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Caroline Flint: This information is not collected. Primary care trusts and strategic health authorities have already developed plans on how they will meet the Choosing Health White Paper target of 48-hour access to genito-urinary medicine (GUM)/sexual health clinics through the local delivery planning process. To support this, the Department is investing an additional £130 million for GUM services and infrastructure in 200607 and 200708 to enable clinics to expand their services and reduce waiting times. An additional £15 million capital funding has also been recently allocated.
Mr. Amess: To ask the Secretary of State for Health what estimate she has made of the number of premature deaths caused by smoking in the past 12 months in the Southend, West constituency; and what action she is taking to reduce the number of such premature deaths. 
Since 1998, the Government have put in place a comprehensive strategy to tackle smoking to reduce the deaths caused by smoking. The strategy focuses on action to discourage people from ever starting, and help for all smokers. We are aiming to create a climate where non-smoking is the norm.
We have banned almost all tobacco advertising, sponsorship and promotion. Our highly effective national anti-smoking education campaign is reaching smokers and helping motivate them to quit. People who wish to give up smoking can get help from the national health service stop smoking services. We set out proposals to bring in new measures to improve the way the NHS helps smokers to give up in our White Paper, Choosing Health". We will reduce exposure to second-hand smoke and, through a staged approach, make almost all enclosed public places and workplaces
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smoke-free. We will consult on introducing picture warnings onto tobacco packs. Together, these strategies have helped reduce adult smoking rates in England from 28 per cent. in 1998 to 25 per cent. in 2004.
Jane Kennedy: Information about funding for acute trusts is not held centrally. National health service financial allocations are made directly to primary care trusts who have responsibility for commissioning NHS services for the treatment and care of their local population from local acute trusts.
Ms Rosie Winterton [holding answer 17 October 2005]: It is for the Coventry Primary Care Trust in partnership with the strategic health authority and other local stakeholders to determine the most appropriate use of the funding allocated to it in order to commission services that best meets the needs of the local population.
The Department has set out national standards for stroke services through the older people's national service framework, which have helped kick-start the widespread development of stroke services. More patients are being seen by stroke specialists and stroke mortality is declining. The Department is also tackling the lifestyle factors that can lead to strokesmoking, poor diet and high blood pressureboth through concerted public health campaigns and through rewarding general practitioners via their contractual payments for identifying and supporting the groups of patients most at risk.
Mr. Amess: To ask the Secretary of State for Health how many surgeons have (a) left and (b) started working in the NHS in (i) Southend, (ii) Essex, (iii) inner London and (iv) Greater London in each of the last 10 years for which figures are available. 
Ms Rosie Winterton:
The estimate of joiners and leavers in the surgical specialties for the period 19932004, within Essex, London and Southend Hospital National Health Service Trust is shown in the table.
28 Oct 2005 : Column 589W
|All London strategic health authorities (SHAs)|
|Surgical specialty group (medical specialties)||60||74||76||63||54||90||67||76||76||63||61|
|Oral and Maxillo facial surgery specialists||96||61||88||107||77||94||122||71||96||106||81|
|Surgical specialty group (medical specialties)||3||1||8||4||5||1||3||9||6||9||3|
|Oral and Maxillo facial surgery specialists||14||9||13||11||17||18||19||11||16||18||8|
|Southend Hospitals NHS Trust|
|Surgical specialty group (medical specialties)||1||0||2||0||3||0||0||5||0||1||0|
|Oral and Maxillo facial surgery specialists||3||3||5||5||3||5||4||1||2||4||3|
|All London SHAs|
|Surgical specialty group (medical specialties)||215||128||118||81||92||126||104||113||98||135||138|
|Oral and Maxillo facial surgery specialists||59||86||125||89||79||104||90||104||93||93||83|
|Surgical specialty group (medical specialties)||6||30||8||11||9||12||7||6||21||13||23|
|Oral and Maxillo facial surgery specialists||11||14||14||17||15||18||14||15||14||13||12|
|Southend Hospitals NHS Trust|
|Surgical specialty group (medical specialties)||2||5||1||1||2||5||4||1||1||2||3|
|Oral and Maxillo facial surgery specialists||2||3||5||5||4||4||0||4||2||4||6|
