The Health Department is developinga range of equality and diversity partnerships aimed at delivering the Partnershipfor Care commitment of ensuring that whatever the individual circumstances ofpeople’s lives they have access to the right health services for their needs. Centralto this is ensuring that staff have the training and support to communicate effectivelywith individuals who may have a communication impairment.

TheNational Programme for Improving Mental Health and Well-Being, for example, is establishingpartnerships with a number of organisations representing the interests of peoplewith sensory impairment to take forward work in relation to mental health and sensoryimpairment. This work aims to collect information and data on needs across Scotland; identifywhat services are currently available and what the main gaps are in relation topromotion, prevention and care and treatment services. Specific service exampleswill be identified and good and emerging practice highlighted. The work is due tostart in autumn 2004 and will continue until March 2006.

Similarly,People with Learning Disabilities in Scotland, a Health Needs AssessmentReport published by NHS Health Scotland in February, sets out at pages 36 and 37 informationabout sensory impairments in people with learning disabilities. A copy of whichis available in the Parliament's Reference Centre (Bib. number 32825).

The Scottish Prison Service haveinformed us that their main young offender institution at Polmont keeps recordsrelating to Speech and Language Communication Therapy needs, and there are estimatesof poor literacy and numeracy skills, which lead to communication impairment. Inthe last reporting year 26% of those assessed were offered therapy, including 6%whose hearing ability was checked. At least 70% of young offenders have problemswith poor literacy and numeracy.

Allprisoners undergo a health care assessment on admission to custody to identifyany health care needs or problems. If a prisoner reports that they have a drugor alcohol problem this will be noted in the health care records for furtherassessment by a doctor who will prescribe medication if this is consideredappropriate. This can include medication for detoxification, stabilisation ormaintenance.

Prisons also offer a range ofprogrammes and approved activities addressing alcohol and drug addictionproblems and a number of agencies work in prisons providing support and adviceto prisoners. Additionally all prisoners serving under four years can accessthe addictions services provided by prison staff and under contract toCranstoun Drug Services and avail themselves of the transitional carearrangements which provide for support in the community for up to 12 weeksfollowing release.

Decisions on treatment interventions,or combinations of interventions, are for individual patients and their health professionals.People who are experiencing difficulty with their methadone prescriptions can discuss,for example, reduced dosage regimes, other pharmacological treatments, psychosocialinterventions, or detoxification. Guidance for health professionals is set out inthe UK Health Departments’ Drug Misuse and Dependence – Guidelines on ClinicalManagement.

The UK Health Departments’ DrugMisuse and Dependence – Guidelines on Clinical Management set out guidance forhealth professionals on assessing patients and monitoring compliance with treatmentprogrammes, including urine testing and inspection of injecting sites. The extentand frequency of testing are decisions for individual clinicians, based on the circumstancesof each patient.

Methadone is used as a treatmentin many countries, and its benefits are supported by a substantial body of nationaland international research. Both the National Treatment Outcome Research Study andthe early results from the Drug Outcome Research in Scotland study confirm the benefitsfrom drug treatment, including methadone, in terms of reduced use of illegal drugs,reduced levels of injecting, reduced criminal activity and significant health gainsfor individuals.

We would not argue that methadonewill suit every patient, but decisions on treatments, or combinations of treatments,are for individual patients and their medical professionals. The Executive doesnot administer a centrally-managed methadone programme.

The following, based on information provided by Drug and Alcohol Action Teams in their annual corporate action plans, indicates the maximum waiting times for residential detoxification services in 2002-03:

Health Board	Waiting Time
Argyll and Clyde	6 to 8 Weeks
Ayrshire and Arran	6 to 8 Weeks
Borders	24 Weeks
Dumfries and Galloway	No residential service in area
Fife	No residential service in area
Forth Valley	No residential service in area
Grampian	Variable*
Greater Glasgow	6 weeks
Highland	1 to 2 Weeks
Lanarkshire	No residential service in area
Lothian	2 Weeks
Orkney	No residential service in area
Shetland	No residential service in area
Tayside	2 to 3 Weeks
Western Isles	No residential service in area

Note:

*Independent sector service.

These figures are for illustration only, since waiting times can fluctuate over a relatively short period. Work is already under way with Drug and Alcohol Action Teams to obtain more frequent and consistent information.

The remit of the majority of residential addiction services in Scotland covers drug and alcohol misuse. Areas listed where there are no local services, will refer patients to services in other areas.

It is not possible to providethis information.

Costs of prescribing by GPs andother medical professionals will depend on fees and remunerations which vary fromarea to area. The same principle applies to pharmacy costs, which are also negotiatedlocally. Costs will also be affected by the doses of methadone supplied to individuals,the duration of treatment, and other factors such as social care and counsellingwhich often accompany substitute prescribing.

Decisions on treatment interventionsand options are for individual patients and their clinicians. The UK Health Departments’Drug Misuse and Dependence – Guidelines on Clinical Management set out advicefor clinicians on the range of treatment options available and recommendations fortesting arrangements.

A great deal of activity andfunds are already being directed to help people who have recovered, or are recovering,from drug and alcohol problems into training and employment.

For example, resources from theNew Futures Fund, which is unique to Scotland, are being used to fund a range of local projects aimedat providing support and opportunities for training and employment. Social inclusionpartnerships and the UK-wide Progress2Work initiative are also supporting thosewith drug and alcohol problems to improve their employability skills. Mainstreameducation, training and employment services, such as Job Centre Plus, further andhigher education institutions and the careers service will also have contact withthose experiencing substance misuse problems, and some have developed specific initiativesto address these needs.

The Executive’s Effective InterventionsUnit has published evidence-based guidance to local service planners and providerson effective ways to improve the employability of drug users. This guidance is influencingthe design and delivery of employability and employment services for those withsubstance misuse problems.

Both the National Treatment OutcomesResearch Study in England, and the early results from the Drug Outcome Researchin Scotland (DORIS) study confirm the benefits from treatment, in respect of reducedcriminal activity, reduced use of illegal drugs and reduced levels of injecting.Over 25% of the sample from the DORIS study were being treated with methadone.