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Mr. Hutton: The pathfinder project was designed to deliver real changes at local level and to improve care for patients and included a consultation period with all the key stakeholders to determine how the findings of the orthotic pathfinder report can be adopted nationally and what resources services would need to achieve this.
This report differs from previous reports in that it describes a project that was designed to deliver the changes necessary to improve patient care rather than merely comment on the state of existing services. The document details the experiences of six trusts as they went through a process of change and the benefits that can be achieved if these changes were rolled out across the rest of the NHS. It details the specific changes made to improve the access to and clinical effectiveness of orthotic clinics.
The report has been published on the national health service purchasing and supply agency website and stakeholders have now the opportunity to respond. The report is intended not only to force the debate for change, but also to serve as a resource for those working to develop local solutions to local problems. We hope the information it contains can be widely shared, explored and evaluated both within and beyond the orthotic community. It would be premature to comment in advance of the community's response to this report and further evaluation on how we develop this important area of health.
Miss McIntosh: To ask the Secretary of State for Health what recent assessment he has made of the impact in the NHS of the working time directive on (a) the training of junior hospital doctors, (b) nurses and (c) accident and emergency departments in hospitals. 
Mr. Hutton: Compliance with the working time directive (WTD) is a legal requirement for all employers. Responsibility for its implementation in the national health service rests with local operational authorities. We have vested responsibility for monitoring compliance with strategic health authorities (SHAs), as part of mainstream NHS performance management.
NHS trusts' plans to comply with the WTD were agreed with SHAs, which continue to support their achievement throughout the NHS. These plans take account of the need to maintain the quality of medical education and training; to develop the contribution made by staff in other disciplines; and to continue to provide excellent services to patients.