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HEALTH

Endocrine Disrupting Chemicals

Norman Baker: To ask the Secretary of State for Health what research has been carried out into the impact of endocrine-disrupting chemicals on human health. [99254]

Ms Blears: There has been and continues to be a large amount of research relevant to the broad hypothesis that current exposures to chemicals may alter the functions of the endocrine system in such a way as to harm human health, and many expert reviews have been published. The most recent comprehensive review is in the International Programme on Chemical Safety (IPCS), Global assessment of the state-of-the-science of endocrine disrupters, published in August 2002 by the World Health Organization (WHO/PCS/EDC/02.2). A copy will be deposited in the Library. The report is also available at http://www.who.int/pcs/emerg site/edc/global edc TOC.htm

The Department of Health provided financial support for the IPCS review and both financial and secretariat support were provided by the Department of the Environment, Food and Rural Affairs.

Several Departments fund research projects on possible health effects from and levels of potential endocrine disrupters present naturally or man-made, in food, consumer products and the environment.

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Attention Deficit Disorder

Mr. Burstow: To ask the Secretary of State for Health what assessment he has made of the effect of (a) junk food and (b) additives in food on (i) ADD and (ii) ADHD; and if he will make a statement. [99679]

Ms Blears: Independent evidence suggests that some foods and their ingredients can affect certain aspects of children's behaviour. While eliminating some foods may thus be helpful, a dietary approach to the treatment of children with the more severe form of attention deficit hyperactivity disorder has been found to be of limited value.

The Food Standards Agency (FSA) considers that more definitive information is needed on the relationship between additives and the behavioural effects on children. The FSA is currently seeking advice on undertaking further research in this area.

Cancer Services (Investment)

Mrs. Calton: To ask the Secretary of State for Health (1) whether the findings of the exceptional tracking exercise on the additional investment in cancer services will be published (a) in full and (b) on his Department's website; [99313]

(2) if his Department will use the findings of the exceptional tracking exercise on the additional investment in cancer services to inform its work to improve the patient's experience of cancer, as an NHS Cancer Plan priority; [99314]

(3) if his Department will contact (a) patient stakeholder groups and (b) their representative organisations to inform them of the publication of the findings of the exceptional tracking exercise on the additional investment in cancer services; [99312]

(4) when his Department plans to publish the findings of its exceptional tracking exercise on the additional investment in cancer services; [99311]

(5) what format will be used for the publication of the findings of the exceptional tracking exercise on the additional investment in cancer services. [99926]

Ms Blears: We intend to publish headline national and network level figures on cancer investment on the Department's website in late spring. The exact format will depend on the level and type of information received from strategic health authorities. We will continue to work with key stakeholders and patient representative groups to improve the patient experience including making available to them the figures from the cancer investment tracking exercise. At a local level this exercise will inform cancer networks' discussions with their stakeholders on plans for future investment, to further improve patient care.

Further details of the tracking investment exercise can be found at www.doh.qov.uk/cancer/trackinginvestment.htm

Cloning

Mr. Amess: To ask the Secretary of State for Health what discussions he has held with his European counterparts on cloning; and if he will make a statement. [100319]

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Ms Blears: My right hon. Friend, the Secretary of State, has held no meetings with his European counterparts on cloning. However, cloning has been on the agenda at a number of international meetings attended by the Prime Minister and Science Minister since 1998.

The United Kingdom was the first European country to put in place a specific legal ban on human reproductive cloning in 2001 and we continue to support moves in the United Nations to introduce a global ban on human reproductive cloning.

Continuing Care

Mr. O'Hara: To ask the Secretary of State for Health what plans he has to revise the notes for guidance on continuing care in the light of the case of R v North and East Devon Health Authority ex parte Pamela Coughlan. [100815]

Jacqui Smith: Revised guidance was issued in light of the case of R v North and East Devon Health Authority ex parte Pamela Coughlan in June 2001.

Contraception

Jim Dobbin: To ask the Secretary of State for Health how many girls aged (a) under 16, (b) under 18 and (c) under 20 have been given the morning-after pill under Patient Group Directives in each year in which Patient Group Directives have been in force. [99460]

Ms Blears: The information requested is not collected centrally. The use of patient group directions for health professionals to supply emergency contraception is a local decision taken by the relevant primary care trust.

National data on the occasions on which emergency contraception is provided is derived from the KT31 form annual returns from national health service contraceptive services in England. This data does not identify whether the provision is through a patient group direction.

