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.

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.

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.

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.

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.

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.

The information requested is given in the table.

Deaths from Hypertrophic Obstructive Cardiomyopathy ¹, Scotland, 1999-2004

1999	2000	2001	2002	2003	20042
6	7	7	10	2	5

Notes:

1. 1999: International Classification of Diseases, Ninth Revision, code 425.1 2000–2004: International Classification of Diseases, Tenth Revision, code I42.1.

2. Provisional.

Clinicians have access to standard diagnostic criteria and a multitude of assessment tools for the diagnosis of dementia. These include consideration of intellectual and behavioural functions. Updated best practice clinical guidelines on dementia will be published by the Scottish Intercollegiate Guidelines Network this summer.

While the carer’s role is always taken into account in the assessments of those with dementia, there are no specific standards for carers’ assessments of people with dementia.

In its final report in 2003, the Housing Improvement Task Force recommended that there should be no prescribed “shelf life” for the single survey on the basis that a surveyor can be expected to assess the condition of a property only at the time when survey is carried out. This is similar to the current position when surveys are commissioned by buyers.

 The Scottish Executive consultation paper on proposals for the Housing Bill included a question on time limits for surveys. Eighty-six percent of those who responded on this point said that there should be a time limit on single surveys. Of those who agreed that there should be a time limit over 60% proposed that the time limit should be six months or less. A further quarter of respondents to this question said that the maximum time limit on the validity of a single survey should be one year.

Some respondents, for example the National Association of Estate Agents and the Law Society, suggested that a compulsory time limit on single surveys would place financial pressures on sellers particularly in areas where the market is less active.

The Royal Institution of Chartered Surveyors expressed strong opposition to any time limit, noting that a survey is a “snapshot” of the property at the time of the inspection. It also pointed out that there are risks in relying on old information.

The Council of Mortgage Lenders argued that it would be difficult to be prescriptive about a time limit. It expressed the view that in areas where there is a buoyant market, such as Edinburgh, the valuation might change significantly over a three-month period. However, in less active areas a valuation might not change significantly over a six or even a nine-month period.

From our discussions with the parties mentioned above, we are not aware of any changes to these views on this issue. We will work closely with all stakeholders on this and other issues to deliver an effective scheme.

A full report on the consultation can be found at http://www.scotland.gov.uk/library5/housing/mhphcr-00.asp.