Chamber and committees

The treatment of women with ovarian cancer is a matter for specialists experienced in the management of cancer. The use of platinum/paclitaxel in the treatment of ovarian cancer depends on the clinical judgement of the specialist concerned.

GPs do not receive item of service payments to provide the main target group with diphtheria, polio and tetanus vaccine. They receive target payments if they immunise at least 70% of children aged five and under on their medical list; and a higher target payment if they achieve 90%. An item of service fee is paid for vaccinations outwith the target group. Target payments are paid to encourage GPs to immunise in order to achieve herd immunity.

The provision of influenza vaccination has been regarded as a matter of good clinical practice in the management of patients who may be at risk of developing complications from influenza. GPs have available advice from the Chief Medical Officer and the Joint Committee on Vaccination and Immunisation on "at risk" groups.

The forthcoming legislation to establish a statutory right of responsible access will not introduce any change in the provision of funding to local groups. The legislation will introduce powers to allow local authorities to maintain footpaths that form part of their core path networks.

Legislation to establish a right of responsible access is only one element of a package of measures necessary to ensure greater opportunity for people to enjoy the countryside. Resources will also be required for the establishment and maintenance of path networks in each local authority area. We are already making additional funds available to Scottish Natural Heritage for access-related work, and are looking at the requirements of local authorities in the context of the spending review.

The legislation to establish a right of responsible access will require local authorities to establish core path networks in their areas, and will include powers for local authorities to maintain them.

It is for health boards, in conjunction with NHS Trusts, to determine the increased staffing levels necessary in light of local needs and circumstances, and to ensure the appropriate funding is in place.

The Scottish Executive is providing record levels of financial resources to the NHS in Scotland. The Minister for Finance announced in Parliament on 30 March that, in addition to the increase agreed in the Budget Bill, the Health budget will be increased by £173 million in 2000-01, with major real terms increases each year following through to 2003-04.

The Chief Medical Officer has set up a short-life working group to look at intensive care and high dependency services. One of the issues the group will consider is staff recruitment, retention and training. Health boards are expected to take the working group's recommendations into account when deciding how to use their share of the additional £6.8 million, which I announced on 22 February, together with their general revenue allocations.

Guidance was issued in March 1999 to the NHS and local authorities on Services for Women with Postnatal Depression. This offered advice on identification and the best organisation of multi-agency care and support for mothers and their families, and placed emphasis on the physical and mental well being of mothers and children.

I also announced on 1 February that the Scottish Executive intended to work with relevant interests in the development of a National Framework for Maternity Services. Work on this is now underway and will include consideration of post-natal care and support.

Approximately £1 million a year is spent by health boards on health promotion activities specifically aimed at reducing smoking. Following the publication of the White Paper on tobacco control Smoking Kills, an additional £3million over three years from 1999 was allocated to health boards to spend on smoking cessation services and Nicotine Replacement Therapy. These resources are targeted at areas of social deprivation.

In addition, the Scottish Executive is working with key agencies to implement the measures laid out in Smoking Kills and provides financial support to a range of other bodies, such as the Health Education Board for Scotland (HEBS) and ASH (Scotland) who actively promote measures on smoking cessation.

Improvements in survival from cancer are already evident. For example, five-year survival from breast cancer is now 75%, compared to 66% in the 1980s. In men with testicular cancer more than 90% are alive after five years.

The Scottish Executive is determined to continue to tackle the challenges posed by cancer in all its forms and cancer is one of three clinical priorities for the NHS in Scotland.

A great deal of work is already underway ranging from health promotion, earlier detection, improved treatment and care through to palliative and terminal care.This includes a continuing commitment to breast and cervical screening and a pilot programme of colorectal cancer screening. Led by the Scottish Cancer Group, cancer-specific managed clinical networks are being set in place. Underpinned by robust quality assurance/prospective audit systems and committed to sharing good practice for the benefit of patients across the country, the focus of these networks is on continuous quality improvements in patient care. Additional one stop clinics are being established and the reduction of waiting times for cancer diagnosis and treatment is a high priority for the Scottish Cancer Group. Clinical standards for cancer services - developed in collaboration with patients and carers - will be piloted during spring/summer 2000 by the Clinical Standards Board for Scotland.

Health boards and local authority Social Work Departments incur expenditure in relation to mental health.

In terms of NHS expenditure, mental illness is equated with the specialties of General Psychiatry, Adolescent Psychiatry, Child Psychiatry and Geriatric Psychiatry.

The figures for 1997-98 and 1998-99 are provided in the publication Scottish Health Service Costs for each of the years. Figures relating to expenditure by health boards are not yet available for 1999-2000.

The following table sets out the net revenue expenditure by local authority social work departments on services for people with mental health problems. The source of data for 1997-98 is different to that for 1998-99 and 1999-2000. Care should be taken when making comparisons as the categories in which expenditure data are collected are different for these two sources.

Local Authority Social Work Expenditure on Mental Health 1997-98 to 1999-00 (£ million)
			1997-98		1998-99	1999-2000
					Provisional Outturn	Budget Estimate
Net Expenditure			30.1		33.5	36.8

Source: 1997-98 Figures as reported by local authorities on local financial returns (LFR3 Social Work). 1998-99 and 1999-2000 as reported by local authority on Provision Outturn Budget Estimate (POBE) returns.