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Ms Blears: Hospital cancer services have been assessed against national standards and we are working to develop primary care services for cancer patients. Cancer clinical leads have recently been appointed in every primary care trust.
Cancer standards will be included in the quality framework of the new general medical services contract. This is being negotiated by the National Health Service Confederation and the British Medical Association and will be made public in due course.
Llew Smith: To ask the Secretary of State for Health what assessment he has made of the work published in the International Journal of Cancer, volume 99, by University of Newcastle researchers in respect of cancer risks from the BNFL plant at Sellafield. 
Ms Blears: This study has been referred to the Committee on Medical Aspects of Radiation in the Environment (COMARE). COMARE will advise on this study and several other much larger studies concerned with the incidence of cancer in the children of radiation workers, in the committee's seventh report, which is expected to be published shortly.
Mrs. Calton: To ask the Secretary of State for Health what steps he is taking to ensure that the NHS Cancer Plan and the implementation of the NICE guidance do not suffer while the structural changes to the NHS become established. 
Ms Blears [holding answer 27 June 2002]: We recognise the need to maintain and improve delivery of services for patients while structural changes in the national health service are made. Strategic health authorities, primary care organisations and trusts are responsible for implementation of the Cancer Plan. They need to work through existing cancer networks to do this.
Primary care trusts have a legal requirement to ensure that funding for the appropriate implementation of National Institute for Clinical Excellence technology appraisals will be available within three months.
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Mr. Jim Cunningham: To ask the Secretary of State for Health what recent assessment he has made of the reasons underlying the lower survival rate for (a) cancer and (b) colon cancer in the United Kingdom than in (i) Germany and (ii) the United States. 
Ms Blears [holding answer 10 July 2002]: While other developed countries have broadly similar incidence of cancer, there is evidence to suggest that for many cancers, including colon cancer, survival rates for patients diagnosed a decade ago are lower in this country than in comparable European countries and the United States. Experts in the field suggest that the reason for the lower survival rates is due at least in part to patients in the United Kingdom having more advanced disease at the time of treatment.
That is why, in September 2000, we published the "NHS Cancer Plan" which sets out a programme of action to improve cancer prevention, detection, treatment and research which are intended to bring our survival rates in line with the rest of Europe.
Ms Blears [holding answer 3 July 2002]: The Department contributed to the recent production of Cancer Research UK's leaflet, "Testicular CancerSpot the Symptoms". Copies are available in the Library and also on both Cancer Research UK's and the Department's websites. We have also been working with Cancer Research UK on the development of information to support the prostate cancer risk management programme.
Ms Blears [holding answer 3 July 2002]: Cancer services in England are organised in 34 cancer networks. Cancer networks bring together primary, secondary, tertiary and voluntary service providers to plan and deliver specialist services across the patient pathway. Information on the number of participating institutions is not collected centrally.
Ms Blears: Since April 2001, every top tier local authority in England has a local teenage pregnancy strategy and rolling three-year action plan, developed jointly by health and local authority partners and agreed by the Teenage Pregnancy Unit in the Department. Responsibility for the implementation of the local strategy is held jointly by the local authority and relevant primary care trusts (PCTs).
Since April 2002, funding to support implementation of agreed local strategies has been routed to local authorities through a teenage pregnancy local implementation grant. The local authority is the accountable body and must take decisions on the expenditure of the grant to ensure that it
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is used to support the aims of the agreed local strategy. The local teenage pregnancy partnership board, with representation from the local authority, PCTs and key local partners, should make recommendations on the use of the grant and oversee implementation of the local action plan.
Mr. Clifton-Brown: To ask the Secretary of State for Health if he will make a statement on the reasons why the Food Standards Agency are making representations to the Commission to ban the use of sheep intestines in sausages; and what scientific evidence his Department has collated on whether scrapie in sheep could mask the detection of BSE. 
Ms Blears: I am advised by the Food Standards Agency that the Agency's Board endorsed a report on bovine spongiform eucephalopathy (BSE) and sheep from a core group of stakeholders at its meeting in Armagh on 13 June. It contained a recommendation that the European Commission be requested to add sheep intestine to the current list of specified risk material for sheep as an additional precautionary measure. The Board agreed the recommendation on the basis that the measure, added to the current controls, could reduce potential infectivity entering the food chain by up to two-thirds if BSE were found in sheep. Current precautionary measures are estimated to reduce risk by approximately one-third.
There is a theoretical risk that BSE exists in the national flock as some consumed the same type of feed that is thought to have infected cattle. A sheep apparently suffering from scrapie could instead be suffering from BSE as it is currently not possible to differentiate between the symptoms of the two diseases. In an Opinion issued in February 2001, the Scientific Steering Committee (SSC) of the European Union stated: 'the agent causing scrapie, the expression of clinical disease in scrapie- affected sheep, cannot currently be distinguished from BSE by any means other than biological strain typing of the agent responsible.' Bioassays in mice take up to two years to complete. It has only been possible to test a small sample of brains from sheep thought to have scrapie to determine whether a BSE-like strain is present.
Ms Blears: No. The only risk to health identified from the use of toothpaste containing fluoride is dental fluorosis. I am satisfied that the instructions on use which manufacturers include on packets and tubes of toothpaste protects the public from this risk.
Ms Blears: Yes. In dilute aqueous solution, sufficient to increase the naturally occurring fluoride concentration to one part per million, hexafluorosilicic acid yields fluoride ions, hydrogen ions and silica. Disodium hexafluorosilicate yields sodium ions in addition. All of these products occur
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naturally in water supplies. The only product whose concentration is significantly raised by fluoridation is the fluoride ion.
Ms Blears: We have asked the Medical Research Council for advice on how the research base on the safety and efficacy of water fluoridation in reducing tooth decay might be strengthened and their report is expected shortly. In the meantime our advice to health communities in areas of high dental decay is to consider consulting their local populations on whether they should have their water fluoridated.
Ms Blears: The quality of drinking water is subject to The Water Supply (Water Quality) Regulations 1989 (SI 1147) as amended. This sets a maximum limit for fluoride at 1.5 mg per litre. Therefore, companies making baby food or infant formula using tap water would have less than 1.5 mg per litre for the water component of the feed, plus any other source of fluoride. As the limit for fluoride is the same for Private Water Supplies (The Private Water Supply Regulations 1991 SI 2790), manufacturers using such a supply would not be expected to produce baby food with a different level of fluoride.
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