Chamber and committees

There are no formal guidelines specifically targeted at malnutrition in the community. In 1999 by the Scottish Executive Health Department set out an action plan for nursing homes to assess the nutritional status of residents and provide for their dietary needs in line with UK Department of Health Dietary Reference Values. The plan was also to be applied by health boards and Trusts in all NHS facilities.

The Scottish Executive is also pursuing a range of initiatives to encourage and support people to make the lifestyle changes necessary to improve their health.

All doctors are aware of the importance of patients stopping smoking following myocardial infarction. Patients taking part in cardiac rehabilitation programmes are given repeated brief and supportive advice on how to stop smoking.

The Royal College of General Practitioners (RCGP) in collaboration with Scottish Heart and Arterial Disease Risk Prevention (SHARP) and Scottish Intercollegiate Guidelines Network (SIGN) have developed "The Heart Pack" which is an implementation kit designed to help GPs implement SIGN Guidelines 40 and 41: Lipids and the prevention of Coronary Heart Disease and Secondary Prevention of Coronary Heart Disease following Myocardial Infarction. The pack has been sent to every GP practice in Scotland. I was pleased to have been asked to launch this initiative in February of this year.

GPs and other primary care staff are able to refer smokers for a course of specialist counselling, advice and support.

Nicotine Replacement Therapy is also routinely considered as a means of assisting smokers to stop.

Additional funding of £11 million was made available earlier in the year from the Capital Modernisation Fund for the modernisation of A&E services. It is for health boards and NHS Trusts to determine the level of investment required in a particular service in accordance with local needs and priorities.

Scotland's arrangements for clinical effectiveness are different from England and Wales. The Report of the Working Group on the Implementation of a Scottish Health Technology Assessment Centre, published on 17 November 1999, explains the reasons for establishing a special health board and how the board will work with reference to Scotland's ongoing clinical effectiveness agenda led by the Clinical Resources and Audit Group (CRAG) and involving the Chief Scientists Office and the Scottish Intercollegiate Guidelines Network (SIGN).

SIGN is an independent network of clinicians drawn from all Scottish medical colleges with financial support from CRAG. SIGN has produced over 40 guidelines since its establishment in 1993. SIGN enjoys an international reputation on guidance methodology and the new Health Technology Board will benefit from a close working and sharing of methodological expertise with SIGN.

The role of the GMC in Medical Regulation is a "reserved" matter and is the responsibility of the UK Government.

NHS Trusts and health boards already have a range of formal and informal measures to ensure that incompetent or dangerous doctors are not allowed to practise within their area. These include: voluntary withdrawal from one or more segments of the practitioner's work; limitation of some elements of his or her work; close supervision of the work; retraining in the areas of concern, and formal suspension of the practitioner by the health board or Trust. The Medical Act 1983 is currently being amended to give the General Medical Council additional powers to impose immediate interim suspension on any doctor, in the public interest, for the protection of patients and the maintenance of confidence in the medical profession. This GMC suspension would prevent the doctor from practising anywhere in the United Kingdom.

Comprehensive information on delayed discharges following the first census is expected to be published by the Information and Statistics Division of the NHS in Scotland around mid-August.

It is widely recognised that, next to smoking, diet is the most important contributor to poor health, and that overweight or obesity is the main problem in Scotland as opposed to under nourishment. The Scottish Diet Action Plan provides the framework within which the Executive is tackling Scotland's poor diet.

The Scottish Executive has issued guidance on core nutritional standards and has asked that they be applied in nursing homes and in all NHS care facilities by Health Boards and NHS Trusts. In addition, the Clinical Resource and Audit Group (CRAG) has funded an audit of the nutrition of elderly people to assess and improve the quality of nutritional care provided to elderly people living in a variety of NHS and non-NHS settings. This study included the development of a nutrition education pack and nutrition action plan toolkit to raise staff awareness. The results of the study will be published shortly and it is planned to hold a series of meetings throughout Scotland to feedback the results and reinforce the existing standards and guidance to NHS and social services managers and staff. In March, the Health Education Board for Scotland launched a training package for healthcare staff, which is available through HEBSWeb, and a resource will be available later this year for healthcare staff to give to patients, including children, on obesity and weight management.

The number of cases of tuberculosis in Scotland has been comparatively low and relatively stable in the 1990s, with no suggestion of an upward trend. The increase of 5.5% in 1998 is likely to be due to natural random variations in incidence. In 1999, the provisional number of notified cases is 373, slightly lower than 1998.

In 1998, a comprehensive guidance document on the management and control of tuberculosis, The Control of Tuberculosis in Scotland, was issued to health professionals.

In February 1999, a letter to health professionals from the Executive's Health Department drew attention to new UK guidelines on the prevention and control of HIV-related tuberculosis and drug-resistant, including multiple drug-resistant, tuberculosis.

The Executive is funding the Scottish Centre for Infection and Environmental Health (SCIEH) to carry out enhanced surveillance of tuberculosis in Scotland. This surveillance scheme was introduced in January 2000 and is intended to provide fuller information, to enable better targeting of interventions and better control of the disease in future.

No. It is a matter for each individual Health Board to determine its prescribing policy on drugs, taking into account advice from Local Drug and Therapeutic Committees. When the Health Technology Board for Scotland begins work later this summer Health Boards will have access to a single focus of national advice on the clinical and cost-effectiveness of health technologies, including drugs.