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Dental Services

Mrs. Ballard: To ask the Secretary of State for Health what measures his Department takes to monitor the quality of private dental treatment. [18400]

Mr. Milburn: The General Dental Council is the regulatory body responsible for dental treatment provided outside the National Health Service. The Department, which provides funding for the continuing education and training of dentists who have an arrangement to provide general dental services under the National Health Service, gets regular feedback from the Council on matters like professional conduct and fitness to practise. The great majority of general dental practitioners carry out some NHS work even if they also undertake private practice.

Mr. Kidney: To ask the Secretary of State for Health what action he is taking to ensure access to NHS dentistry for all residents of the South Staffordshire health authority district. [18487]

Mr. Milburn: On 9 September we announced the "Investing In Dentistry" initiative, which makes available up to £9 million in 1997-98 to help health authorities improve the availability of National Health Service dentistry in areas of the country where there are particular problems of access to NHS dental services.

Breast Screening

Mr. Stinchcombe: To ask the Secretary of State for Health (1) what plans he has to provide national guidelines on the introduction of two-view screening for each round of breast screening; [18506]

(2) what plans the Government have to improve the United Kingdom's detection ratio for those rounds of breast screening following the first screening; [18508]

(3) what assessment he has made of the advantages of two-view mammography for detecting small cancers. [18510]

Mr. Boateng: The Cancer Screening Evaluation Unit, which is funded by the Department of Health, is reviewing the advantages of two-view mammography. Recently published data suggest that for a woman's first screen, the use of two-view mammography increases by 45 per cent. the detection of invasive cancers of less than 15 millimetres, and for subsequent screens it increases the detection rate by 25 per cent.

All breast screening units currently take a second mammographic view of the breast at a woman's first visit to the screening programme. Breast screening units have discretion over the use of two view mammography at subsequent screening rounds. The case for requiring all units to take two views at every screening round will have to be assessed along with the outcome of research currently being carried out into other changes that might be made to improve the quality of the service offered to women, for example extending the screening programme to older women, and reducing the screening interval.

Mr. Stinchcombe: To ask the Secretary of State for Health (1) what is Her Majesty's Government's policy on extending the upper age limit of those automatically invited to breast screening; [18507]

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(2) if he will assess the advantages of extending the upper age limit of those automatically invited to breast screening to 69 years of age. [18526]

Mr. Boateng: The Government are funding a pilot schemes in Northern and Yorkshire, Trent and South Thames regions to evaluate the effectiveness of extending the screening programme to include women aged 65-69. These pilots will run for three years to 1999-2000 to give a clear picture of likely uptake among older women, and effectiveness in terms of the number of cancers detected. We will base any changes to policy on the evidence emerging from these.

Screening every three years is currently available to older women on request. This is well publicised in a number of ways. Women who have already been screened through the programme are informed of their right to request screening after the age of 65. The booklet "Your Health: A Guide to Services for Women", which is widely available through general practitioner's surgeries, clinics, post offices and some shops, makes clear that women aged 65 and over will be screened free of charge three yearly if they request it.

Social Service Provision

Mr. Gardiner: To ask the Secretary of State for Health if he will review the incidence of patients forced to remain in hospital after they have been discharged because of a lack of appropriate social service provision. [18518]

Mr. Boateng: The incidence of patients who remain in hospital after they have been declared clinically fit for discharge is reviewed quarterly by the National Health Service Executive and the reasons for the delay in discharge are collected.

Dental Students (Tuition Fees)

Mrs. Ballard: To ask the Secretary of State for Health what calculations his Department has made of the impact on the National Health Service budget of the introduction of tuition fees for dental students. [18360]

Mr. Milburn: Dental students will make a means-tested contribution to their tuition fees for the first four years of their course. The Department of Health will pay the contribution from year five onwards. This will not be at the expense of patient care--a transfer of resources from the Department for Education and Employment is being agreed to meet the cost.

Myalgic Encephalomyelitis

Mr. Llew Smith: To ask the Secretary of State for Health (1) what plans he has to commission research into the physical causes of myalgic encephalomyelitis; [18660]

(2) what consultation the Government have carried out with those who suffer from myalgic encephalomyelitis; [18658]

(3) what assessment he has made of existing services provided by health authorities for those suffering with myalgic encephalomyelitis; [18662]

(4) what guidance has been given to GPs on the treatment of myalgic encephalomyelitis; [18661]

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(5) if he will commission a national epidemiological study into myalgic encephalomyelitis. [18659]

Mr. Boateng: Priorities for funding research in the Department are set very carefully, based on the burden of disease and other criteria. Bids for conducting research into chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) are therefore always considered on that basis. The Department continues to fund research into the management and treatment of CFS/ME through the National Health Service Research and Development Programme.

It is currently funding an on-going research project, costing about £60,000, which is looking at whether general practitioners are best placed to manage CFS/ME patients. A recently completed research project, costing over £65,000, considered whether a particular type of psychological treatment was effective in reducing disability in CFS/ME patients. The main agency through which the Government support medical and clinical research is the Medical Research Council. The Council currently provides support for one Small Project Grant in the area of Chronic Fatigue Syndrome entitled "The role of noradrenaline in the neuropsychological pathogenesis of the chronic fatigue syndrome". The total amount awarded was £37,000.

There are no plans to commission a national epidemiological study into CFS/ME. A number of small studies of epidemiology have indicated that prevalence is around 1-2/1000 of the population with a peak incidence in the 20-40 age group and a slight female predominance. Obtaining accurate epidemiological information is particularly difficult in the case of CFS/ME due to variations in definitions and the difficulties in making an accurate diagnosis. There is no single diagnostic test for CFS/ME. It is usually diagnosed by testing for and eliminating other conditions. People with CFS/ME can experience any or all of a wide range of symptoms, but chronic fatigue is a key factor in the syndrome.

The Government have not carried out a consultation of people who suffer from CFS/ME. However, we have funded CFS/ME voluntary organisations who have close contact with sufferers. Since 1988, we have made over £225,000 available to CFS/ME organisations and by 1998, this will have risen to over a quarter of a million pounds.

The NHS provides a wide range of services to which sufferers of CFS/ME have access and such patients are seen within a wide range of community services and hospital specialties. Patients can discuss the options available to them with their GP and they may also request an assessment of their needs by local authority social services departments. It is the responsibility of health authorities to decide how the needs of CFS/ME sufferers should be met and whether or not they should purchase dedicated services. All such decisions are made in the light of competing priorities and finite resources.

We consider that it is more appropriate for clinical guidelines to be produced by clinicians themselves or through their representative professional bodies. Establishing definitions of disease and the criteria for their diagnosis is also a matter for the professions. Furthermore, the Medical Royal Colleges point out that, whilst CFS/ME should be managed by GPs, it is inappropriate at present to issue clinical guidelines given

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the lack of methodologically sound research. There is no single effective treatment for CFS/ME. The condition varies significantly from one patient to another and therefore individual patients benefit from different treatment regimes.

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