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Chronic Disease Management

Mr. Burstow: To ask the Secretary of State for Health if he will estimate the total cost of chronic disease to (a) the NHS and (b) the economy as a whole. [157582]

Mr. Hutton: There is a range of evidence that confirms that patients with chronic conditions make the most use of health services. For example, around 80 per cent. of general practice consultations and 60 per cent. of hospital bed usage relates to chronic diseases. It is, however, difficult to estimate the full costs of these conditions reliably. Spending on the disease-focused national service frameworks was estimated at £9.9 billion in 2002–03 by Derek Wanless in "Securing our Future Health: Taking a Long-Term View", but this represents only a part of the costs of chronic disease.

Improving the care offered to people with chronic conditions now represents a major challenge to the National Health Service and partner organisations and we have just announced plans to establish demonstration sites within each strategic health authority as part of a programme to address this challenge.

Dentistry

Mr. Watts: To ask the Secretary of State for Health how many vacancies there are for NHS (a) general practitioners and (b) dentists in each primary care trust. [158181]

Mr. Hutton: Information on the number of general practitioners (GP) vacancies in each primary care trust that occurred between 1 April 2002 and 31 March 2003 has been placed in the Library.

The recruitment, retention and vacancy survey is a count of all GP vacancies that have occurred during each year. It will include existing posts that doctors have left and also new posts created to increase the work force, even where they were filled very quickly. The

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number of vacancies in parts is a result of there being more posts overall, reflecting the Government's plan to increase the GP work force.

In the general dental service dentists are recruited and employed by independent contractors. This information is therefore not available centrally.

Mr. Gordon Prentice: To ask the Secretary of State for Health what incentives are being offered to dentists to practise NHS dentistry in Pendle. [162783]

Ms Rosie Winterton: Burnley, Pendle and Rossendale Primary Care Trust has been identified as one of the 16 PCTs where access is a significant problem. The National Health Service dentistry support team is currently working with the PCT to provide advice and guidance on best practice in increasing access and modernising dentistry locally, backed by £9 million nationally. A Dental Action Plan has been developed jointly with the two neighbouring primary care trusts in East Lancashire This plan is wide-ranging, but includes offering incentive grants to dental students willing to practice in the area for three to five years following vocational training, equating to £3,000 per year.

Mr. Hancock: To ask the Secretary of State for Health what research he has (a) commissioned and (b) evaluated on the reasons for dentists leaving the NHS for the private sector; and if he will make a statement. [160768]

Ms Rosie Winterton: The Department has not itself commissioned any such research. However, the Department has been aware, through working with the dental profession and from various reports by independent bodies such as the Audit Commission, that there is a high level of discontent amongst dentists with the current arrangements. Dentists tell us that the current remuneration system, which is based on fee for item of service, feels like a treadmill and is the main cause of dissatisfaction among dentists and patients. It gears payments towards treatment rather than prevention and its piecework nature is thought to act as a barrier to dentists agreeing to undertake National Health Service work.

In 2001, the then Chief Dental Officer, Dame Margaret Seward, was invited to lead a working group, comprising representatives from the profession, patient groups and other stakeholders, to look at the options to modernise NHS dentistry, building on the Government's strategy document, "Modernising NHS Dentistry: Implementing the NHS Plan", published in September 2000.

The group's conclusions are set out in "NHS Dentistry: Options for Change", which was published in August 2002. The key themes and priorities that emerged were the need for local commissioning and funding and new methods of remuneration for general dental practitioners.

We have followed up this work by taking powers through the Health and Social Care (Community Health and Standards) Act 2003 to undertake wide-ranging reform of NHS dentistry. Under these proposals, primary care trusts will assume responsibility for commissioning primary dental care services. With these responsibilities will go the financial resources,

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totalling some £1.3 billion this year (2003-04), which are currently held centrally. These changes are aimed to underpin modernised, high-quality primary dental care services properly integrated with the rest of the NHS and providing better access, improved patient experience and better working lives for dentists and their staff.

