7.0	-21.1	7.0	2.0
Greater Glasgow	-1.9	-1.1	-3.9	-0.3	2.3
Highland	-3.4	8.2	-2.8	4.2	7.0
Lanarkshire	3.7	5.0	1.1	0.2	-2.1
Lothian	-4.8	-2.4	2.7	-1.1	11.7
Orkney	7.4	12.9	2.7	2.5	1.4
Shetland	-10.8	0.5	21.2	-2.3	3.3
Tayside	1.7	-0.5	2.2	-4.2	-2.7
Western Isles	14.2	5.7	18.4	-8.6	-1.0

Notes:

1. Some activity for emergencynurse practitioners is recorded as nurse-led activity from 2004-05 onwards.

2. Some information for 2005-06and 2006-07 is estimated, this is mainly due to the implementation of the new EmergencyDepartment Information System.

3. There is a substantial changein accident and emergency activity for some boards for 2006-07. This is due to re-classificationof medical admissions units from in-patient to accident and emergency. The fourhour accident and emergency waiting time now applies to these units.

The Scottish Government doesnot hold information on the composition of CHP management committees centrally.However, CHP regulations set out minimum requirements for membership of CHP committeesand boards have local discretion in terms of additional members.