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Withholding Food and Fluid

Mr. Drew: To ask the Secretary of State for Health (1) what his policy is on the use of sedation, with specific reference to withholding food and fluid from a patient; [67215] (2) what his policy is on withholding food and fluid from patients and the notice to be taken of relatives' wishes; [67214] (3) what advice his Department offers on the use of drugs that suppress the symptoms of terminal dehydration. [67216]

Mr. Lammy: I am advised that food and fluids should always be offered to patients who are capable of swallowing them. For terminally ill patients in the final days of life the objective is to control distressing and painful symptoms. Achieving such control may result in sedation. Many patients stop drinking and eating during the final days and it will be for clinical judgment to decide what is the appropriate treatment. Where nutrition and hydration have to be provided by artificial means, their possible withdrawal is in all cases a matter of clinical judgment which is undertaken in accordance with professional advice in accordance with a responsible body of medical opinion and the general law.

An adult patient who is capable of making his or her own treatment decision is entitled to do so and can refuse artificial hydration and nutrition just as he can any other form of treatment. In the absence of a valid advance

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refusal of treatment, doctors are required to act in the best interests of a adult patient who is unable to make his or her own treatment decisions. Sometimes this will mean that medical treatment (which includes artificial hydration and nutrition) which is no longer beneficial to the patient should be withdrawn. In these circumstances, suitable medical or other care should be provided to ensure that the comfort and dignity of the patient are maintained. In line with good practice, decisions to withdraw medical treatment should be made only after discussions with the healthcare team and those close to the patient.

Guidance in relation to palliative care (Changing Gear—Guidelines for Managing the last days of life in adults) was issued by the Department of Health in 1998, and advice on withdrawing and withholding treatment was included in the Reference Guide to Consent for Examination and Treatment, published in March 2001. Further guidance is also available from the British Medical Association.

North Surrey Primary Care Trust

Mr. Wilshire: To ask the Secretary of State for Health what the (a) budgeted income and (b) planned expenditure of the North Surrey Primary Care Trust are for 2002–03. [67465]

Ms Blears: The North Surrey Primary Care Trust has reported that the current position on the 2002–03 budget is expenditure of £166.640 million. This position takes account of the trust's £2.3 million internal savings programme.

The trust's income is subject to service and financial framework discussions between Surrey & Sussex Health Authority and the Department's Directorate of Health and Social Care for the South of England, which are still ongoing.

IT Projects

Mr. Heald: To ask the Secretary of State for Health (1) what assessment he has made of the cost to private sector IT suppliers of developing proposals for core ICT demonstrator projects initially supported by his Department, but for which funding was not found; [67976] (2) what representations he has received from private sector IT suppliers concerning the provision of funding for core ICT demonstrator projects initially supported by his Department. [67977]

Ms Blears: A programme of small-scale pilot projects—electronic record demonstrator and implementation programme (ERDIP) was funded by the Department. These are currently being evaluated to assess progress and lessons learned prior to a decision being taken about further work.

In addition, joint work between the Department and a number of private sector consortia was undertaken to explore potential large-scale development projects in information technology (IT). Resources were made available by both the Department and the private sector for this but the considerable monies required for the execution of the projects could not be found.

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All future IT developments in the NHS are now subsumed into the National Programme described in "Delivering 21st Century IT Support for the NHS—National Strategic Programme"—copies are available in the Library and at: deliveringit

The Department will continue to work in partnership with the private sector to deliver IT for the NHS.

Mr. Heald: To ask the Secretary of State for Health (1) what the status is of existing NHS ICT procurements at PCT level; and if he will make a statement; [67987] (2) if he will publish the guidance which he has issued to PCTs to halt existing NHS ICT procurements; [68003] (3) whether he intends to issue further guidance concerning existing NHS ICT procurements at PCT level. [67986]

Ms Blears: The new National Health Service information technology programme was outlined in the document "Delivering 21st Century IT Support for the NHS: National Strategic Programme", published by the Department in June 2002. The key change of direction is to take greater central control over the specification, procurement, resource management, performance management and implementation of the information and IT strategy.

Existing local procurements, and the development by local primary care organisations of system specifications and functional requirements, are valuable in the development of a new national approach. Guidance published by the Department in support of the June 2002 document states:

On 29 April 2002 the NHS primary care information modernisation programme published a guidance document advising local organisations that have not yet begun procurements to await further guidance arising from the new approach to system certification and accreditation. There was no advice to halt existing procurements; instead the programme advised:

As the new procurement strategy is developed, the Department will issue further advice as to how migration to the new arrangements will be made. This will cover all NHS IT procurements, including those relating to primary care organisations, and will take into account developments arising from existing local procurements.

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Primary Care Drug Dictionary

Mr. Heald: To ask the Secretary of State for Health (1) what procedures were followed in procuring the design, prototyping and population of the primary care drug dictionary; [67992] (2) whether tenders were issued for the design, prototyping and population of the primary care drug dictionary. [67990]

Mr. Lammy: A drug dictionary has been developed as part of the research phase of the development of PRODIGY, a computerised decision and learning support tool for general practitioners.

A recent re-procurement of primary care decision support (based on PRODIGY) is near completion as the work moves from research and development to the implementation phase. Reference to the design work and prototyping for an electronic drug dictionary was included as part of the procurement process. This is consistent with European Union procurement rules.


Mr. Laws: To ask the Secretary of State for Health if he will list the statistics that are collected by his Department by English parliamentary constituency; and if he will make a statement. [67100]

Mr. Lammy: The Department collects a wide range of statistics, most of which are collected at a local level. They are based on administrative areas such as health authorities, primary care trusts, National Health Service trusts or local authorities that reflect local lines of responsibility and accountability. They are not collected at Parliamentary constituency level.

Members of the Government statistical service (GSS) in all Government Departments provide a statistical service to the Library.

The Library provides a tailored service for Members. Statistics that can often be provided at parliamentary constituency level include economic status (employment, unemployment, and inactivity), claimant count, employee jobs, average earnings and census data. Also, many statistics that are available at a lower level can generally be aggregated to parliamentary constituency level. This includes the increasing range of statistics at ward level becoming available through the neighbourhood statistics service (

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