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9. James Duddridge (Rochford and Southend, East) (Con): What discussions she has had with the Secretary of State for Environment, Food and Rural Affairs on public health procedures in the event of a suspected outbreak of avian influenza. 
The Secretary of State for Health (Ms Patricia Hewitt): The Department of Health is working closely with the Department for Environment, Food and Rural Affairs to ensure consistent planning, briefings and preparations for a possible outbreak of avian influenza. That work is based on advice from the two Departments' joint expert advisory committees on the risks to human health and transmissibility of avian influenza from birds to people.
James Duddridge: What steps are being taken to avoid a repeat of what happened when a worker at an Essex quarantine centre, who also worked at Southend hospital, was not vaccinated for three days after DEFRA discovered that there was a problem?
Ms Hewitt: There is, of course, no vaccine against avian flu at the moment, if that is what the hon. Gentleman is referring to, although we have issued a tender for vaccines against the current strain of bird flu. However, I am assured that all necessary investigations in respect of the quarantine premises in Essex have been undertaken by the Health Protection Agency and the state veterinary service. I emphasise, to the hon. Gentleman and to the whole House, that there is no bird flu in the UK at the moment. We retain our status as a bird flu-free zone.
Dr. Ian Gibson (Norwich, North)
(Lab): Will my right hon. Friend confirm that companies can buy vaccine shots for their employees? In the present situation, might not an increase in that activity deflect attention away from where the vaccine should go?
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Ms Hewitt: My hon. Friend may be referring to antivirals and the availability of Tamiflu. We have ordered and are stockpiling very substantial quantities of the drug, and certain companies are also seeking to obtain Tamiflu for their staff. The Department has just placed a tender for a significant quantity of vaccine against the H5NI virus in case that might prove useful in the event of a bird flu outbreak in Britain.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The Secretary of State will recall that on 17 October she told the House and, in particular, the hon. Member for Chorley (Mr. Hoyle), that orders were being placed for a strategic stockpile of face masks and gloves, which she will know would be an important aspect of the overall public health measures to combat avian flu outbreaks. Has that order been placed?
Ms Hewitt: I have checked again with the chief medical officer on the issue of masks and other protective clothing, which are of course routinely available and kept in stock for NHS staff and those supporting them. We are now working with the Health Protection Agency to discuss whether further stocks should be made available to the public and not only to NHS staff.
The Secretary of State will recall that only 12 days ago the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint) wrote, in reply to my written question, that in the event
"of an outbreak of highly pathogenic avian influenza . . . poultry workers . . . vets, contractors and other people engaged in disease control activities, will be offered seasonal influenza vaccine . . . within 24 to 48 hours of disease confirmation."[Official Report, 10 November 2005; Vol. 439, c. 666W.]
Given what we now know about the availability of seasonal influenza vaccine, what assurance can the Secretary of State give that the vaccine will be available should avian flu occur in this country in the coming months?
Ms Hewitt: As we do every year, the Department of Health obtained its own stockpile of winter flu vaccine for this year, and we are reserving a significant number of doses to use for poultry workers should there be an outbreak of bird flu.
10. Mr. Tobias Ellwood (Bournemouth, East) (Con): If she will make a statement on the implementation of National Institute for Health and Clinical Excellence guidance relating to photodynamic therapy for wet age-related macular degeneration. 
The Minister of State, Department of Health (Jane Kennedy):
The National Institute for Health and Clinical Excellence issued its guidance on photodynamic therapy on 24 September 2003. Implementation of the guidance was co-ordinated by local specialist commissioning groups and all primary care trusts are funding photodynamic
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therapy treatment for patients with both the wholly classic and predominantly classic forms of age-related macular degeneration.
Mr. Ellwood: I am grateful for that reply, but according to the Audit Commission, thousands of people have gone blind from AMD while waiting for Government action. Does the Minister agree that quick referral times are essential if photodynamic therapy is to work? Will she find out why a quarter of trusts have yet to implement the policies that she mentioned? At the moment, this issue is another example of the postcode lottery.
