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Schizophrenia

Mr. Sanders: To ask the Secretary of State for Health what distinction there is between the use of the words 'would' and 'should' within the National Institute for Clinical Excellence guidelines for schizophrenia when describing what patients can expect from services; and if he will make a statement. [102685]

Mr. Hutton: The National Institute for Clinical Excellence (NICE) guidance and technology appraisals are prepared by independent expert members of its advisory committees and guideline development groups who are drawn from the national health service, patients and carers, and the academic world. Although these committees and groups seek the views of organisations representing health care professionals, patients and carers, manufacturers and government, their advice is independent of any vested interests.

The use of the words 'would' and 'should' in NICE guidance and appraisals should be interpreted within the individual context they are used.

Scotland

Pete Wishart: To ask the Secretary of State for Health how many times he has visited Scotland on official duties each year since 2000; and what meetings were held on each occasion. [103606]

Mr. Lammy: My right hon. Friend, the Secretary of State for Health, had the opportunity to visit Scotland on three occasions during 2000. He addressed the Social Services 2000 Conference and the NHS Confederation Annual Conference and attended a Joint Ministerial Committee meeting.

He has not had the opportunity to visit since, but should a request to do so be received in the Department, he would give it his full consideration.

Pete Wishart: To ask the Secretary of State for Health what plans Ministers in the Department have to (a) visit Scotland on official business, (b) announce public appointments and (c) make ministerial announcements in April. [103659]

Mr. Lammy: Departmental business during the campaign period preceding elections to the Scottish Parliament will be conducted in accordance with the Guidance on Conduct for Civil Servants in the United

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Kingdom Departments, in respect of elections to the Scottish Parliament and National Assembly for Wales, published by the Cabinet Office on 10 March.

There re no current plans in my official diary, or those of my ministerial colleagues, to undertake a visit to Scotland during April.

Seroxat

Mr. David Stewart: To ask the Secretary of State for Health (1) what advice he has received from the Medicines Control Agency about the possible link between the use of the drug Seroxat and suicide; [104566]

(2) what representations he has received on the withdrawal of the antidepressant Seroxat; [104567]

(3) how many coroners have written to him expressing concerns about the drug Seroxat; and how many have called for urgent inquiries. [104565]

Ms Blears: Since it was authorised in 1990 the safety of paroxetine (Seroxat) has been closely monitored by the Medicines Control Agency (MCA) and the Government's independent expert advisory committee, Committee on Safety of Medicines (CSM). The CSM has considered the question of suicidal behaviour in association with Seroxat on a number of ccasions and carefully assessed any new data. The CSM has advised that there is insufficient evidence to confirm a causal relationship between Selective Serotonin Reuptake Inhibitors (SSRIs) and suicidal behaviour.

The CSM has advised that it is general clinical experience that patients taking any antidepressant may develop an increase in suicidal behaviour in the first few weeks of treatment. Product information for prescribes and patients for all SSRIs has been amended to include warnings that suicidal behaviour may increase in the early stages of treatment as with any antidepressant. In September 2000, an article was published in the drug safety bulletin, Current Problems in Pharmacovigilance, which is distributed to all doctors and pharmacists.

An expert working group on the safety of SSRIs has been set up by the CSM to review the current available evidence relating to the safety of SSRIs, including paroxetine, particularly in relation to suicidal behaviour and withdrawal reactions. The expert working group will report its findings to CSM in due course.

Since 1997, the MCA has received a range of representations, including parliamentary questions, letters from hon. and right hon. Members, patients and health care professionals expressing concerns about the safety of paroxetine (Seroxat), none of which have been from coroners.

The MCA and the CSM receive reports of suspected adverse drug reactions to medicinal products via the yellow card scheme. Since marketing authorisation was granted in 1990, the MCA and CSM have received 8,702 such reports for paroxetine (Seroxat). One of these reports has been received from a coroner. In addition the MCA has written to the coroner for Brecon to obtain further details of a recently publicised case.