East Midlands Ambulance Service

Mr. Garnier: To ask the Secretary of State for Health if he will make a statement on recent trends in the response times by the East Midlands Ambulance Service to Category A emergency call outs within the Melton, Rutland and Harborough Primary Care Trust Area; and if he will set up an inquiry into the management of this ambulance service. [162589]

Dr. Ladyman: Information on recent trends by the East Midlands Ambulance Service to Category A emergency call outs within the Melton, Rutland and Harborough Primary Care Trust area are not available centrally.

Information about the performance of ambulance trusts is published annually in a statistical bulletin. The latest data are in "Ambulance Services, England: 2002–03". A copy of the bulletin is available in the Library and at www.publications.doh.gov.uk/public/sb0313.htm.

In line with "Shifting the Balance of Power", it is for Trent and Leicestershire, Northamptonshire and Rutland strategic health authorities to decide whether an inquiry into the management of the trust is necessary.

Elderly People

Bob Spink: To ask the Secretary of State for Health what his policy is for the rehabilitation of elderly people; and if he will make a statement. [162913]

Dr. Ladyman: The development and expansion of intermediate care services is key to the Government's policy for the rehabilitation of elderly people. In 2003–04 a total of £405 million has been made available to the national health service for intermediate care services.

The national service framework (NSF) for older people asks the NHS and local councils, in partnership with independent sector providers, to develop an appropriate range of services that aid rehabilitation and recovery. Individual care plans should clearly identify any potential for rehabilitation.

Environmental Protection

Norman Baker: To ask the Secretary of State for Health what mechanisms exist to assess (a) the health benefits and (b) the potential savings for the NHS in the regulatory impact assessments undertaken by (i) Department for Environment, Food and Rural Affairs and (ii) Department of Trade and Industry on proposed environmental protection measures. [155429]

Mr. Hutton [holding answer 23 February 2004]: I understand all regulatory impact assessments (RIAs) undertaken by the Department for Environment, Food and Rural Affairs (DEFRA) and the Department for

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Trade and Industry include details, where appropriate, of not only the obvious costs and benefits of the proposal but also the wider economic, social and environmental impacts. This includes health benefits and, where appropriate, public sector impacts, including savings. Information regarding the costs and benefits analysis of policy proposals is contained in the Cabinet Office guidance, Better Policy Making: A Guide To Regulatory Impact Assessment.

Within DEFRA, use of the integrated policy appraisal screening tool is also encouraged, which provides a checklist of questions on potential impacts of a proposed policy, including a question on access to National Health Service services.

Analytical work within DEFRA also covers the quantification and valuation of health benefits and costs to inform policy making and feed directly into the RIA process. For example, considerable work has been undertaken on quantifying and valuing the health benefits of improved air quality, on valuing the benefits of improvements to bathing water quality and on valuing the "intangible" impacts of flooding, that is the health and stress effects associated with flooding.

DEFRA will be shortly issuing further guidance to operating authorities on the application of the results of research on the health and stress impacts of flooding for use in project appraisal.

NHS Trusts

Mr. Burstow: To ask the Secretary of State for Health if he will estimate the total cost of his Department's policy to franchise the management of failing NHS trusts. [154100]

Mr. Hutton: Staff time is not recorded by task undertaken and it is therefore not possible to differentiate the amount of time allocated to this task by the organisations involved.

Mr. Burstow: To ask the Secretary of State for Health what his Department's policy is on franchising the management of failing NHS trusts. [154141]

Mr. Hutton: National health service franchising is a way of introducing new senior management to poorly performing NHS organisations as a means of improving performance.

Franchising is only considered for zero star trusts, which are unable to demonstrate their capacity under existing management for sustainable improvements in performance. Normally, it is a last resort for trusts where less direct forms of assistance, support and/or intervention have already failed or are considered unlikely to succeed.

It is for strategic health authorities to decide what support and intervention is necessary in zero star trusts and primary care trusts.

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