Cancer in Scotland: Action for change sets out a variety of measures aimed at improving prevention, earlier detection and treatment for all cancers including breast. Investment plans for 2001-02 and 2002-03 include details of additional investment targeted specifically at breast cancer services. Investment plans are published on the Cancer in Scotland website, www.show.scot.nhs.uk/sehd/cancerinscotland. Copies are also available in the Parliament's Reference Centre (Bib. numbers 17445 and 21487).

I refer the member to the answer given to question S1W-30193 today. 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/webapp/search.wa.

NHS boards have access to various sources of advice on any link between hormone replacement therapy (HRT) and an increased risk of breast cancer, including the product information for HRT and the British National Formulary.Importantly, the Medicines Control Agency (MCA) and the Committee on Safety of Medicines (CSM) monitor the safety of marketed medicines and provide advice when necessary. The MCA/CSM publish a quarterly bulletin Current Problems in Pharmacovigilance drawing attention to problems with medicines and providing advice on the ways medicines can be used more safely. The April 2002 (Volume 28) edition of the bulletin reviewed the risks of cancer with use of HRT. This bulletin is available on the MCA's website www.mca.gov.uk.On 11 July 2002, the department provided NHS boards and trusts with information to help health professionals advise women on HRT who may have been concerned about the risks of this treatment following publicity about the Women's Health Initiative (WHI) study. A copy of this information has been placed in the Parliament's Reference Centre (Bib. number 24544).

I refer the member to the answer given to question S1W-30193 today. 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/webapp/search_wa.

As described in the consultation document Towards Better Oral Health in Children, issued on 24 September 2002, an expert scientific review, published in 2000, concluded that, aside from a possible increase in the prevalence of dental fluorosis of aesthetic concern, there is no evidence of other adverse effects on health, where fluoride is used at recommended doses.

Grading for nurses is currently determined according to the guidance laid down in the Nurses and Midwifery Staffs Negotiating Council's Handbook.However, grading is one of the issues being addressed in the national negotiations on Agenda for Change - Modernising the NHS Pay System. A key part of the system will be a new job evaluation system purpose built to covering amongst others, all NHS nursing posts.

Figures are not held centrally on the number of people, including children, who have been prescribed methylphenidate hydrochloride (Ritalin) or other drugs for attention-deficit hyperactivity disorder (ADHD). Data collected centrally relate to the number of prescribed items and cost dispensed in the community by community pharmacists and dispensing doctors. The data is not patient-specific.In deciding whether or not to prescribe Ritalin or other drugs for ADHD, clinicians would be expected to take account of advice and guidance about these treatments. This would include the national clinical guideline on Attention Deficit and Hyperkinetic Disorders in Children and Young People issued by the Scottish Intercollegiate Guidelines Network (SIGN) in June 2001, the guidance issued in October 2000 by the National Institute of Clinical Excellence (NICE) on the use of methylphenidate (Ritalin and Equasym) for ADHD in childhood and the Scottish Medicines Consortium advice dated July 2002 about the methylphenidate sustained release OROS formulation Concerta XL. Through the Chief Scientist Office, the Scottish Executive is funding a preliminary study of complementary therapy for children with ADHD. Given that there are well-established mechanisms for assessing clinical research and developing evidence-based guidelines for use within the health service, it would be inappropriate for the Executive to offer assessments of individual research papers.

The national target in relation to out-patient waiting, set out in Building a Better Scotland, published on 12 September 2002, is that, by 2006, no patient should wait more than six months for a first out-patient appointment. Information on out-patient waiting times is collected centrally at specialty level only. The median waiting time for a first out-patient appointment with a consultant, following referral by a General Medical/Dental Practitioner, for the six most common specialties and for cardiology, in the year ended 31 March 2002, are given in the table.NHSScotland. Median Waiting Times for a First Out-Patient Appointment with a Consultant, following Referral by a General Medical Practitioner: Year Ended 31 March 2002.

Specialty	Median Wait
Cardiology	42 days
ENT	66 days
General Surgery	40 days
Gynaecology	49 days
Ophthalmology	69 days
Orthopaedics and Trauma	97 days
Urology	68 days
All Specialties	50 days

Source: ISD Scotland.

Decisions regarding the use of stimulant medication in children with attention-deficit hyperactivity disorder (ADHD) are a matter of clinical judgement taking into account the circumstances of the individual patient, in consultation with the patient and/or their guardian/carer.The Scottish Intercollegiate Guidelines Network (SIGN) Guideline 52 on ADHD provides advice about the most frequent side-effects associated with psychostimulants. The guideline recommends that the child or young person should be engaged in the therapeutic process with an understanding of their perception of their difficulties, the possibilities of treatment and their responsibility in the management of the disorder. The SIGN Guideline can be accessed on their website www.sign.ac.uk.

Information on the number of children diagnosed with attention-deficit hyperactivity disorder is not available centrally. However, information from a sample of GP records in practices across Scotland whose population is nationally representative suggests the following numbers of patients with attention deficiency disorder/attention deficit hyperactivity disorder were seen by GPs over the last four years. It is not possible to provide information prior to 1998-99 because of code differences prior to that date.

Year	Estimated Number of Patients Seen by GPs
1998-99	1,600
1999-2000	1,800
2000-01	1,800
2001-02	1,700

These data refer to diagnoses known to the patients' GP. There may be other patients whose condition is managed by specialist services, such as child psychiatry, who may not see their GP for these conditions and will therefore not be included in the data.