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Smallpox

Mr. Waterson: To ask the Secretary of State for Health what categories of (a) health service employees, (b) civil servants, (c) Ministers, (d) servicemen and women and (e) other public service personnel (i) have been and (ii) are intended to be vaccinated against smallpox. [90612]

Mr. Hutton: The written ministerial statement of 2 December 2002, Official Report, column 63WS, set out our intention to vaccinate around 350 health care staff across the United Kingdom. This programme has commenced. Those vaccinated will form regional smallpox response groups around the UK. They will consist of infectious disease physicians and paediatricians, public health physicians, microbiologists/virologists, acute care and communicable disease control nurses and occupational health staff.

Service personnel to be vaccinated against smallpox will include those nuclear, biological and chemical specialists and specialist medical personnel who would form the spearhead of our armed forces' defensive response, including vaccination teams, in the event of a confirmed, suspected or threatened release of smallpox. Vaccination of these service personnel has commenced. Where immunisation is not routine, it is not our practice to go into precise details of counter-biological warfare immunisation programmes for the armed forces as this information could be of use to an aggressor.

Currently, there is no evidence of a specific threat of the deliberate release of smallpox as a biological agent. There is no plan to vaccinate civil servants, Ministers or other public service personnel.

As set out in the "Interim Guidelines for Smallpox Response and management in the Post Eradication Era", available on the Department's website www.doh.gov.uk/epcu/cbr/biol/smallpoxplan.htm, if the threat level increases, we shall step up vaccination of more emergency, laboratory and other essential personnel. This includes all those likely to be directly involved in the assessment, management and investigation of smallpox cases as well as emergency and other key essential staff, including police and fire service personnel. Officials are consulting with other Government Departments about which other key essential workers should be vaccinated at different threat levels.

Speech Therapists

Mr. Ruffley: To ask the Secretary of State for Health how many speech therapists there are in (a) mainstream schools and (b) special schools in (i) Suffolk, (ii) Essex, (iii) Norfolk and (iv) Cambridgeshire. [104823]

Mr. Lammy: The number of speech therapists in mainstream schools and special schools in Suffolk, Essex, Norfolk and Cambridgeshire is not collected centrally.

Under the special educational needs category of the standards fund, operated by the Department for Education and Skills, grant support is currently available to local education authorities to enhance therapy services in conjunction with the National Health Service and the voluntary sector.

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Usual Residency

Mr. Drew: To ask the Deputy Prime Minister if he will make a statement on the definition of usual residency for those who have been placed by one social services department in the area of another department; and what funding implications there are if the former decides (a) to reduce and (b) to remove funding. [100539]

Jacqui Smith: There is no definition of "ordinarily resident" in the National Assistance Act 1948 and it should be given its ordinary and natural meaning subject to any interpretation by the courts. The concept of ordinary residence involves questions of fact and degree. In determining ordinary residence, factors such as time, intention and continuity—each of which may be given different weight according to the context—have to be taken into account. Local Authority Circular LAC(93)7 on "Ordinary Residence" gives full details.

Generally, if a council places an individual in a care home in the area of another council under section 21 of the National Assistance Act 1948, the first council has continuing responsibility to fund and care manage the individual's stay in residential care. This is because the individual is regarded as remaining ordinarily resident in the "placing" authority's area, by virtue of section 24(5) of the 1948 Act.

Residents who are placed in care homes by councils are financially supported when their income and assets are not sufficient to cover the cost of care home fees. The amounts that supported residents should contribute to these fees are governed by the National Assistance (Assessment of Resources) Regulations 1992. Once the resident's contribution has been determined, the council should make its contribution sufficient to meet the costs of care as set out in the resident's care plan and contract between the council and care home. If the care home's fees are higher than the council would normally expect to pay, third parties such as relatives may make up the difference.

Whether a supported resident is placed by a council in its own area, or the area of another council, the placing council would be acting outside its statutory duties if it attempted to reduce its contribution to care costs in situations where supported residents' income and assets and assessed needs remain unchanged. When the resident's financial situation or needs change, a council may legitimately reduce or remove its funding. For example, a supported resident who acquires extra income and assets during his stay in residential care may lose entitlement to council funding. A council may reduce its funding when, following a re-assessment of needs, it agrees with a resident that some aspect of care within the care home may be reduced. In such circumstances, the resident should continue to pay their assessed contribution and the council makes up the difference with regard to the lower care home fee.

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