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22 Mar 2004 : Column 598W—continued
Hormone Replacement Therapy
Sandra Gidley: To ask the Secretary of State for Health how many women in England were prescribed hormone replacement therapy, broken down by drug type, in each year since 1997; and if he will make a statement. [161928]
Dr. Ladyman: We do not know how many women in England are prescribed hormone replacement therapy (HRT). The information that is available is on the number of prescription items of HRT that are dispensed in the community in England. This is shown in the table.
| Number of prescription items | ||||||
|---|---|---|---|---|---|---|
| Chemical Entity | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 |
| Estradiol | 1,139.6 | 1,164.7 | 1,176.4 | 1,186.4 | 1,202.6 | 1,167.1 |
| Estradiol and Estriol | — | — | — | 0.0 | 0.0 | — |
| Estradiol and Estriol with Progestogen | 166.7 | 142.0 | 118.8 | 101.6 | 86.3 | 69.8 |
| Estradiol Valerate | 244.2 | 258.5 | 271.7 | 282.7 | 291.4 | 283.2 |
| Estradiol with Cyproterone Acetate | — | — | 0.0 | 0.0 | 0.0 | 0.0 |
| Estradiol with Progestogen | 1,228.8 | 1,337.4 | 1,426.5 | 1,552.3 | 1,638.5 | 1,597.3 |
| Estradiol, Estriol and Estrone | 76.1 | 76.4 | 69.9 | 68.4 | 68.2 | 63.6 |
| Estriol | 1.9 | 1.8 | 1.9 | 2.0 | 2.2 | 2.1 |
| Estropipate | 63.7 | 58.9 | 56.4 | 52.0 | 46.6 | 39.6 |
| Estropipate with Progestogen | 3.4 | 3.0 | 0.9 | 0.0 | 0.0 | — |
| Ethinylestradiol | 36.2 | 32.3 | 30.2 | 28.1 | 26.5 | 23.9 |
| Mestranol With Progestogen | 16.2 | 13.7 | 7.3 | 0.1 | — | 0.0 |
| Oestrogens Conjugated | 1,120.5 | 1,101.0 | 1,091.5 | 1,080.9 | 1,058.5 | 976.3 |
| Oestrogens Conjugated with Progestogen | 1,409.2 | 1,392.6 | 1,355.8 | 1,317.5 | 1,269.8 | 1,113.3 |
| Oestrogens Esterified With Androgen | — | — | 0.0 | 0.0 | 0.0 | 0.0 |
| Other Preparations | 0.0 | 0.0 | 0.0 | 0.0 | — | — |
| Raloxifene Hydrochloride | — | 4.1 | 43.4 | 79.9 | 119.0 | 160.7 |
| Tibolone | 334.3 | 349.0 | 387.5 | 425.4 | 454.3 | 464.2 |
| Total for Oestrogens and HRT | 5,840.8 | 5,935.6 | 6,038.2 | 6,177.5 | 6,263.8 | 5,961.0 |
Notes:
1. Oestrogens and HRT are defined as those drugs within the British National Formulary (BNF) paragraph 6.4.1.1.
2. The data are from the Prescription Cost Analysis system and cover all prescription items dispensed in the community in England. Information on items dispensed in hospitals or private prescriptions is not available.
3. "—" indicates no data. 0.0 indicates less than 50 items were dispensed.
Source:
Prescription Cost Analysis (PCA) data from the Prescription Pricing Authority (PPA)
Hospitals (Body Disposal Procedures)
Mr. Fabian Hamilton: To ask the Secretary of State for Health (1) whether NHS hospital staff are obliged to see green forms issued by a registrar of births, marriages and deaths prior to the release of a body; [159965]
- (2) what powers NHS staff have to prevent the release of a body from a hospital solely because funeral arrangements have not been made; [159999]
(3) under what powers staff in the NHS must release the bodies of those who die in hospitals. [160000]
Ms Rosie Winterton [holding answers 15 March 2004]: The Department recognises how important it is that national health service staff are sensitive to the needs of people who die in hospital and the relatives of dying or deceased patients. Guidance to the NHS on the need to ensure this (HSG(92)8, "Patients who die in hospital" and its supplementary guidance HSG(97)43) was published in 1992 and 1997, respectively.
However, the law governing the disposal of bodies is complex. When a patient dies in hospital, the trust chief executive has lawful possession 1 of the body until
22 Mar 2004 : Column 599W
someone with better title claims the body. This can include a coroner, whose powers can override the right of the next of kin to call for possession of the body. Hospital authorities must, therefore, ensure that a body is not, and will not be, the subject of a coroner's inquiry before releasing it.
Additionally, any death in England and Wales must be reported to the Registrar of Births, Marriages and Deaths for the sub-district in which the death occurred 2 . The person registering the death receives the Registrar's Certificate of Burial or Cremation (commonly known as the "Green Form"), which authorises disposal of a body, so that it can then be given to the person disposing of the body (usually, but not necessarily, the undertaker).
National guidance therefore highlights the need for NHS trusts to document the movement of, and identify, bodies correctly before transferring them to relatives or undertakers. This guidance is currently being updated following the Chief Medical Officer's recommendation in his report, "The Removal, Retention and Use of Human Organs and Tissue from Post-Mortem Examination" (2001).
