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.

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.

In line with the undertaking in Our National Health: A plan for action, a plan for change, the Health Department is working with NHSScotland to develop a new comprehensive performance management framework which will assess health improvement, clinical outcomes and standards of service alongside good financial management. It is intended that the new framework will provide information to underpin NHS Boards' annual reports, which will set out achievements and performance at board level. Boards will be free to publicise performance information in other ways.

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.

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 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.

The Scottish Executive currently has no plans to reform procedures for dealing with clinical negligence claims. However, we are aware of recent developments to assess the potential benefits of mediation for such claims and intend to explore the matter with the British Medical Association.

The New Deal for Disabled People will be extended nationally from July 2001 to all people claiming incapacity benefits which will offer new opportunities for people with mental health problems.The Disability Discrimination Act already protects people disabled by mental illness. The UK Government has asked the Disability Rights Commission to look at the Disability Discrimination Act's coverage of people with mental health problems and will consider carefully any recommendations for legislative change that the commission makes.The UK Government has announced its intention to end in 2004 the exemption of small firms from the Disability Discrimination Act employment provisions and, when legislative time allows, the exemption of many occupations and types of employment. This will ensure that employees or job applicants in those areas who are disabled with mental health problems are protected from discrimination.As an Executive we are committed to removing stigma and improving access to care and support. The Executive's Scottish Health Plan, Our National Health: A plan for action, a plan for change, announced a £4 million investment in a campaign to promote positive mental health. Consideration continues on the scope of that campaign.The Executive is also funding a project run by the Scottish Development Centre for Mental Health to examine ways in which people with mental health problems can be helped to return to and remain in employment.

Our objective for every discharge or transfer from hospital care is for the continuing care arrangements to fit the assessed needs of the individual. This is particularly true for those with a mental illness where needs can be complex and require co-operation and planning among a number of agencies. The aim always is to provide care, support and in some cases accommodation that matches needs and is both sustainable and responsive to changing needs.The Care Programme Approach (CPA) has been designed specifically for people with more severe and enduring mental illnesses. The objective is to ensure that properly designed and managed packages of health and social care are arranged for such people in appropriate accommodation in the community. No-one is included in the CPA without the agreement of a consultant psychiatrist and informed consent is sought wherever possible.

Following a commitment in Our National Health, the Chief Medical Officer has asked Professor David Lawson to lead work with the Health Technology Board for Scotland and with local area drug and therapeutic committees on removing inequities in prescribing practice across Scotland. As a result of this, a seminar was held on 16 May at which the concept of a Scotland-wide consortium of Area Drug and Therapeutic Committees - a Scottish Medicines Consortium - was launched. This would provide a single source of Scottish advice to clinicians as close to the time of marketing of a new drug as possible. The Health Technology Board for Scotland has agreed to provide administrative and methodological support to the consortium. Discussions are ongoing with local area drug and therapeutic committees and health boards across Scotland and it is hoped that the consortium could begin operating in the autumn.