Seòmar agus comataidhean

The Scottish Executive is required to conduct regular independent external reviews of major recurring grants to voluntary sector organisations. Accordingly, the Education Department has planned such a review of the ENQUIRE service during the course of this year. The findings of the review will then be considered by the department.

It is not possible to provide a complete answer, as many callers opt not to provide identity details. Furthermore, until recently, the Enquire database did not store this information in the case of relatively straightforward enquiries such as requests for publications. Where the status of the caller is known, the breakdown is as follows:

2002-03

Parents: 973

Others: 431

2003-04

Parents: 1,509

Others: 523

2004-05

Parents: 15,52

Others: 510.

The Scottish Executive is committed to eliminating mixed sex wards in all NHS hospitals, and very good progress has been made. All NHS hospital wards in Scotland comply with current guidelines, with the exception of certain areas within the Royal Edinburgh Hospital.

The Executive is working closely with NHS Lothian to ensure that the Royal Edinburgh Hospital complies fully with the guidelines as soon as possible. We understand from the Board that work on three formerly non-compliant wards is now complete, and remedial work on the remaining wards is scheduled for completion next month.

A total of 37 completed and unique replies were received to the Executive’s questionnaire on the current and future role of community hospitals. Replies were received from the following organisations:

NHS Borders

NHS Grampian

NHS Highland

NHS Dumfries and Galloway

Ian Charles Hospital

NHS Ayrshire and Arran

NHS Grampian

NHS Lothian

NHS Grampian

NHS Orkney

NHS Argyll and Clyde

East Lothian Local Health Care Co-operative

North Glasgow Division of Mental Health

Royal Pharmaceutical Society of Great Britain

Scottish Ambulance Service

Association of Scottish Chief Pharmacists

Scottish Association of Community Hospitals

NHS Education for Scotland

Multiple Sclerosis Society Scotland

Port Ellen Practice

Strathcarron Hospice

St.Andrews Memorial Hospital

NHS Tayside Specialist Palliative Care

Fife Palliative Care Services

Marie Curie Cancer Care

Highland Hospice

Alzheimer Scotland

Palliative Care Working Group, NHS Highland

North East Scotland Cancer Co-ordinating and Advisory Network

MS Society Scotland

Scottish Partnership for Palliative Care

Community health services division, university of Dundee

Glasgow Caledonian University, Dept of nursing. Midwifery and community health

Dept of Nursing and Midwifery, Stirling University

Royal College of Surgeons, Edinburgh

Royal College of Psychiatrists.

The Executive is aware of the concerns expressed by Alzheimer Scotland about the National Institute for Clinical Excellence (NICE) preliminary recommendations on the use of donepezil, rivastigmine, galantamine and memantine in the treatment of Alzheimer's disease.

NICE provides technology appraisal guidance for the NHS in England and Wales. In Scotland, NHS Quality Improvement Scotland (QIS) is a consultee in the NICE consultation process. This allows NHS QIS to consider any specific implications arising from draft NICE guidance which will affect its use in Scotland.  Because NHS QIS is involved in the NICE appraisal process, it allows them to issue advice to healthcare professionals in Scotland at the same time as the NICE guidance issues to healthcare professionals in England and Wales.

NHS QIS is currently considering the draft NICE appraisal on donepezil, rivastigmine, galantamine and memantine and have sought the views of a number of consultees in Scotland, including Alzheimer Scotland. These views will be reported to NICE.

The NICE appraisal process involves a further consultation on their Final Appraisal Determination. At that stage, NHS QIS will seek further comments from their consultees about any important differences that may have an impact on the suitability of the final guidance for Scotland. NHS QIS will take these comments into account in assessing whether the final NICE guidance is valid for Scotland.

Information about the NHS QIS process for commenting on NICE guidance can be accessed at:

http://www.nhshealthquality.org/nhsqis/files/NICE%20Guidance%20process%20.pdf.

The information to support an answer to this question is not held centrally.

I refer the member to the answer to question S2W-15090 on 17 March 2005. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

Donepezil, rivastigmine and galantamine are licensed for the treatment of mild to moderately severe dementia in Alzheimer’s disease. In 2001, the then Health Technology Board for Scotland (HTBS) (now part of NHS Quality Improvement Scotland), commented on an appraisal by the National Institute for Clinical Excellence on the use of these drugs. The HTBS estimated that, in Scotland, there were approximately 23,000 patients with mild to moderate Alzheimer’s disease. Of those patients, 11,500 may be eligible for treatment and approximately 40% (4,600 patients) were expected to respond to treatment and to remain on treatment in the longer term. The comment can be accessed at www.nhshealthquality.org.

Memantine is licensed for the treatment of moderately severe to severe dementia in Alzheimer’s disease.

In August 2003, the Scottish Medicines Consortium (SMC) undertook an assessment of memantine and advised that it was not recommended for use in NHSScotland. Following a resubmission by the manufacturer, the SMC assessed memantine again in December 2003 and on review of the evidence submitted by the manufacturer did not recommend it for use in NHSScotland. The SMC view is that the clinical trials for memantine have involved an extremely low number of patients and its effect on people with Alzheimer’s disease appeared to be marginal. The manufacturer failed to demonstrate the effectiveness of the product or identify a subgroup that might benefit from it. In addition, the economic case submitted by the manufacturer did not support a recommendation that use of this drug would be cost effective relative to standard practice in Scotland.

It is planned that a draft strategy on the future of community hospitals will be circulated for consultation during Summer 2005. The final version will be available in April 2006.

At all times, all clinically urgent calls are dealt with immediately by NHS 24 nurse advisers. During peak times, less clinically urgent calls are prioritised and receive a call back by a nurse adviser within a specific timescale. All callers who are categorised in this way are advised that should their condition deteriorate or they become concerned they should immediately contact the service again. The number of Priority one (P1) and Priority two (P2) call back calls and the percentage of those for which NHS 24 did not reach the target call back time since its establishment are listed in the table (these figures are not available broken down by NHS board area):

	2002*	2003	2004**	2005*
Total P1 calls	4,049	20,257	42,215	31,586
P1 calls outwith target	45	2,305	6,147	2,317
%age outwith target	1%	11%	15%	7%
Total P2 calls	4,013	27,910	60,529	43,864
P2 calls outwith target	408	8,702	20,617	7,705
%age outwith target	10%	31%	34%	18%

Notes:

*NHS 24 was launched on 8 May 2002.

**Call back standard for Priority 1 calls changed from 30 minutes to 60 minutes from November 2004. Call back standard for Priority 2 calls changed from 60 minutes to 120 minutes from December 2004.

***Figures available for January and February 2005.

It should also be borne in mind that NHS 24 did not roll out to the whole of Scotland until November 2004, so these figures over each year are not yet comparable.

The rationale for changes in call back targets for Priority 1 and Priority 2 calls, which were agreed by NHS 24’s Executive Team in December 2004, related to risk management balancing clinical appropriateness, managing demand and available resources. NHS 24’s Executive Team agreed that, subject to appropriate clinical prioritisation and on-going monitoring and review of the call back queue, the clinical cases in Priority 2 could safely be clinically assessed within two hours. All calls awaiting call back are regularly reviewed by experienced nursing staff and can be re-prioritised based on clinical need.

The review of NHS 24 which was announced in February will identify performance improvements to ensure that it realises its full potential in delivering high quality services for patient. The use of call back and how it can be reduced is part of the NHS 24 review team’s remit.