Dr. Iddon: To ask the Secretary of State for Health (1) why the proposed limit of 220 milligrames of tryptophan per supplement capsule has been set on the basis of dividing the average therapeutic dose by 10; and what steps she is taking to satisfy herself that this approach (a) is based upon scientific data on safety, (b) is proportionate in its impact on industry, (c) does not reasonably deny consumer choice and (d) is consistent with the principles of good regulation established by the Better Regulation Task Force; 
(2) what information she has collated on the levels of tryptophan that are allowed in food products in other European countries; what information the Food Standards Agency received from (a) the Health Food Manufacturers Association and (b) other industry bodies about the safety of tryptophan in response to its consultation exercise on that subject; and why the agency decided not to accept the recommendations of those industry bodies about safe levels of tryptophan; 
(3) whether the criteria for establishing a safe upper limit for essential nutrients established in the Report of her Ad Hoc Expert Group on Vitamins and Minerals have been followed in the setting of maximum permitted levels for tryptophan; what assessment she made of the merits of using advisory statements on tryptophan
28 Oct 2005 : Column 590W
similar to those developed with industry when setting maximum levels of vitamins and minerals; and if she will make a statement. 
Caroline Flint: Scientific data supporting the safety of tryptophan were assessed by the committee on toxicity (COT) in 2004. In its evaluation, the COT noted significant uncertainties and decided that an uncertainty factor of 10 should be applied to derive a dose that would not be expected to be a risk to health to the general population. The limit proposed by the COT was 220 milligrammes of tryptophan per supplement capsule. This factor is applied where there is uncertainty due to gaps in the scientific evidence.
A regulatory impact assessment (RIA) was carried out to determine the impact on industry and consumers, which was followed by a 12 week consultation period with stakeholders on the proposed regulations and the draft RIA. Tryptophan supplements were banned in the United Kingdom in 1990 and the new legislation will allow the reintroduction of the sale of L-tryptophan at a specified level and purity criteria. The impact on industry was considered and on balance was considered to be positive, given that supplements containing tryptophan have been prohibited for sale since 1990. Consumer choice will also be increased without
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presenting an appreciable risk to health. This approach is consistent with the principle of good regulation established by the better regulation task force.
Responses were received by the Food Standards Agency (FSA) from the Health Food Manufacturers Association and the Institute for Optimum Nutrition (ION), on the approach taken by the COT on setting levels for the use of tryptophan in supplements and suggesting higher levels be permitted.
The COT secretariat has reviewed the data submitted by ION in May 2005 and found that there was no new evidence to that already reviewed by COT in 2004, when it reached its conclusions on the safety of tryptophan that would support a higher level of tryptophan being used in food supplements. The FSA therefore adopted the level and purity criteria proposed by COT, and this has therefore been adopted into UK legislation to reintroduce the sale of tryptophan supplements in the UK, in the interests of consumer choice and safety. We have asked COT to review its recommendation and any new information on tryptophan since June 2004, and this will be considered at the COT meeting in December. Depending on COTs advice the legislation may be amended.
The expert group on vitamins and minerals (EVM) proposed safe upper levels (SULs) for vitamins and minerals using the well-established paradigm for setting acceptable and tolerable intake levels for chemicals in food. Where the data were not adequate to set a SUL, the EVM gave guidance on levels that would not be expected to result in adverse effects. The COT uses the same paradigm in its consideration of the safety of tryptophan as a supplement. However, the scientific data did not support derivation of a SUL, and the COT conclusion is expressed in the same terms that EVM used for its guidance levels.
The use of advisory statements was not considered appropriate due to the severity of the symptoms of Eosinophilia-Myalgia Syndrome in people taking dietary supplements containing tryptophan pre-1990, and the uncertainty relating to gaps in the scientific evidence. COT decided to recommend a daily dose level of 220mg that would not present an appreciable risk to health.
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