In line with "Shifting the Balance of Power", it is the responsibility of the NHS to interpret how best to follow such guidance, in accordance with local circumstances.
- 1 Section 1 (7) of the Human Tissue Act 1961.
- 2 Section 15, Births and Deaths Registration Act 1953 and Regulation 41 of the Registration of Births and Deaths Regulations 1987.
Marlow Day Hospital
Mr. Goodman: To ask the Secretary of State for Health how many responses have been received from patients in relation to recent consultations carried out at Marlow Day Hospital. [162427]
Ms Rosie Winterton [holding answer 18 March 2004]: The Marlow Day Hospital closed on 28 November 2003, following a six-week internal consultation process with staff as prescribed in the trust's human resources policies. In view of the plan to re-provide an equivalent service for the population of Marlow at the other day hospitals based at Wycombe Hospital and Amersham Hospital, there was no formal public consultation during this period.
Marlow Community Hospital, which is on the same site but managed by Wycombe Primary Care Trust, was unaffected by this change of service.
Medicines and Healthcare ProductsRegulatory Agency
Paul Flynn: To ask the Secretary of State for Health whether the Head of Enforcement at the Medicines and Healthcare Products Regulatory Agency has a (a) past and (b) present connection with the pharmaceutical company GlaxoSmithKline. [162490]
Ms Rosie Winterton: The head of medicines inspection and enforcement at the Medicines and Healthcare products Regulatory Agency was employed from 1970 until 1997 by Glaxo, latterly Glaxo Wellcome. He has no present connections with Glaxo Smith Kline.
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Myalgic Encephalomyelitis
Jon Trickett: To ask the Secretary of State for Health how many specialists in myalgic encephalomyelitis (ME) are employed in the NHS; how many sufferers from ME there are in (a) each of the Wakefield primary care trusts, (b) West Yorkshire and (c) the UK; what diagnostic tests for ME are recommended to general practitioners by the Department; and if he will make a statement. [162157]
Dr. Ladyman: The Department does not collect numbers of specialists in myalgic encephalomyelitis (ME).
The Department does not routinely collect statistics on the prevalence of individual conditions like ME. The report of the independent chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) working group, published in January 2002, estimated a population prevalence of around 0.2 to 0.4 per cent. in adults and around 0.07 per cent. in children.
We have asked the National Institute for Clinical Excellence to develop a clinical guideline for the diagnosis and management of CFS/ME. The report of the independent CFS/ME working group, published in January 2002, provides a source of advice to general practitioners on recognition of this debilitating and distressing condition.
Older People (Medication)
Sandra Gidley: To ask the Secretary of State for Health (1) what representations he has received on poor concordance with medication for older people living in sheltered housing; [161937]
- (2) what monitoring is undertaken by his Department of the medication of older people with particular reference to (a) concordance and (b) over-medication; and if he will make a statement; [161938]
(3) what guidance he has provided to staff at extra care sheltered housing schemes with regard to management and administration of the medicines of frail elderly people. [161940]
Dr. Ladyman: I am not aware of any representations suggesting there is a particular problem with the use of medications in sheltered housing.
The National Minimum Standards for Care Homes for Older People set out the requirements care homes are expected to meet and include a standard on medication.
The regulatory body, the National Care Standards Commission (NCSC), takes the standard into account when carrying out inspections of care homes.
National Minimum Standards for Domiciliary Care Agencies set out the requirements that agency staff are expected to meet and these also include a standard on medication. The standards apply to agencies providing personal care to people in their own homes, including extra care housing and sheltered housing schemes. The NCSC takes the standard into account when they register and inspect domiciliary care agencies.
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The NCSC and, from 1 April 2004, the Commission for Social Care Inspection, has the powers to take whatever enforcement action it considers necessary in the event of poor management or administration of medicines including overmedication.
Sandra Gidley: To ask the Secretary of State for Health how many adverse drug reactions and adverse incidents relating to the medication of older people living in sheltered housing there were in the last 12 months for which figures are available; and if he will make a statement. [161939]
Dr. Ladyman: Reports of suspected adverse drug reactions (ADRs) to medicines are collated by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Committee on Safety of Medicines (CSM) through the spontaneous reporting scheme, the Yellow Card scheme.
The table shows details of the number of reports of suspected adverse drug reactions received through the Yellow Card scheme in 2003 for individuals aged 60 years and above. The figures provided relate to the number of reports received. Some reports may contain more than one reaction.
| Age range (years) | Number of reports received |
|---|---|
| 60–69 | 2,389 |
| 70–79 | 2,231 |
| 80–89 | 1,234 |
| 90+ | 196 |
We cannot specify whether any of these reports relate to individuals in sheltered housing, as residential details of patients are not collected by this scheme.
It is important to note that data from the Yellow Card scheme, as for all spontaneous reporting schemes, is limited by under-reporting. This does not impair its usefulness for detection of signals of emerging drug safety issues but means that numbers of reports are not complete. A report of an adverse reaction does not necessarily mean that it was caused by the medicine. Additionally, a range of factors may affect how an individual responds to a medicine, for example, their medical history and underlying disease conditions and other concomitant medication.
Use of medicines in the elderly is higher than in other age groups and elderly patients are more likely to be using combinations of medicines.
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