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Harry Cohen: To ask the Secretary of State for Health whether she has fully funded the NHS for the costs its has incurred from implementing Agenda for Change"; and if she will make a statement. 
Mr. Byrne: In England, the Government have made available around £1 billion of extra investment by 200506 to meet the costs of implementing Agenda for Change". This is in addition to money needed to meet the costs of the general pay uplift of around 10 per cent. over three years to 200506, agreed as part of the Agenda for Change" package. This is a huge investment and, while we do not underestimate the challenge of implementing Agenda for Change", we believe that this investment is sufficient to fully fund its implementation this year.
Mr. Burns: To ask the Secretary of State for Health what discussions she has had with memory clinics about the impact of withdrawing drug treatments for people with Alzheimer's disease from NHS prescription. 
The National Institute for Health and Clinical Excellence has not issued final guidance on drugs for the treatment of Alzheimer's disease. Until it does so, the guidance it issued in 2001 remains in force.
Mr. Burns: To ask the Secretary of State for Health how many memory clinics there are in England; and what assessment she has made of the likely impact on these services if the National Institute for Health and Clinical Excellence final guidance recommends that drug treatments for Alzheimer's disease should not be available on the NHS. 
Responsibility for mental health services rests with local service planners, commissioners and providers, who are best placed to determine the right mix of services based on local priorities and the needs of their local population.
At the moment, the 2001 National Institute for Health and Clinical Excellence (NICE) appraisal of drugs for Alzheimer's disease is extant. In the light of NICE's announcement on 19 July to embark on a further round of very focused and detailed discussions with key stakeholders, it would be inappropriate to anticipate at this stage what the conclusion of this work will be.
Mr. Hoyle: To ask the Secretary of State for Health (1) what guidelines have been issued on moving patients with head injuries from Chorley Accident and Emergency to Preston Accident and Emergency by taxi rather than ambulance; 
Mr. Byrne [holding answer 18 July 2005]: It is for the local national health service to ensure appropriate transport and governance arrangements are in place to support the transfer of patients between accident and emergency departments.
The NHS Modernisation Agency issued Driving Change: Good practice guidelines for Primary Care Trusts on commissioning arrangements for emergency ambulance services and non-emergency patient transport services" in September 2004.
In 1991, the Department issued guidance on Ambulance and other patient transport services: Operation, use and performance standards", which includes reference to performance standards and quality of service issues.
Under the National Health Service and Community Care Act 1990 (the 1990 Act), the Secretary of State has the power to make regulations about the membership and procedure of NHS trusts. The Secretary of State exercised this power in making the NHS Trusts (Membership and Procedure) Regulations 1990. Under the 1990 Act, the Secretary of State appoints the chairman and the non-executive directors of the trust, although both these functions have been delegated to the NHS Appointments Commission. The Secretary of State also has powers, subject to provisions set out in the 1990 Regulations, to terminate the tenure of office of the chairman and non-executive directors of a trust in certain circumstances.
The Secretary of State can dissolve an NHS trust by means of an order if she considers it appropriate in the interests of the health service (under the 1990 Act), subject to the provisions of the NHS trusts (Consultation on Establishment and Dissolution) Regulations 1996.
The Secretary of State can make an intervention order under section 84A of the 1977 Act if she is of the opinion that the trust is not performing one or more of its functions adequately or at all, or that there are significant failings in the way the body is being run and she is satisfied that it is appropriate for her to intervene. An intervention order may provide for the removal or suspension from office of trust members and their replacement with other specified individuals, or for certain functions to be carried out by a specified individual, or for a function of the trust to be performed in a way that will achieve objectives specified in the directions.
The Secretary of State can make a default order under section 85 of the 1977 Act where she is of the opinion that a NHS trust has failed to carry out functions conferred on them under the 1977 Act or the 1990 Act or have failed to comply with regulations or directions relating to those functions. The effect of the default order is to terminate the tenure of office of the members of the trust and provide for the appointment of new members and may make such supplementary provision as the Secretary of State deems necessary.
Caroline Flint: Preparing for a pandemic, whether it arises from the avian influenza currently circulating in South East Asia or from another strain, is part of the ongoing work of the Department and plans continue to be updated as appropriate. However, although we can prepare for an influenza pandemic, it is highly unlikely that we will be able to prevent it occurring.
As part of the United Kingdom's preparedness for a flu pandemic, the Department has committed some £200 million and will continue to evaluate what other measures could be taken to further improve our preparedness, such as purchasing specific vaccine against pandemic influenza.
Ms Rosie Winterton [holding answer 18 July 2005]: We issued general practitioner (GP) cancer referral guidelines in March 2000 to assist GPs in determining those patients who need to be referred urgently to see a specialist within two weeks, those patients that can be referred for a routine appointment and those who can be safely watched at a primary care level.
The referral guidelines should be used locally to agree criteria and referral pathways. All trusts have been encouraged to undertake local audits to assess the appropriateness of urgent and routine referrals against the guidelines to be fed back to referring GPs.
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