Digital Hearing Aids

Mr. Rosindell: To ask the Secretary of State for Health (1) how many digital hearing aids have been issued by the NHS in the London Borough of Havering in the last 12 months; [99735]

(2) if he will make a statement on the availability of digital hearing aids in the London Borough of Havering; [99750]

(3) what proportion of the funding for digital hearing aids will be available to hospitals in the London Borough of Havering. [99749]

Mr. Hutton: Barking, Havering and Redbridge Hospitals National Health Service Trust will start to fit digital hearing aids routinely from the end of March. Audiology staff are currently being trained and new equipment is being installed.

We have recently announced that £94 million is being made available, over the next two years, to support the introduction of a modernised hearing aid service, including the provision of digital hearing aids, across the whole of England.

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Primary care trusts are being asked to fund 25 per cent. of the additional revenue costs of a modernised service.

Drug Treatment

John Mann: To ask the Secretary of State for Health what clinical trials there have been on heroin treatment using (a) methadone, (b) buprenorphine, (c) naltraxone, (d) psychotherapy and (e) residential rehabilitation. [98153]

Ms Blears: Comprehensive reviews of the effectiveness of methadone have been provided by several authors (Hall et al., 1998, Farrell et al., 1994, Bertschy 1995, Marsch, 1998). Most of those studies demonstrating the effectiveness of methadone are of on-going maintenance treatment but the evidence generally becomes weaker as the duration of treatment shortens, with little systematic evidence to support short-term detoxification. Specific studies include Fontain & Ansseau, 1995, Glass, 1993 and Gossop, M. et al., 2001. High quality medical and psychosocial services, a clear orientation towards social rehabilitation, treatment longevity and slow detoxification of well-stabilised patients have all been identified as giving the best outcomes (Cacciola et al 1998, Bertschy 1995). Randomised controlled trials (RCTs) show a relationship between higher doses (>50 mg) and reduced illicit drug use with better treatment retention rates (Ward et al 1992, Ling et al 1996, Fontaine & Ansseau 1995 and D'Aunno & Vaughan 1992).

Buprenorphine has more recently been established as a potential effective alternative substitution treatment for some patients by a number of studies such as those concentrating on effective doses including Johnson et al., 1995, Ling et al., 1998 and Strain et al., 1994. Specific differences from methadone have been highlighted in other studies including Walsh et al., 1994, Reynaud et al., 1998, Bickel & Amass, 1995, Reisinger, 1997 and Barnett P. G. et al., 2001) and trials in Europe have been reviewed by Chapleo et al., 1997. Also see Uehlinger, C. et al. 1998 and Fischer, G. et al. 1999 for published studies.

The Cochrane review of buprenorphine maintenance for opioid dependence in August 2002 concluded 'Buprenorphine is an effective intervention for use in the maintenance treatment of heroin dependence, but it is not more effective than methadone at adequate dosages.'

The effectiveness of naltrexone for relapse prevention has been demonstrated in controlled studies by Shufman et al., 1994 and Gerra et al., 1995. Probation-linked supervised naltrexone has been used as an alternative to custody in opiate-misusing offenders and studied by Brahen & Brewer, 1993. A recent systematic review of the efficacy of naltrexone maintenance treatment in opioid dependence by Kirt Mayer et al. 2002 noted limit support for naltrexone in its findings and this treatment is generally seen as appropriate for a minority of patients.

The Cochrane review of naltrexone maintenance for opioid dependence in January 2002 concluded 'The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in

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favour of treatment with naltrexone was observed for certain target groups (particularly people who are highly motivated), as has been previously described in the literature.'

There is a very limited experimental research base comparing specific psychotherapies. McLellan et al., 1994 reviewed the evidence and concluded that 'successful outcomes are related to marked and consistent differences between counsellors,' and 'a study of whether the addition of counselling improved the efficacy of methadone maintenance programmes found that the addition of basic counselling on a weekly basis resulted in major and significant improvements'.

International literature (Gerstein D. R. et al., 1990, Kooyman M., 1993 and Hubbard, R., 1994) demonstrates improvements from residential rehabilitation with programmes offering additional services having improved outcomes. The National Treatment Outcome Research Study (Gossop et al. 2001) has confirmed benefits in the UK for those attending residential rehabilitation and found that time in residential treatment is predictive of superior outcomes.

Useful general references containing more detailed references as above:

Community treatment of drug misuse: more than methadone. Nicholas Seivewright, Cambridge University Press 2000.

The task force to review services for drug misusers—report of an independent review of drug treatment services in England (DH 1997).

Methadone substitution therapy—policies and practices. Monograph series number one. Ghodse, A. M. et al. 1998. European Collaborating Centre in Addiction Studies (ECCAS).

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