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Coronary Heart Disease

Dr. Evan Harris: To ask the Secretary of State for Health at how many places it was possible to treat coronary heart disease (a) in each health authority and (b) in total in England for the last two years for which figures are available. [13616]

Jacqui Smith: Coronary heart disease is treated throughout the national health service. Depending on the severity and nature of the disease, patients are treated in a variety of settings, covering prevention, treatment and rehabilitation in both community and hospital settings. It is therefore not possible to quantify provision in the manner requested.

Pneumococcal Vaccination

Dr. Stoate: To ask the Secretary of State for Health (1) what assessment he has made of the value of pneumococcal vaccination in reducing the winter burden on the NHS; [13970]

(2) if he will reduce the target age for pneumococcal vaccination to match the flu vaccination programme for older people. [13971]

Jacqui Smith: Pneumococcal vaccine is recommended for all those aged two years or older in whom pneumococcal infection is likely to be more common and/or dangerous, ie those with:

Asplenia or severe dysfunction of the spleen

Chronic renal disease or nephrotic syndrome

Immunodeficiency or immunosuppression due to disease or treatment, including HIV infection at all stages

Chronic heart disease

Chronic lung disease

Chronic liver disease including cirrhosis

Diabetes mellitus.

The Department continues to recommend this vaccine based on underlying ill health rather than age. Because the Department's policy on pneumococcal vaccine is designed to reduce morbidity and mortality, we have made no specific studies on the reduction of winter burden on the national health service.

Mental Health

Lynne Jones: To ask the Secretary of State for Health what plans he has to proceed with the reforms of the Mental Health Act 1982 outlined in the White Paper, "Reforming the Mental Health Act"; and if he will make a statement. [15178]

Jacqui Smith: We remain committed to the reform of the Mental Health Act 1983. New legislation will be introduced as soon as parliamentary time allows.

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Nursing Care

Mr. Burstow: To ask the Secretary of State for Health (1) how much each (a) primary care trust and (b) health authority paid in respect of free nursing care up to 31 October; and how many nursing home residents were placed in each registered nursing care contribution band; [12341]

(2) what estimate he has made of how many hours of nursing care will be funded from each of the registered nursing care contribution bands; [12343]

(3) pursuant to his answer of 18 October 2001, Official Report, column 1329W, on nursing care, if he will place in the Library a copy of the background papers concerning the testing of the registered nursing care contribution tool; [12416]

(4) pursuant to his answer of 18 October 2001, Official Report, column 1329W, on nursing care, (a) how many assessments had been completed by 31 October and (b) how many of these assessments were conducted face to face; [12415]

(5) pursuant to his answer of 18 October 2001, Official Report, column 1329W, on nursing care, how many nurses had completed the training in the use of the tool by 31 October; how many nurses have been designated to undertake assessments; and of these, how many were in post by 31 October. [12417]

Jacqui Smith [holding answer 5 November 2001]: I refer to the answers given to the hon. Member for West Chelmsford (Mr. Burns) on 9 November 2001, Official Report, columns 478–79W.

Copies of an "Evaluation of the Registered Nurse Care Contribution for the Determination of Residents' Needs for Registered Nursing Care, When in Use in Nursing Homes" undertaken by the Gerontological Nursing Programme of the Royal College of Nursing have been placed in the Library.

The Department is commissioning an evaluation of the implementation of free nursing care.

Mr. Hoyle: To ask the Secretary of State for Health what the projected cost is of providing free nursing care for the elderly in England in the next three financial years. [15420]

Jacqui Smith: £100 million was made available for free nursing care for adults over the age of 18 in nursing homes for the last six months of 2001–02. The full year costs for 2002–03 are currently being considered and allocations will be made early next year.

EU Food Supplements Directive

Dr. Iddon: To ask the Secretary of State for Health what progress has been made in negotiations regarding the draft EU food supplements directive in protecting the interests of the UK health food industry. [12753]

Ms Blears: We supported the final compromise proposal on which political agreement was reached in the Council of Ministers recently. The final text includes a number of important and hard won concessions which will benefit both United Kingdom consumers and the UK health food industry.

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Cutlass Review

Mr. Heald: To ask the Secretary of State for Health (1) what the timetable is for the Cutlass review of medicines; [13787]

(2) how many patients have been recruited to the Cutlass review (a) to take the existing medicines and (b) to take the atypical medicines; [13786]

(3) what assessment he has made as to the opinion of psychiatrists on the efficacy of atypical anti-psychotic medicines. [13783]

Jacqui Smith [holding answer 12 November 2001]: A multi-centred, randomised, controlled trial of the Cost Utility of The Latest Antipsychotics in Severe Schizophrenia (CUTLASS) is being conducted under the Department's health technology assessment programme. The trial, which compares new (atypical) drugs with conventional drugs, started in 1999 and is due to end in November 2002. The design of the trial means that it is not possible to extract information before the trial is completed about how many patients have taken which drugs. It is similarly not possible to provide information on results until the trial is ended.

Treatments

Mr. Heald: To ask the Secretary of State for Health (1) if it is his policy that treatments should not be available in the NHS unless they have been subjected to randomised controlled trials; [13782]

(2) what proportion of treatments used in the NHS have been subjected to randomised controlled trials. [13781]

Jacqui Smith: No. Clinicians may choose to prescribe medication on the national health service which has not yet been licensed for use in this country (with the manufacturer providing supplies on a "named patient" basis) or is not licensed for a particular indication for which it is to be used. The clinician will do so only after considering the benefit of administering the medicine in relation to the risk involved.

We do not hold information on the use of treatments which have not been the subject of randomised controlled trials.

Antipsychotic Medicines

Mr. Heald: To ask the Secretary of State for Health (1) what assessment he has made as to the likely occurrence of (a) tardive dyskinesia and (b) other side effects from the use of (i) atypical antipsychotic medicines and (ii) older treatments; [13784]

(2) what the main side effects are from the use of typical antipsychotic medicines; and if he will make a statement. [13785]

Jacqui Smith: The safety and efficacy of antipsychotics are assessed at the time of licensing by the Medicines Control Agency (MCA) with expert advice from the Committee on Safety of Medicines (CSM).

Tardive dyskinesia is a well-recognised side effect of older "typical" antipsychotics. Tardive dyskinesia is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. Factors predisposing to the development of tardive

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dyskinesia include old age, female sex, affective disorder, schizophrenia characterised by negative symptoms and organic brain damage. Newer atypical antipsychotics have been developed that are better tolerated, but tardive dyskinesia can still occur following long term administration with these drugs. The lower incidence of tardive dyskinesia with atypical antipsychotics remains to be established although at present this does appear to be the case.

Information on possible adverse effects is available in the summary of product characteristics which is produced by the manufacturer and approved by the licensing authority for each medicine. Tardive dyskinesia is well documented in the product information for both typical and atypical antipsychotics and is also described in the British National Formulary which provides guidance on prescribing to doctors.

Other side effects of older, typical antipsychotics can include; drowsiness, agitation, convulsions, dizziness, headache, confusion, gastrointestinal disturbances, dry mouth, constipation, difficulty with passing urine and blurred vision, cardiovascular symptoms, endocrine effects, blood abnormalities and skin rashes.

As with all medicines the safety of antipsychotics (typical and atypical) are continuously monitored by the MCA and the independent expert advisory body, the CSM.

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