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16 May 2006 : Column 934W

Ms Rosie Winterton: We do not hold information centrally on planned levels of funding on cancer services, however around £3.4 billion was spent on cancer services in 2003-04 and this increased to around £3.8 billion in 2004-05. National health service funding is allocated to primary care trusts to meet the health needs of their local population, who in partnership with strategic health authorities and other local stakeholders determine how best to use their funds to meet national and local priorities for cancer services.

Childhood Diseases

Mr. Jenkins: To ask the Secretary of State for Health what estimate she has made of the number of children with (a) asthma, (b) diabetes, (c) Down's Syndrome, (d) epilepsy, (e) visual impairment, (f) hearing impairment and (g) autism, broken down by ethnic group. [71250]

Mr. Ivan Lewis: We have made no estimates of the number of children, broken down by ethnic group, living with asthma, diabetes, Down's syndrome, epilepsy, visual and hearing impairments, and autism.

The Department, in collaboration with the information centre for health and social care and NHS Employers, issued updated guidance to the national health service on ethnic monitoring in July 2005 that emphasised the importance of collecting, analysing and using data on the ethnic group of both NHS patients and staff.

Children’s Health Services

Tim Loughton: To ask the Secretary of State for Health if she will list school nursing teams which provide drop-in clinics in schools. [67648]

Mr. Ivan Lewis: The information requested is not collected centrally.

Choose and Book System

Andrew George: To ask the Secretary of State for Health (1) how much will (a) a GP and (b) a GP practice be paid for each hospital appointment booked through the new Choose and Book system; [65772]

(2) what payments are made to (a) GPs and (b) GP practices for registering with the Choose and Book system for arranging hospital appointments for their patients; and what financial incentives are offered for using the system; [66996]

Mr. Ivan Lewis [holding answers 25 April and 2 May 2006]: Revisions to the general medical service (GMS) contract from 1 April 2006-07 include a reward for general practitioner (GP) practices, through a directed enhanced service (DES), for utilisation of the choose and book service and for delivering choice to patients. No payments are made to GPs or GP Practices purely for choose and book registration.

The full value of DES is 96p per registered patient and comprises two equal components, one for choice
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(48p) and one for choose and book (48p). Half of the choice component, worth 24p will be made as an aspiration payment to those GP practices who make a written commitment to ensure that choice is offered to relevant patients. The remaining half, also worth 24p, will be paid based on the results of a new survey of patient experience.

Half of the choose and book component, worth 24p, will be made as an aspiration payment to those GP practices who make a written commitment to utilising the choose and book system. Practices that make at least 25 per cent. of their referrals to first consultant out-patient appointments through choose and book by the end of June 2006, will be allowed to keep this payment. The other half, also worth 24p, will be payable on a sliding scale if referrals through choose and book reach 50 per cent. in the period 1 September 2006 to 28 February 2007.

Full details of how the DES will be paid are available in “Revisions to the GMS contract 2006/07: Delivering investment in general practice,” published by the NHS Employers Organisation and the British Medical Association’s general practitioners committee, and is available in the Library and at

Demographic Trends

Mr. Waterson: To ask the Secretary of State for Health what account her Department takes of demographic trends in determining local provision of (a) obstetrics and gynaecology, (b) paediatrics and (c) geriatric services. [68395]

Mr. Ivan Lewis: It is the responsibility of health professionals in primary care trusts (PCTs) to commission obstetric and gynaecology, paediatrics and geriatric services locally, taking account of current and forecast need for services and in consultation with stakeholders.

Revenue allocations are made to PCTs on the basis of the relative needs of their populations. The weighted capitation formula is used to determine PCTs' target shares of available resources, to enable them to commission similar levels of health services for populations in similar need.

The components of the formula are used to weight each PCT’s crude population according to their relative need (age, and additional need) for healthcare and the unavoidable geographical differences in the cost of providing healthcare.

The age related need adjustments recognise that more elderly populations tend to make more use of health services than the rest of the population. The additional need adjustments identify several socio-economic variables as indicators of need because of their effect on utilisation, including standardised mortality ratios, the proportion of low birthweight babies born and the standardised birth ratio.

Departmental IT

Mrs. Curtis-Thomas: To ask the Secretary of State for Health what recent assessment she has made of whether her Department is adequately updating its
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information and communications technology infrastructure in line with the Gershon report’s recommendations. [60627]

Caroline Flint: The national programme for information technology, which is being delivered by the NHS Connecting for Health agency, is creating a multi-billion pound information infrastructure that will enable national health service patients to make informed health choices and increase the efficiency and effectiveness of clinicians and other NHS staff, as envisaged in the Gershon report. The foundations have been laid, and the organisational and commercial infrastructure established, to deploy the systems the NHS needs. Implementation has grown substantially in recent months, and its impact is now evident across the NHS.

