Chamber and committees

In December 2004, Chiron, themajor supplier of diamorphine injection in the UK, informed the Department of Healththat its supplies of this product were limited. The other supplier, Wockhardt UK, continuesto produce diamorphine injection and has increased its production and these extrasupplies are being distributed to the NHS.

Because of the limited availabilityof diamorphine injection, prescribers have been asked, wherever possible, to switchpatients to alternative analgesics. Given the switch in prescribing habits, stocksof diamorphine injection are being conserved for those patients whose need is greatest.The UK Health Departments are taking whatever action is necessary to secure sufficientsupplies of the alternative medicines to meet the needs of patients in the UK.

This information wasprovided in press releases, copies of which are available in the Parliament’s ReferenceCentre (Bib. numbers 35664 and 35665) which announced the appointments.

The consultation document ANew Public Involvement Structure for NHSScotland, held in the Parliament’s ReferenceCentre (Bib. number 26830), outlined the proposals for the Scottish Health Councilwhich were based on an increasing emphasis on NHS Boards directly engaging withand involving the public, and the need for a new body to provide quality assuranceof boards’ performance.

Providing advice and supportservices to people wishing to comment on NHS services has been the responsibilityof the board. This service has been provided by some local health councils in thepast and some NHS boards have provided funding for complaints support staff. Thereare currently no national standards for the delivery of complaints advice and supportand it is outwith the health council core remit. Arrangements are now being developedto establish a partnership with Citizens Advice Scotland and their local bureauxto formalise their existing arrangements for providing advice and support on NHSservices.

The Scottish Health Council willnot provide advice and support services, but they will seek to ensure that NHSboards have appropriate and effective arrangements in place. The Scottish HealthCouncil will also ensure that individual patients, carers and members of the publicare able to make their views on health services known.

Diamorphine is one of the opioidanalgesics used in pain relief in cancer patients. On 23 December 2004, the Scottish Executive Health Department wrote to health professionals to alert themto a potential problem with supplies of diamorphine. Health professionals were askedto take every possible step to conserve stocks of diamorphine injection for patientsin whom the need is greatest. Alternative analgesics to diamorphine are availableand care is needed when switching from one opioid analgesic to another to ensureequipotent dosage. The advice which issued from the department included a dosageguidance table.In June 2000, the Scottish IntercollegiateGuidelines Network (SIGN) issued a guideline on the control of pain in patientswith cancer. This guideline, number 44, can be accessed at www.sign.ac.uk.

The British National Formulary(BNF), issued free to doctors, gives advice on prescribing in palliative care. TheBNF can be accessed at www.bnf.org.

On 23 December 2004, the Scottish Executive Health Department issued guidance to health professionals alertingthem to a potential shortage of diamorphine injection. Alternative analgesics todiamorphine are available, principally morphine, and clinicians will need to decidewhich product is most appropriate for each individual patient.

The Right Medicine; a Strategyfor Pharmaceutical Care in Scotland identifies community pharmacists as having a role inproviding access to advice in various areas of sexual health promotion such as adviceon safe sex and avoiding sexually transmitted infections as well as providing contraceptiveservices, for example access to emergency hormonal contraception.

As part of its work in PhaseOne (2001-04), the National Demonstration Project Healthy Respect enabledcommunity pharmacists in Lothian to provide Chlamydia testing as part of an integratedsexual health service. Their work on postal Chlamydia testing kits which were widelydistributed in retail outlets including pharmacies has helped to inform the developmentof the Scottish Executive’s sexual health strategy Respect and Responsibility: Strategyand Action Plan for Improving Sexual Health.

I launched the strategy witha statement to the Scottish Parliament on 27 January. The strategy sets out, forthe first time in Scotland, a coherent framework for improving sexual health. Weexpect its implementation to be driven by the relevant agencies, taking accountof input from key stakeholders. Contained within the strategy is a commitment onthe Health Department to consider the possible extension of the Chlamydia postaltesting kit in the light of the evaluation of Healthy Respect. We will also considerthe potential of developing and testing sexually transmitted infections diagnostickits in rural and urban settings.

The safety of medicines availableon the UK market is the responsibility of the Medicines and Healthcare products RegulatoryAgency (MHRA) and the expert independent advisory committee, the Committee on Safetyof Medicines (CSM).

There have been longstandingconcerns about the safety and efficacy of co-proxamol. The CSM first warned prescribersabout the risks associated with co-proxamol in 1985. Despite being identified bythe British National Formulary as “less suitable for prescribing”, co-proxamol remainswidely prescribed.

During 2004, the CSM reviewedall the available evidence regarding the risks and benefits of co-proxamol. A publiccall for evidence on the risks and benefits of co-proxamol was also conducted for12 weeks in 2004; the MHRA wrote to a large number of organisations representinghealthcare professionals, patient groups and other stakeholders as well as publishingthe request for information on their website (www.mhra.gov.uk).The CSM reviewed all the responses together with international evidence on the safetyof co-proxamol. The information gathered during this exercise provided no new objectiveevidence concerning the risk:benefit of co-proxamol.

The CSM noted that previouslystrengthened warnings to doctors and patients on the hazards of co-proxamol provedineffective. After considering the wide range of available evidence and the optionsfor action to reduce the risk of overdose (e.g. prescriber and patient education,smaller pack sizes and restricted indications) the CSM determined that the risksof co-proxamol clearly outweigh the benefits of allowing this medicine to remainon the market.

No fixed site safety camerashave been permanently removed since safety camera partnerships startedoperating in Scotland. Information relating to the removal of cameras beforethe establishment of partnerships is not held centrally.

The Scottish Executive is currently undertaking a study, in conjunction with Dundee City Council and other stakeholders, to consider the likely traffic impacts on the A90 in the vicinity of the Swallow and Myreside roundabouts, Dundee, as a result of major development pressures on the Dundee western approaches.

The Scottish Executive is in regular contact with both harbour authorities.
Peterhead Bay Authority and Peterhead Harbour Trust are presently pursuing plansfor a merger. A Minute of Agreement was signed in January 2005 outlining the proposals with a timetable to formally merge on 1 January 2006. A decision on whether to merge is a matter for the commercial judgement of the two harbour authorities. Given a successful outcome to the merger proposals, the newconstitution that a unified Peterhead harbour authority would require would be given legislative effect through an application to the Executive for an Order under the Harbours Act 1964.