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Mr. Davidson: To ask the Secretary of State for Health what assessment she has made of the likely impact of the EU Directive on Services in the Internal Market on (a) the national health service and (b) privately-owned care homes owned by an identity based in another EU member state. 
Ms Rosie Winterton:
Since the replies I gave on 12 September, 2005, Official Report, columns 26856W, to similar questions tabled by my hon. Friend, the situation remains that negotiations on the draft European Union directive on services in the internal market are on-going. Until the text is finalised it is difficult to assess its precise effects on particular sectors.
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A number of general impact assessments are available. The Department of Trade and Industry (DTI) has performed a partial regulatory impact assessment for the proposal, which indicates that the general benefits are likely to be substantial. This is available on DTI's website at www.dti.gov.uk/ccp/topics2/pdf2/servicesria.pdf. An independent consultancy, Copenhagen Economics, has also assessed the general economic impact of the directive. They predicted that the services directive would add £25 billion to the EU economy, create an extra 600,000 jobs, boost EU gross domestic product by 0.6 per cent., and lead to an increase in real wages of 0.4 per cent.
In addition to these general impact assessments, the Department has held informal consultations and taken the views of relevant parties concerning the possible impact of the services directive on the national health service and on social care providers. No economic analysis has been carried out to date.
The United Kingdom Government's position is to seek an exclusion for publicly-funded healthcare from the scope of the Directive, plus a derogation for all healthcare from the country of origin principle, and the deletion of Article 23 on the assumption of healthcare costs.
Mr. Austin Mitchell: To ask the Secretary of State for Health (1) on what date (a) the Food Standards Agency adopted formal advice to Ministers in relation to proposed objectives for the finalisation of the provisions of the Food Supplements Directive and (b) she reached a conclusion on that advice; what that conclusion was; what steps have been taken since within the EU by (i) her Department and (ii) the Food Standards Agency to further her objectives for further negotiations on the Directive; and if she will make a statement; 
Caroline Flint: The Food Standards Agency (FSA) board discussed proposed objectives for the finalisation of the provisions of the food supplements directive, in terms of the setting of maximum levels for vitamins and minerals in food supplements on 15 September 2005. Ministers were advised of the FSA board's position on 11 October. I accepted this advice on 22 November 2005. FSA officials have had a preliminary discussion with the European Commission on the issue of setting maximum safe levels of vitamins and minerals in food supplements.
When we announced the review in August 2005, we indicated that we expected the review to report in early 2006. It is now likely that the review will report later in 2006. This takes into account arguments put forward by the main representative bodies for extending the time scale to ensure full consideration of the issues. It will also ensure that the review is able to reflect the forthcoming White Paper on services outside hospital.
Mr. Burstow: To ask the Secretary of State for Health what savings were identified in her Department as a result of the Gershon Review; and what progress has been made towards making these savings to date. 
The Department has assessed the evidence for use of buprenorphine, the active ingredient of Suboxone, and has actively supported its increasing use, working with the National Treatment Agency for Substance Misuse (NTA), and by pursuing a number of measures:
In 2003, clinical guidance referring to the key research evidence on buprenorphine was published in the NTA document, Prescribing services for drug misuse, which supported its use as a treatment alongside other treatments such as methadone prescribing.
The Department has subsequently asked the National Institute for Health and Clinical Excellence to carry out a technology appraisal on methadone and buprenorphine as opiate substitutes. That is currently under way and due to report in March 2007.
The Department's Clinical Guidelines (1999) 1 promote the use of supervised consumption. That NTA has also promoted the availability of pharmacy supervised consumption schemes. Supervised consumptionin order to minimise the risk of inappropriate injecting of prescribed buprenorphineis feasible in the UK context. With careful selection for its suitable use, it does provide an additional option to the pharmacological approach that Suboxone might offer in this regard.
1.Data received and processed by 16 December 2005. 2.These data do not include diagnosed children who are known to have died or left the country.
National Study of HIV in Pregnancy and Childhood, Institute of Child Health, London.
Ms Rosie Winterton: We acknowledge the valuable contribution the voluntary sector makes to the provision of palliative and specialist palliative care services. We have not made any estimate of the effect on costs to the national health service of the contribution of the hospice movement. However, data from the voluntary organisation Help the Hospices show that the total expenditure from all adult voluntary hospices in England in 2004 was £286 million, of which £97.8 million was from national health service funding, an average of 34 per cent. of hospices' expenditure.
Mr. Lansley: To ask the Secretary of State for Health what recent estimate she has made of (a) the percentage of hospital admissions which are due to adverse drug reactions and (b) the resultant cost to the public purse. 
Jane Kennedy: Reports of suspected adverse drug reactions (ADRs) are collected by the Medicines and Healthcare products Regulatory Agency (MHRA) and Commission for Human Medicines (CHM) through the spontaneous reporting scheme, the Yellow Card Scheme. Approximately 20,000 reports of ADRs are reported to the MHRA/CHM through this scheme each year. Between 1 December 2004 and 30 November 2005, 18,482 reports were received. Of these 4,018 (28 per cent.) reported that the suspected ADR involved or prolonged in-patient hospitalisation. It is not possible to estimate from the Yellow Card Scheme the number of people who suffer adverse reactions to drugs since the scheme is associated with an unknown level of under-reporting.
Addressing the impact of adverse drug reactions on public health is a key concern for the MHRA. A study funded by the MHRA and published in the British Medical Journal on 2 July 2004, was conducted in two large hospitals in Merseyside in order to ascertain the current burden of ADRs in the NHS. The study found that of 18,820 patients aged over 16 years admitted to hospital over a six month period, there were 1,225 admissions judged to be related to an adverse drug
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reaction (ADR), giving a prevalence of 6.5 per cent. Of these 1,225, the ADR was judged to lead directly to the admission in 80 per cent. of cases. The median bed stay was eight days, accounting for 4 per cent. of the hospital bed capacity. The projected annual cost of such admissions to the NHS is £466 million.
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