New systems have already been delivered to thousands of locations in the NHS, and we estimate that over 2 million patients have already received improved and safer care as a result. This figure is increasing every week as the deployment of new systems and services accelerates. For example, a quarter of a million patients have now booked their hospital appointments using the choose and book electronic booking system and three quarters of a million prescriptions have been transmitted using the electronic prescriptions service.


Mr. Beith: To ask the Secretary of State for Health whether her Department has issued guidance to general practitioners on the use of fingerprints as a compulsory personal identifier for patients; and whether she has taken steps to discourage the use of fingerprints for this purpose. [67399]

Caroline Flint: No guidance on the use of fingerprints has been issued and there are no plans for using fingerprints as compulsory identifiers for patients. The Department is not aware of any general practitioners (GPs) having adopted this practice as a prerequisite for care provision, and would not find this acceptable. Some GPs, do however, provide facilities for patients to review the content of electronic health records and systems that enable this, for example the patient access electronic record system (PAERS), may use fingerprint biometrics to ensure that patients can only access their own records and not those of other patients. While the opportunity to review records in this way is generally welcomed by patients, patients are not compelled to use this sort of service and are legally entitled to be provided with paper copies of their records if they would prefer.

General Practice Boundaries

Mr. Lansley: To ask the Secretary of State for Health whether she plans to permit general practices to extend their boundaries so that they cut across (a) primary care trust and (b) local authority social services boundaries. [49554]

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Caroline Flint: The existing contractual arrangements for general practice allow practices to extend their areas, including potentially across other administrative boundaries. The White Paper “Our health, our care, our say: a new direction for community services” recognises this and commits us to explore ways of supporting practices who wish to expand, thereby increasing patient choice. This will form part of continuing discussions with the British Medical Association.

Health Treatment Centres

Paul Holmes: To ask the Secretary of State for Health how much and what percentage of the total payment made by the NHS to private sector companies awarded contracts to operate independent sector treatment centres is accounted for by (a) the cost of the operations performed and (b) an additional premium, broken down by (i) company and (ii) centre. [61718]

Mr. Ivan Lewis: The amounts paid to independent sector treatment centre (ISTC) providers are to cover the cost of providing all elements of the care pathway defined in the contract.

Value for money has been ensured by running a robust and competitive procurement process, benchmarking procedure prices between contracts and comparing them to those traditionally paid to the national health service and also to estimates of NHS equivalent costs. The premium to NHS equivalent cost is calculated only to provide a benchmark.

The amounts paid to individual independent sector providers are commercially sensitive and so cannot be disclosed. Local primary care trusts do not pay above the estimated NHS equivalent cost for the procedures they commission from ISTCs. Any cost above the NHS equivalent cost is currently met by the Department.

Healthcare Commission

Mr. Baron: To ask the Secretary of State for Health what the average waiting time was for a complaint against the NHS to be processed by the Healthcare Commission in the last period for which figures are available; and what the average cost of dealing with a complaint was in that period. [71396]

Andy Burnham: The Healthcare Commission assumed responsibility for the independent review stage of national health service complaints at the end of July 2004. Between then and the end of March 2006 the Commission received 13,400 cases. This compares with about 3,000 a year under the previous, NHS system.

The chairman of the Healthcare Commission has informed me that the average time between receipt and closure for cases closed in April 2006 was seven months. The average age of currently open cases is7.5 months. The chairman of the Commission has also confirmed that its budget for dealing with complaints
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in 2005-06 was £7.99 million. The Commission resolved 7,400 cases that year at an average costof £1,079.

Hospital Closures

Mr. Ancram: To ask the Secretary of State for Health what assessment she has made of the potential impact on patient choice of the closure of local hospitals. [65528]

Mr. Ivan Lewis [holding answer 25 April 2006]: Primary care trusts (PCTs) commission the menu of four or more providers from which patients may choose, where clinically appropriate, when referred by their general practitioner to planned hospital care. We expect PCTs to discuss the options with patient groups before deciding which to make available. If a local hospital were to close, the PCT must ensure that it has commissioned an appropriate alternative provider to include on its choice menu to ensure that patients are still able to choose from four or more providers when referred.

By 2008, we expect choice of hospital in these communities to be extended to all national health service hospitals. Any closures of local hospitals is likely to have little impact on the availability of alternatives for patient choices.

