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Mr. Laurence Robertson: To ask the Secretary of Statefor Health what (a) instructions and (b) policy guidelines on proposed mergers of ambulance services have been given by his Department to health authorities. 
Ms Rosie Winterton: No specific guidance has been issued to the national health service on proposed mergers of ambulance services.
However, under section 11 of the Health and Social Care Act 2001, NHS bodies are under a duty to consult and involve patients, the public and their representatives in the planning of changes to services and to involve them in decisions affecting the operation of services. Should a proposal to change services represent a substantial development or variation, NHS bodies are under a duty to consult relevant local authority overview and scrutiny committees.
Once the results of these consultations are known, if the trust boards and strategic health authority agree that a merger should take place, they are required to write to the Secretary of State for Health asking that the Department take action to merge the organisations. If that request is approved by Ministers, an order will be drawn up dissolving the organisations in question and creating a replacement organisation.
There are no set standards for what the Secretary of State would take into account when considering a request to merge NHS organisations. But as a general rule, before approving the merger of any NHS trusts, the Secretary of State would seek to satisfy himself that:
the merger will help improve performance against the requirements and standards set out in National Standards, Local Action and other relevant documents.
Mr. Laurence Robertson: To ask the Secretary of State for Health if he will make a statement on the merging of ambulance services. 
Ms Rosie Winterton: Any decisions around the configuration of ambulance trusts are a matter for the local health economy to consider, led by the strategic health authority (SHA) and in consultation with patients and the public. Under section 11 of the Health and Social Care Act 2001, national health service bodies are under a duty to consult and involve patients, the public and their representatives in the planning of changes to services and to involve them in decisions affecting the operation of services. Should a proposal to change services represent a substantial development or variation, NHS bodies are under a duty to consult relevant local authority overview and scrutiny committees.
It is appropriate for SHAs and commissioners to examine how ambulance services are provided in their area and consider whether the current arrangements could be improved to benefit patients and staff, reduce duplication and improve efficiency.
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Dame Marion Roe: To ask the Secretary of State for Health pursuant to the oral answer of 18 January 2005, Official Report, column 675, on chiropody services, when the guidance on the provision of podiatry services contained in the report of the joint Department of Health and NHS Chiropody Task Force, Feet First, was discontinued. 
Dr. Ladyman [holding answer 31 January 2005]: Feet First was published in 1994 and replaced statutory eligibility criteria from that date. The NHS Plan, published in July 2000, superseded this guidance.
Tim Loughton: To ask the Secretary of State for Health what changes have been made involving direct admission of children to the paediatric department rather than the accident and emergency department at the Conquest Hospital in East Sussex. 
Ms Rosie Winterton: In line with our policy of Shifting the Balance of Power", it is now for primary care trusts (PCTs) in partnership with strategic health authorities (SHAs) and other local stakeholders to plan, develop and improve services for local people.
An ambulatory service at the Conquest Hospital operates seven days a week from 8 am to 8 pm. This service has been up and running for quite some time. Specially trained nurses and doctors assess and treat children without the need for them to be admitted. The children can go home supported by specially trained community nurses and the reassurance that help and advice is just a phone call away.
Children attending accident and emergency with medical conditions during the above hours are referred straight to the ambulatory service on the children's unit. Children's trauma is dealt with in A and E and those children requiring admission are admitted to the children's ward in the normal manner.
Tom Cox: To ask the Secretary of State for Health how many people living in the Greater London area have been diagnosed as suffering from dementia. 
Dr. Ladyman: The information requested is not held centrally.
Mr. Fisher: To ask the Secretary of State for Health how many dentists in Stoke-on-Trent have signed up for the new dental contract. 
Ms Rosie Winterton: In Stoke-on-Trent, three dental practices have applied to move to the personal dental service (PDS) contract. One of those practices, consisting of four dentists, started working under the new arrangements in August 2004. A further two practices are expected to join the scheme in February 2005.
We are committed to introducing new contractual arrangements, involving the delegation of the commissioning of national health service dentistry to
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primary care trusts, not later than April 2006. Dentists who wish to have advanced benefit of these new arrangements may move to the PDS contract.
Mr. Webb: To ask the Secretary of State for Health how many (a) principal and (b) assistant dentists offered NHS treatment in the strategic health authority of Avon, Gloucestershire and Wiltshire in each year since 1997. 
Ms Rosie Winterton: The table shows the numbers of dentists in the Avon, Gloucestershire and Wiltshire strategic health authority area for the years 1997 to 2004.
|General dental service (GDS) principal||GDS assistant||Personal dental service (PDS) provider||PDS performer||Total|
Dr. Richard Taylor: To ask the Secretary of State for Health what aspects of the implementation of the new contract for NHS dentists have led to the delay in the transfer of responsibility for dental services to primary care trusts. 
Ms Rosie Winterton: I refer the hon. Member the written ministerial statement on national health service dentistry reforms made by my right hon. Friend the Secretary of State for Health on 10 January 2005, Official Report, columns 68WS.
Tim Loughton: To ask the Secretary of State for Health if he will make a statement on recent interruptions in the supply of diamorphine. 
Ms Rosie Winterton: Immediately before Christmas, Chiron, the major supplier of diamorphine injection in the United Kingdom, informed the Department that its supplies of this product were limited. It is unlikely that the company will be able to supply more for some months. The other supplier, Wockhardt UK, continues to produce diamorphine and has increased its production. The Department and the National Health Service Purchasing and Supply Agency are working closely with manufacturers of alternative medicines to ensure that patients receive the care they need. They are monitoring the position very closely until the supply of diamorphine returns to normal and will be taking whatever action is necessary to secure the supply of alternative medicines for the management of pain.
Mr. Kidney: To ask the Secretary of State for Health how many people in each primary care trust are receiving Enbrel on NHS prescription for juvenile arthritis. 
Ms Rosie Winterton: The Department does not hold information on the number of people receiving drugs on prescription or the reasons for which a drug is prescribed.
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