Chamber and committees

Consultant nurse/midwives undertake a combination of educational and clinical preparation.The nature of a consultant nurse/midwife post will demand a portfolio of career-long learning, experience and formal education; the postholder will have been working towards a master's degree; research experience, and a record of scholarship and publication.

One hundred and eleven student midwives will graduate by October 2002.

Breast cancer in men is relatively rare, occurring most often in individuals with a family history of female breast cancer. Genetic counselling and advice is available through cancer genetics services provided through Regional Genetics Centres. Referral is normally arranged either through an individual's general practitioner or specialist consultant responsible for treatment and care following diagnosis.Similarly to women with breast or other types of cancer, the support of the multi-disciplinary team involved in their treatment and care is available to men with breast cancer. Counselling services for people with cancer offer advice and support individualised to meet the particular needs of the patients referred to them.

Health promotion is the responsibility of NHS boards who would be happy to provide information about local activities and campaigns targeted at breast cancer awareness. Contact information for NHS Board Chief Executives is available from Scottish Health on the Web:www.show.scot.nhs.uk.Similarly, the Health Education Board for Scotland (HEBS) is responsible for matters relating to health education. Contact details for the Chief Executive and wider information on the board's activities is available from the HEBS website:www.show.scot.nhs.uk/hebs.

The undernoted table sets out (a) the incidence of male breast cancer for the years 1994-98, which is the most recent year for which completed cancer registry data are available, and (b) deaths from male breast cancer in the years 1994-2000, the most recent year for which completed mortality data are available.Incidence of and Mortality from Breast Cancer in Scotland in Males, 1994-2000

	1994	1995	1996	1997	1998	1999	2000
Cases	15	18	8	17	15	n/a	n/a
Deaths	3	5	10	7	5	7	6

Sources: incidence data provided by ISD Scotland; mortality data provided by General Register Office Scotland (GROS).Notes:1. Breast cancer in males is rare in Scotland with an average of around 15 cases diagnosed per year. Incidence has remained fairly constant over the last 20 years. 2. The estimates are not broken down to NHS health board level because of the very small numbers. To minimise the risk of any inadvertent breach of confidentiality, it is the policy of ISD to avoid publishing tables with small numbers of cases in any cell which might conceivably be used, along with other information, to identify an individual.3. Rates are not presented, again because small numbers of cases are subject to random fluctuation from year to year giving rise to very unstable estimates of risk.

NHSScotland provides National Screening Programmes for Breast and Cervical Cancer. The Breast Screening Programme invites women aged 50 to 64 for breast screening every three years. Women over 64 can self-refer. The Cervical Screening Programme invites women aged between 20 and 60 for a cervical smear at least once every five years. Details of other organisations which provide cancer screening services are not held centrally.

Radiotherapy is a highly specialised form of cancer treatment which is available only in cancer centres. Linear accelerators are the equipment through which radiotherapy is delivered. These are sited in each of Scotland's five cancer centres in Inverness, Aberdeen, Dundee, Edinburgh and Glasgow (NHS boards Highland, Grampian, Tayside, Lothian and Glasgow respectively). There are currently 18 linear accelerators, as follows:

Inverness	1
Aberdeen	2
Dundee	2
Edinburgh	5
Glasgow	8
Total	18

Two additional linear accelerators are being installed in the Beatson Oncology Centre in Glasgow during the course of this year, bringing the total there to 10 and the national total to 20.The Royal College of Radiologists recommends that there should be five linear accelerators per million population. Scotland's current total is equivalent to 3.5 per million population. With the additional two machines in Glasgow this will rise to 3.9 per million population by the end of 2002.A further wave of central purchasing (Wave 4) is currently being planned that, subject to the required investment appraisal process by NHS boards, will see a further six machines being commissioned. Two of these would be replacements but the other four are additional to current numbers.

We did not invite, nor have we received, any responses to the Scottish Needs Assessment Programme (SNAP) report mentioned.The Executive funds SNAP as a co-operative programme of work undertaken by staff from Scotland's Public Health Departments under the auspices of the Public Health Institute. SNAP reports review practice and service provision across Scotland, identified gaps and local effective practice, and make recommendations on how local services can improve their response to a particular condition. SNAP reports are therefore developed by Scottish Public Health staff to support their local work and it is local Public Health Departments, working in co-operation with their local partners, who are responsible for their implementation. We also continue to support a wide range of voluntary organisations committed to raising awareness, and offering support, care and information, to the care groups mentioned in the report.

The latest available information on the number of midwifery vacancies is shown in the following table:Midwifery Vacancies by Health Board Whole Time Equivalent: at March 2001

	WTE
	Total Vacancies	Became vacant in:			Vacancies as a percentage of establishment
		Less than 3 months	3 months or more	Unknown	Total	3 months or more
Scotland	31.3	26.6	1.2	3.5	1.3%	0.0%
Argyll and Clyde	50.0	1.5	-	3.5	2.1%	-
Ayrshire and Arran	-	-	-	-	-	-
Borders	-	-	-	-	-	-
Dumfries and Galloway	-	-	-	-	-	-
Fife	1.5	1.0	0.5	-	1.0%	0.3%
Forth Valley	0.5	0.5	-	-	0.3%	-
Grampian	3.3	2.6	0.7	-	1.3%	0.3%
Greater Glasgow	9.1	9.1	-	-	1.9%	-
Highland	0.8	0.8	-		0.6%	-
Lanarkshire	-	-	-		-	-
Lothian	11.1	11.1	-	-	3.5%	-
Orkney	-	-	-	-	-	-
Shetland	-	-	-	-	-	-
Tayside	-	-	-	-	-	-
Western Isles	-	-	-	-	-	-

Source: ISD(M)36 ISD Scotland.Notes:1. Excludes midwives in training.2. Lanarkshire Primary Care NHS Trust have not submitted a return and data for Lomond and Argyll Primary Care NHS Trust and North Glasgow Hospitals NHS Trust were incomplete3. Establishment is the sum of staff in posts under review and total vacancies.4. The vacancy figures relate to posts vacant at 31 March 2001, irrespective of when the vacancy arose.

The Scottish Needs Assessment Programme (SNAP) review offers a benchmark of expectations for a good, quality-based, service of care and attention for these important care groups. It is for the local statutory agencies to work together with the voluntary sector to respond to the standards set out and implied in the report, and I look for early change and improvement as a result.The performance of NHSScotland is effectively monitored by the health department on an on-going basis, and through escalating intervention to improve identified unacceptable performance.The information requested on the local implementation of the recommendations of the SNAP report will be available from local Public Health Departments, but is not held centrally.