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24 Mar 2004 : Column 914W—continued
Care Homes
Miss McIntosh: To ask the Secretary of State for Health what his policy is on the differentials between rates paid by local authorities for residents in local authority care homes and those paid for residents in private care homes in the same local authority area. [163041]
Dr. Ladyman: Where council-run services are more expensive than those provided by the independent sector, councils need to demonstrate through best value reviews that those higher costs are justified.
Clinical Staff Numbers
Mr. Lidington: To ask the Secretary of State for Health (1) how many (a) doctors and (b) nurses there were per head of population in each year since 1997; [160474]
- (2) how many (a) doctors and (b) nurses were practising per 1,000 population in each year since 1997. [160482]
Mr. Hutton: The table shows the number of doctors and nurses per 100,000 population in each year since 1997.
The standard ratio used in the Department is per 100,000 population.
| 1997 | 1998(20) | 1999(20) | 2000 | 2001 | 2002 | |
|---|---|---|---|---|---|---|
| Population | 48,635,908 | 48,789,240 | 48,986,999 | 49,166,627 | 49,389,736 | 49,561,751 |
| All Doctors(17) (excluding retainers) | 89,619 | 91,837 | 93,981 | 96,319 | 99,169 | 103,350 |
| Per 100,000 population | 184.3 | 188.2 | 191.8 | 195.9 | 200.8 | 208.5 |
| of which: | ||||||
| HCHS Staff(17) | 60,230 | 62,140 | 63,994 | 66,067 | 68,484 | 72,168 |
| Per 100,000 population | 123.8 | 127.4 | 130.6 | 134.4 | 138.7 | 145.6 |
| General Medical Practitoners (excluding retainers) | 29,389 | 29,697 | 29,987 | 30,252 | 30,685 | 31,182 |
| Per 100,000 population | 60 | 61 | 61 | 62 | 62 | 63 |
| Nurses | 318,856 | 323,457 | 329,637 | 335,952 | 350,381 | 367,520 |
| Per 100,000 population | 655.6 | 663.0 | 672.9 | 683.3 | 709.4 | 741.5 |
(17) Excludes Hospital Medical Hospital Practitioners and Hospital Medical Clinical Assistants, most of whom are GPs working part-time in hospitals
(18) All Practitioners (excluding GP Retainers) includes UPEs, Restricted Principals, Assistants, GP Registrars, Salaried Doctors (Para 52 SFA) and PMS Other.
(19) UPEs include QMS Unrestricted Principals, PMS Contracted GPs and PMS Salaried GPs
(20) Practice nurse headcount figures are estimated for 1998 and 1999.
Practice nurse figures are as at 1 October for 1997–99.
All data as at 30 September each year except GP and Practice nurses as at 1 October 1997–99
Source:
Department of Health Non-Medical Workforce Census Department of Health General and Personal Medical Services Statistics Department of Health Medical and Dental Workforce Census 2001 ONS Population Census
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Committee on Safety of Medicines
Mr. Burstow: To ask the Secretary of State for Health (1) when the Committee on Safety of Medicines was first informed of the risk of stroke in certain atypical antipsychotics used for the treatment of elderly people with dementia; [161249]
(2) what arrangements his Department has for sharing information between the Committee on Safety of Medicines and similar organisations in other countries on the safety of medicines used internationally; [161250]
(3) what representations he received on the risk of stroke with antipsychotics before the announcement of 9 March 2004 on the treatment of people with dementia; [161251]
(4) what facilities the Committee on Safety of Medicines has for basing its decisions on medicines used in the UK on clinical trials held in other countries. [161252]
Dr. Ladyman: The safety of medicines is continually monitored by the Medicines and Healthcare products Regulatory Agency (MHRA), with expert advice from the Government's independent expert advisory committee, the Committee on Safety of Medicines (CSM).
Early information on the risk of stroke in dementia patients treated with risperidone was assessed by the MHRA in 2002, resulting in changes to the product information to include appropriate warnings. However, it was not until later in 2003, when further data became available, that revealed the magnitude of the risk and potential public health implications. The CSM was consulted in December 2003, as soon as all the data and subsequent analyses had been compiled and assessed by the MHRA. The CSM considered an assessment of all available data from clinical trials with risperidone and advised that additional analyses of the risperidone clinical trials in dementia and analysis of the risk of alternative treatments were required, as well as expert advice in the treatment of patients with dementia.
An expert working group, including geriatricians, psychogeriatricians and psychiatrists, met on 19 January 2004 to consider a formal meta-analysis of clinical trial data for risperidone and clinical trial data on olanzapine, which had recently become available. The CSM considered the recommendations of the expert working group at the end of January and advised that the risks of stroke with risperidone and olanzapine should be communicated accompanied by comprehensive treatment guidelines to inform the necessary changes in prescribing practice. In the case of a third atypical antipsychotic quetiapine, there were insufficient data to draw conclusions.
Risperidone has a United Kingdom marketing authorisation, whereas olanzapine has a European authorisation valid throughout the European Community. The communication in the UK on 9 March 2004 on risperidone and olanzapine was planned to coincide with a Europe-wide communication on olanzapine following consideration by the European scientific committee, the Committee for Proprietary Medicinal Products (CPMP) at its February meeting.
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The CSM, through the MHRA, has close links with regulatory authorities world-wide. The MHRA is represented on the CPMP and its Pharmacovigilance Working Party (PhVWP), which meet monthly and provide a regular forum for discussion of drug safety issues within the European Union. An electronic communication system allows rapid exchange of drug safety information between member states. The PhVWP has regular videoconferences to share drug safety information with the Food and Drug Administration in the United States of America. The MHRA is a member of the Vigimed mailing list, which is an e-mail distribution list set up to facilitate rapid exchange of information between National Centres participating in the World Health Organisation International Drug Monitoring Programme. The MHRA also has informal links with other regulatory authorities world-wide.
There is an obligation on companies making an application for a marketing authorisation to provide the MHRA with all information relevant to the assessment of risks and benefits on the product at the time of the application; this includes data from clinical trials conducted outside the UK. For marketed drugs, the marketing authorisation holder's "qualified person", who is responsible for their pharmacovigilance system, has an obligation to inform the MHRA of any information relevant to the evaluation of the risks and benefits of the product.
Aside from the data and interpretation received from the company, and their corresponding applications to vary the Marketing Authorisation, no representations were received on the risk of stroke with antipsychotics before the announcement of 9 March.
Community Care Act
Mr. Burns: To ask the Secretary of State for Health how many local authorities had incurred fines following the introduction of the Community Care (Delayed Discharges etc) Act 2003, at the latest available date; how much the fines for each local authority have been since the Act came into force; what the total amount of fines incurred by local authorities is; and if he will make a statement. [162617]
Dr. Ladyman [holding answer 22 March 2004]: Figures for legal liability for delayed discharges for individual councils are not currently held centrally although data on the number of delays and the level of legal liabilities will be available in due course, once the data have been validated. However 17 councils have indicated that they have no liabilities for charges since reimbursement came into force. Further, the majority of social services departments have arranged local investment agreements with the national health service and will only pay charges once they exceed this locally agreed level of investment.
Continuing NHS Care
Mr. Burstow: To ask the Secretary of State for Health if he will make a statement on the review of continuing NHS care in nine strategic health authorities, referred to by the Parliamentary Under-Secretary of State Lord Warner on 10 March. [162188]
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Dr. Ladyman: The independent review of the implementation of fully funded national health service continuing care in nine strategic health authorities is currently underway and is expected to be completed in the spring.
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