Chamber and committees

Details of expenditure on General Medical Services Cash Limited and Non-Cash Limited and their percentage share of total health expenditure for 1996-97 to 1999-2000, based on audited accounts, is given in the table. The abolition of GP fund holding in 1999-2000 led to a change in accounting arrangements which is reflected in that year's apparently smaller proportion of General Medical Services Cash Limited expenditure compared with earlier years.The apparent reduction in the share of General Medical Services Non-Cash Limited expenditure from 1998-99 reflects a transfer of resources from that budget to the Scottish Council for Postgraduate Medical and Dental Education when it took over responsibility for vocational training for GPs.

	General Medical Services Cash Limited		General Medical Services Non-Cash Limited
	Expenditure (£ million)	Percentage of Total Health Expenditure	Expenditure (£ million)	Percentage of Total Health Expenditure
1996-97	95.7	2.30%	237.7	5.60%
1997-98	108.4	2.50%	248.7
1998-99	119	2.60%	243.8	5.30%
1999-2000	108.9	2.20%	268.8	5.40%

Note:The General Medical Services Cash Limited expenditure from 1996-97 to 1999-2000 comprise a central allocation plus additional expenditure by health boards from their general allocations/unified budgets.Information on the total budgets for General Medical Services Cash Limited expenditure for 2000-01 to 2002-03 is not yet identifiable from health boards' unified budgets. Indicative allocations for General Medical Services Non-Cash Limited for 2000-01 to 2002-03 have been issued. They represent 5.2%, 5.1% and 5.0% respectively of the total health budget. However, these proportions are likely to change as actual expenditure on these demand-led services will reflect actual usage.

This is indicative of a change in the pattern of home care services through the period and of a shift toward increasing the proportion of clients requiring more intensive levels of care at home. We are continuing to prioritise home care services and have provided councils with additional resources to extend and improve the home care provision in their areas. The increases in resources for community care of £90 million, £135 million and £195 million in this and each of the next two years respectively will involve major additional investment in home care services.

The maintenance of standards and skills in the area of medical practice is the responsibility of a range of people and groups. The General Medical Council (GMC), which is an independent regulatory body, sets standards of practice for doctors. It is the responsibility of each individual doctor, as a professional practitioner, to keep his or her standards and skills up to the level required by the GMC. NHS employers also have a responsibility to support and manage Continuing Professional Development (CPD) and the introduction of the new appraisal system for consultants will underpin this. The Scottish Executive currently provides substantial financial input to the Scottish Council for Postgraduate Medical and Dental Education (SCPMDE) to enable them to support doctors in undertaking CPD.

To enable a patient to give informed consent they are entitled to a clear explanation of their condition and any treatment, investigation or procedure proposed, including risks and alternatives, before agreeing on the course of action. They must also be given the time and any support, e.g. the services of an advocate, they need to ensure that they fully understand these issues.These entitlements form part of the generic standards developed by the Clinical Standards Board for Scotland. These standards require clinical services to regularly and systematically monitor the extent of patient involvement in making decisions about their own care and to ensure its effectiveness. The Clinical Standards Board is currently carrying out a review of the implementation of these standards across Scotland.

Neither the Scottish Intercollegiate Guidelines Network (SIGN) nor the Health Technology Board for Scotland (HTBS) have this topic in their current work programme. The Executive currently has no plans to ask them to consider it.However, anyone may propose a topic to either body by using the topic proposal forms available on their website (www.sign.ac.uk and www.htbs.org.uk). This would then be considered according to the organisation's published process for the selection of topics.

Information on the total cost of the methadone treatment programme is not available centrally.Total costs include the cost of methadone, fees to pharmacists to dispense methadone and to supervise consumption, the cost of counselling and social support and fees to GPs participating in shared care schemes. There are also costs of providing specialist drug services.Health boards received an additional £2 million for all drug treatment services this year, giving a total of £14.352 million.

The Executive recognises and welcomes the contribution made to oral healthcare by the whole dental team, including that of the professions complementary to dentistry. It is examining how to encourage more dentists into remote, rural and deprived areas. However, the level of service that can be delivered by dental therapists is a reserved matter, and I refer Mary Scanlon to the answer I have given to question S1W-16389.

Heroin and methadone are opioids that act in the same way on receptors in the brain. Opioid dependence is a well-established and clearly defined phenomenon. It is characterised by physical and psychological dependence, which becomes more likely as the dose and duration of use increase.Users of heroin experience a euphoria, but addicts become tolerant to the pleasurable effects of the drug quite rapidly. Methadone does not produce euphoria.Street heroin varies in purity and heroin requires more frequent "hits" than methadone.Heroin is generally thought to be more addictive than methadone. However, because methadone is long acting and the withdrawal effects, though less severe, can last much longer, drug users often claim that methadone is "harder to come off" than heroin.

Towards a Safer Healthier Workplace, the occupational health and safety service strategy for NHSScotland staff, requires all NHSScotland organisations to offer a comprehensive, competent and confidential occupational health and safety service to all staff as an integral part of their Human Resources Strategy. The proposal adopted by the Yorkhill NHS Trust is to provide its employees with the opportunity to have a lifestyle fitness assessment and forms part of the criteria for the Scotland's Health at Work Silver Award. This is in line with current policy for NHSScotland employers to achieve the Scotland's Health at Work Award and for staff to be encouraged to improve and manage their own personal health.

The Scottish Executive shares the concerns of Her Majesty's Government about the impact of illegally imported cigarettes and alcohol. There is close contact with HM Customs and Excise Law Enforcement Directorate about a range of serious and organised crime issues through the Scottish Drug Enforcement Agency.The UK Government announced, in March 2000, the "tackling tobacco smuggling" strategy, which aims to put cigarette smuggling into decline within three years. The strategy will deliver more aggressive enforcement activity, which will detect and deter other forms of smuggling, including alcohol.