Jane Kennedy: I do not agree with that analysis. In the hon. Gentleman's constituency, the Dorset and Somerset strategic health authority has advised me that the photodynamic therapy services for wet age-related macular degeneration are fully compliant with NICE guidelines. I understand that the trust has a dedicated commission arrangement in place to run PDT services for all patients from Dorset. Therefore, his constituents, like other patients throughout the country, are receiving treatment in line with the NICE guidelines.
Michael Connarty (Linlithgow and East Falkirk) (Lab): I congratulate Ministers on the extra money that will be put into the work of optometrists, who will get extra money to check for problems such as AMD in the elderly. Even in my constituency, outwith England, one optometrist offers X-rays to his patients. However, will that money be paid year on year? In conversations with optometrists, they say that it is great to have the money, but they are worried that it will stop at the end of the year and they will have raised people's expectations of services that will not continue.
Jane Kennedy: I am grateful to my hon. Friend for making that point. He will know that resources in the NHS are increasing year on year, up to 2008, and it is expected that planning for such services will form an important part of delivering services of that nature. Photodynamic therapy was implemented as quickly as possible across the NHS, and we had to ensure that we had the staff and equipment to deliver the service effectively and safely.
Mr. Simon Burns (West Chelmsford) (Con): To pick up the point made by my hon. Friend the Member for Bournemouth, East (Mr. Ellwood), does the Minister realise, and share our concern, that some patients will go blind in the time that it takes for them to be referred to a specialist? Will she assure the House that she will urgently ensure that the NICE guidance is fully implemented?
The NICE technology appraisal was published in September 2003, as I said. The guidance recommended photodynamic therapy only for a particular small sub-group of patients and that a second, much larger sub-group of patients should be treated only as part of a clinical study, which is now being set up. The Department of Health organised that study with the Royal College of Ophthalmologists and Novartis, the pharmaceutical company that manufactures the drug used in the treatment. It was entirely proper that the correct services
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and support were in place before implementing the guidance. The treatment will have a significant impact and bring enormous benefits to patients. Obviously, we share concern if patients are perceived not to get treatments that they believe are ready for them, but it was important to make sure that we took the right steps to have the services in place to deliver the treatment properly to all the patients who need it.
The Parliamentary Under-Secretary of State for Health (Caroline Flint): The Health Bill contains a diverse range of provisions on which we have consulted widely and received many representations. Copies of the analyses of responses to the smoke-free and health care associated infection consultations will be published before Second Reading.
Andrew Mackinlay: I welcome that reply but, before Second Reading, will the Minister also publish the findings of the Government's Better Regulation Task Force, which has come out against the Airdrie and Shotts fudge? If the Minister read the political tea leaves, she would understand that there is a majority in the House of Commons for a total ban, comparable with the one that will be introduced by the Labour party in Scotland and by the Labour Government at Westminster in Northern Ireland. We need a free vote to test whether there is a majority in the House of Commons, and I hope that Ministers will reflect on what is prudent, just and protects and promotes the best interests of poor working-class people who suffer
Caroline Flint: We have taken on board a range of views and representations and will publish the regulatory impact assessment in the usual way. The manifesto commitment was discussed through our national policy forums and the wording in the manifesto was agreed at the Warwick national policy forum, so it has gone through our party machinery in the usual way. Although I accept the views of many Members and organisations outside this place who would like a total ban, in terms of public support and the surveys we have carried out, the Office for National Statistics survey in 2004 found that 88 per cent. of people, when asked, supported restrictions in public places but only 31 per cent. supported complete bans. In California, New York and Norway
Mr. Paul Burstow (Sutton and Cheam)
(LD): Given that second-hand smoke is a significant cause of
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increased risk of cancer and heart disease, how can any employer fulfil their obligations under health and safety legislation without implementing a full ban in their premises?
Caroline Flint: I am pleased to say that, through our proposals, 99 per cent. of employees will be fully protected, and will work in a smoke-free environment, up from 51 per cent. at present. For the remaining workers, we are looking to ensure that there is protection in bar areas, too. We want to minimise the damage from second-hand smoke, which is not just about bans but about the support we give in the NHS for people who are giving up smoking. I am not sure whether that would have been achieved through the hon. Gentleman's "Orange Book" social insurance policy.
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