We will work closely with NHSboards to ensure that the NHS provides responsive, efficient services that put patientsfirst and ensure that they are treated as quickly as possible. As part of that,and in line with our manifesto commitment, we will be considering the contributionthat fast-track diagnostic and treatment centres can make.

The Quality Adjusted Life Year(QALY) is one of a number of methods which can be used to measure health benefitswhen deciding on priorities for expenditure in the NHS. Different approaches arerelevant in different circumstances.

TheQALY provides an estimate of the extra quantity and quality of life provided bya health care intervention, combined within a single measure. Estimates of costper QALY are often used, for example, in cost-effectiveness studies of new drugtreatments or health care interventions.

However, the QALY alone cannotform the basis of prioritisation of expenditure across the whole of the NHS. Estimatesof QALYs are not available for every potential health care intervention or preventativeapproach, so there are limits to the possible coverage of this approach. Moreover,other factors such as population health needs and local priorities must be consideredas well.

Exercise-on-prescription is oneway to encourage patients to increase their level of activity by attending leisurecentres or gyms for supervised exercise programmes.Decisions about the most appropriate treatmentor care are taken jointly by the patient and the relevant health care professional.So, if a patient does not wish to participate in an exercise programme this canbe addressed as part of these informed discussions. A national working group hasbeen set up by the Scottish Executive to develop guidance on the promotion of physicalactivity in primary care, including exercise-on-prescription.

The Scottish Government plansto introduce a national online directory of drug treatment and rehabilitation servicesin Scotland.Information on available alcoholtreatment services is currently available from the website www.infoscotland.com/alcohol or fromalcohol and drugs action teams.

I am committed to maximisingthe potential of Allied Health Professionals to reduce waiting times. In particular,I am exploring ways of ensuring that we make the most of the available pool of physiotherapists.As part of this approach, we are working inpartnership with the Chartered Society of Physiotherapy, NHS Education Scotland,and NHS boards to develop a national action plan.

The chronic conditions that entitlepatients to free NHS prescriptions are:

Hypoparathyroidism.

Hypoadrenalism (for which specificsubstitution therapy is essential).

Diabetes insipidus and otherforms of hypopituitarism.

Diabetes Mellitus (except wheretreatment is by diet alone).

Myasthenia Gravis.

Myxoedema (that is, Hypothyroidismrequiring thyroid hormone replacement).

Epilepsy (requiring continuousanti-convulsive therapy).

A permanent Fistula requiringcontinuous surgical dressing or requiring an appliance (also referred to as a stoma).

A continuing physical disabilitywhich prevents the patient from leaving a residence without the help of anotherperson.

We are considering how best totake forward this issue and will consult fully on our proposals in due course.

We will establish an independentreview to investigate the level and distribution of resources available to localauthorities for free personal and nursing care. Future provision for the policywill be considered as part of the spending review.

This will depend on the precisemode of implementation. We are currently actively considering the options for implementingthis manifesto commitment.

I have made clear that we willreverse the previous decisions on accident and emergency services at Monklands andAyrhospitals. In considering proposals for significant service change that come to me for afinal decision in the future, I will considereach case on its merits but will operate a presumption against centralisation ofservices. This does not mean that there will be no changes to health services inthe future but that any NHS board that submits proposals for service reconfigurationmust persuade me that their case is robust, that all possible alternatives havebeen considered, and that due weight has been given to both patient need and publicopinion.