IT Reviews

Steve Webb: To ask the Secretary of State for Health if she will list the functions to be delivered by the National Programme for IT; and what the (a) start date, (b) planned completion date, (c) current expected completion date, (d) planned cost and (e) current estimated cost is for each function. [69656]

Caroline Flint [holding answer 9 May 2006]: The national programme was established with four original core components—the NHS care records service (NHS CRS); the electronic booking service, now knownas choose and book; electronic transmission of prescriptions, now known as the electronic prescription service (EPS); and the new national network (N3). Delivery now also includes the following additional components: picture archiving and communications systems (PACS); the NHSmail e-mail service; and the quality management and analysis system (QMAS). The objective of the programme is to transform health care in England by the provision of pervasive digital information.

There is no single national start or completion date for individual national programme systems and services. The aim is to achieve substantial integration of health and social care information systems in England under the national programme by 2010. Clearly, systems will need to be upgraded in the light of new technology and new national health service requirements beyond that date. The approach, in line with best practice, is to implement new services incrementally, avoiding a big bang approach, and by providing increasingly richer functionality over time.

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The first elements of the NHS care records service, to provide a transaction messaging service, a personal demograhics service, a spine directory service and secure access controls via smartcards, went live on time and to budget on 2 July 2004. The software to support choose and book is complete and went live on time and to budget, also on 2 July 2004. The software to introduce QMAS in support of the general medical services contract went live on time and to budget in August 2004 and was fully rolled out within three months, supporting payments to 100 per cent. of general practitioners (GPs) under the quality outcomes framework every month since then. The software to allow electronic prescriptions to be issued went live on time and to budget in February 2005. N3 is ahead of schedule and over 96 per cent. of GPs now have a broadband connection.

The first PACS system under the programme was implemented in April 2005 and 31 systems have been implemented to date with over 25 million digital images stored. In the south of England, the infrastructure is complete and over 50 per cent. of hospitals have PACS systems. NHSmail was implemented on time in October 2004 and currently has over 170,000 registered users sending 500,000 e-mails per day and 70 million to date. The establishment of an accredited software integration environment is complete and has enabled existing system suppliers of GP, hospital, pharmacy and independent sector systems to gain compliance with the new national and local applications.

The values of centrally-funded contracts let for the original core components of the programme are as follows:

£ million

NHS CRS (including Spine and EPS)


Choose and book




Contract values, and actual/current anticipated expenditure for the additional components are:

£ million




Between 50 and 90(2)



(1) The NHSmail contract value is variable because it is a voluntary service to offer secure, encrypted e-mail with a lifelong e-mail address. The lower amount is based on a reasonable expectation of moderate take-up and is in line with current predictions. The higher figure is the maximum possible take-up by all NHS staff with access to a computer. (2 )Depending on take-up. (3) QMAS was negotiated as an additional service under the NHS CRS contract. The figure quoted is for the initial version of the application software. Additional releases of the software have been and will continue to be commissioned to reflect further changes in the general medical services contract.

For the avoidance of doubt, none of the relevant budgets managed by the Department's NHS Connecting for Health agency have been exceeded. Anticipated expenditure under these contracts remains at planned levels.

Steve Webb: To ask the Secretary of State for Health if she will list the pilot programmes that have been set up for the National Programme for IT. [69657]

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Caroline Flint [holding answer 9 May 2006]: Extensive work was carried out during the 1990s to pilot electronic patient records through the health infomatics system (HIS) programme. This contributed to the publication, in 1998, of the Department's information for health strategy. Following publication, the Department piloted electronic records at 16 sites across the country under the electronic records demonstrator and implementation programme. Each project had its own focus, for example record sharing and confidentiality, and joint working between health and social care.

A series of outputs, evaluations and guidance reports from these projects, supplemented by lessons learned from projects in other countries, including the European Commission's advanced informatics in medicine programme, contributed to the specification of the NHS Care Records Service. A key purpose of the national programme for information technology (NPfIT) was to enable the benefit from the projects to be shared across the whole country.

During the early stages of the NPfIT procurement process, an electronic patient record pilot study with IBM at Warwick investigated primary care trust-level information gathering and reporting. Also during the procurement phase, detailed technical design studies were carried out and each supplier had to complete a series of proof of solution tests to ensure that they understood the national health service's requirements.

Further trialling of NPfIT systems is always undertaken at user sites and in user-based environments to pilot usability before rollout. Systems are only made available locally after successfully passing through extensive national testing phases. For example, both the quality management and analysis system for general practice, and the system to support payment by results, operated in shadow form for a number of months before going live.

All this activity is in line with the recommendations of the ‘Successful IT: Modernising Government in Action’, to demonstrate that products work before they are deployed, and to avoid big bang implementations.

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