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Caroline Flint: Since 2000, the Department has received Parliamentary Questions, letters from hon. Members and letters from members of the public on nutrition, under nutrition and malnutrition. Letters have also been sent to the Chief Medical Officer, Deputy Chief Medical Officer and Chief Executive, as well as Departmental officials in the nutrition team. Similar representations on these subjects have also been received by the Food Standards Agency. These representations are from a wide variety of sources.
Paul Flynn: To ask the Secretary of State for Health when she will specify nutrition standards for meals supplied to patients and service users by (a) nursing homes, (b) residential homes, (c) hospitals and (d) meals on wheels and lunch clubs. 
Food and nutrition in nursing and residential homes is extensively covered in the existing 'Care Homes for Older PeopleNational Minimum Standards', which is available in the Library. The
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national minimum standards, which the Commission for Social Care Inspection has to take into account when it inspects homes against the Care Homes Regulations 2001, address food and nutrition from various perspectives, including nutritional content, religious or cultural requirements, preparation and hygiene and the social value of meals and mealtimes.
'Standards for Better Health', which is available in the Library, requires health care organisations, including hospitals, to offer patients a choice of food, which is safely prepared, provides a balanced diet and meets their individual nutritional, personal and clinical dietary requirements. Compliance with these requirements is mandatory for any provider treating national health service patients and is measured via the Healthcare Commission's annual health check process.
Nutritional standards in hospitals are also included in the Essence of Care framework for clinical governance, launched in February 2001. The Essence of Care benchmarking guidance and toolkit was published in April 2003. This includes guidelines that all hospital patients should be screened and assessed to identify their nutritional needs and that further assessment will take place for all patients identified as at risk. Plans of care, based on ongoing nutritional assessments, will be devised, implemented and evaluated for those patients who need them.
The Food Standards Agency (FSA) is contributing to improving the nutrient and food intake as provided by major public institutions, including nursing homes, residential homes, hospitals and meals on wheels or lunch clubs across the United Kingdom. This will include the development of nutrient and food-based guidance as well as example menus to assist caterers in menu planning, both of which will meet nutritional guidance.
Mr. Todd: To ask the Secretary of State for Health whether applications to the Medicines and Healthcare products Regulatory Agency for European procedures in handling product licence applications are given priority over national procedure applications; and if she will make a statement. 
Jane Kennedy: Applications to the Medicines and Healthcare products Regulatory Agency (MHRA) for product licences should be handled within the timescales established by legislation. The medicines directive implemented into United Kingdom legislation requires us to take all appropriate measures to ensure that authorisation procedures are completed within 210 days of submission of a valid application.
However, the legislation also establishes additional timescales, which must be met where the authorisation is to be granted following European procedures
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amongst one or more other member states or within the entire community. For example, within the so-called mutual recognition procedure, we must make sure to have completed our scientific evaluation within 90 days. And within the community-wide centralised procedure, we must complete our scientific assessment within 80 days.
These tighter European procedural timescales do dictate that such applications receive some priority within the MHRA since to do otherwise might mean that we were obliged to allow marketing of the product in the UK regardless of any concerns we may have for its quality, safety or efficacy.
Mr. Todd: To ask the Secretary of State for Health whether the length of time taken by the Medicines and Healthcare products Regulatory Agency to acknowledge an application for a product licence (a) is measured and (b) is included in the processing time reported by the agency. 
Jane Kennedy: The Medicines and Healthcare products Regulatory Agency (MHRA) has included the time it takes to receive and acknowledge applications for product licences in its overall processing times. However, for incomplete or potentially invalid applications the time taken by the company to correct the application is not included in the processing times. Incomplete or potentially invalid applications include those not accompanied by appropriate data or documents, submitted under the wrong legal basis or without payment of the correct fee.
The MHRA information management system sends the applicant a notification of receipt letter as soon as the application is entered into the database and showing the date on which the application was received. A subsequent acknowledgement of submission letter is sent to the applicant as soon as the application has been validated and is ready for the start of assessment.
Mr. Amess: To ask the Secretary of State for Health what recent research her Department has evaluated on the (a) uses and (b) effects of the drug misoprostol; and if she will make a statement. 
Jane Kennedy: Misoprostol is a synthetic analogue of a naturally occurring hormone (prostaglandin). As a licensed medicine, the uses and effects of misoprostol are evaluated by the Medicines and Healthcare products Regulatory Agency (MHRA).
Misoprostol is licensed for the treatment and prevention of gastrointestinal ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs). It can be given alone, or combined with NSAIDs such as diclofenac or naproxen, and is effective in reducing gastric acidity, which may be the cause of ulcers. Misoprostol is especially suitable for the frail and elderly who need to take long-term NSAIDs for arthritic conditions, and who are therefore at risk of ulcers.
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As with all medicines, misoprostol may be associated with side effects in some patients, and safety is continually monitored by the MHRA. The known side effects of this drug are described in product information for healthcare professionals and patients. When used for the treatment or prevention of gastrointestinal ulcers, the recognised adverse effects of misoprostol include diarrhoea, abdominal pain, dyspepsia (indigestion), flatulence, nausea and vomiting, skin rashes and dizziness. As prostaglandin hormones also have effects on the lining of the uterus in women, misoprostol can also lead to vaginal bleeding.
Doctors may decide to use a medicine outside the terms of the marketing authorisation, on their own responsibility, if they consider that it is in the best interests of their patients. Unlicensed uses of misoprostol include the induction of labour and medical abortion, where it is sometimes used in combination with other drugs such as mifepristone. This is in line with the advice of the Royal College of Obstetricians and Gynaecologists in its evidence based clinical guideline. Side effects of misoprostol in unlicensed indications have been documented to include abnormal uterine contractions and haemorrhage, retained placenta, release of amniotic fluid into the circulation (embolism), incomplete abortion and premature birth.
Mr. Spellar: To ask the Secretary of State for Health pursuant to the answer of 20 December 2005, Official Report, column 2726W, on the Public Appointments Annual Report, when the NHS Appointments Commission will publish a list of the appointments to the bodies for which it is responsible. 
Mr. Byrne: Information on appointments to local national health service boards has been published by the NHS Appointments Commission and can be found on their website at: www.appointments.org.uk/publications.asp.
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