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PCT Contracts signed Contracts rejected UDA percentage (contracts rejected)









Southern Norfolk




Notes: 1. Data have been provided by the Information Centre for health and social care and the data source is the Business Services Authority. 2. A dentist with a GDS or PDS contract may provide as little or as much NHS treatment as he or she chooses or has agreed with their PCT. Information concerning the amount of time dedicated to NHS work by individual GDS or PDS dentists is not centrally available. 3. Dentists consist of principals, assistants and trainees. Prison contracts have been excluded. 4. The postcode of the dental practice was used to allocate dentists to specific geographic areas. Constituency areas have been defined using the Office for National Statistics all fields postcode directory. 5. The data for dentists who have left the NHS include those who have retired.

Paul Holmes: To ask the Secretary of State for Health what steps she is taking to monitor the impact of the new dental contract on access to dental care. [73300]

Ms Rosie Winterton: Under the new arrangements, the NHS Business Services Authority will monitor the numbers of patients who receive care or treatment from national health service primary care dentists on one or more occasions within a given period of time, as had previously been the system for most personal dental services pilots.

I have asked the implementation review group, which has been set up to review the impact of the NHS dental reforms and identify any issues that need to be addressed, for views on what time period should be used as the main basis for this monitoring.

Mr. Lansley: To ask the Secretary of State for Health whether she has received representations from patients who have been removed from a general dental practitioner’s list because of a failure to attend an appointment; what estimate she has made of the number of patients who have been removed from a general dental practitioner’s list because of a failure to
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attend an appointment since the introduction of the new general dental services contract and personal dental services agreement; and whether the threat of removing a patient from a dentist’s list if they fail to attend an appointment is a method (a) sanctioned, (b) approved and (c) recommended by her Department for the reduction of the number of failures to attend appointments. [76969]

Ms Rosie Winterton: We are not aware of any representations from patients whose dentist has declined to provide further treatment because of failure to attend agreed appointments. No estimate has been made of the number of patients whose dentist has terminated treatment on these grounds.

Paragraph 5 of Schedule 3 to both the national health service (general dental services contracts) Regulations 2005 (S.I. No 2005/3361) and the national health service (personal dental services agreements) Regulations 2005 (S.I. No 2005/3373) provide that where, in the reasonable opinion of the contractor, there has been an irrevocable breakdown in the relationship between the patient and that contractor, and notice of such a breakdown has been given to the patient by the contractor, the contractor may notify the primary care trust (PCT) that it will no longer provide services to that patient under the contract.

Persistent failure by a patient to keep appointments without good cause constitutes an irrevocable breakdown in the relationship.

Terminating treatment is not a step that any dentist takes lightly. PCTs are encouraged to work with national health service contractors to help them to manage their appointment systems in ways that minimise missed appointments and therefore the need for this sanction. This is in the interest of patients and dentists.

Mrs. Iris Robinson: To ask the Secretary of State for Health (1) what safeguards are in place to prevent patients from mistakenly receiving private dental treatment in the belief that it is being provided on the NHS; and what recourse is available to patients who incur charges in this way; [77291]

(2) what consent is required from patients for private dental treatment by NHS dentists. [77292]

Ms Rosie Winterton: An Office of Fair Trading Report, ‘The Private Dentistry Market in the United Kingdom’, published in 2003, identified the need for improvements in the regulation of private dentistry. The Department has worked with the General Dental Council (GDC) to implement the report’s recommendations. The GDC has revised its maintaining standards guidance to require dentists to provide the information that patients need to choose whether they wish to be treated under the national health service or privately. The guidance specifies,

Through amendments to the Dentists Act 1984, approved by Parliament last July, the GDC has introduced a service for the investigation and resolution of complaints about private dentistry. The service can be accessed through the website or by telephone on 08456 120 540.

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Mr. Bone: To ask the Secretary of State for Health (1) how much diamorphine was used by the NHS in each of the last five years; and how much she expects to be used in 2006-07; [79462]

(2) what the sources are of the supply of diamorphine used by the NHS; [79463]

(3) what criteria her Department uses to decide how much diamorphine the health service requires; [79464]

(4) whether she has been informed of a shortage of supply of diamorphine in any NHS hospital; and if she will make a statement. [79466]

Andy Burnham: The usage of diamorphine in the national health service in the community in England for each of the last five years is shown in the following table.

British national formulary chemical name Number of prescription items (Thousand) Net ingredient cost (£000)


Diamorphine hydrochloride




Diamorphine hydrochloride




Diamorphine hydrochloride




Diamorphine hydrochloride




Diamorphine hydrochloride



This information is taken from the prescription cost analysis (PCA) system, supplied by the prescription pricing division of the Business Services Authority (formerly known as the Prescription Pricing Authority (PPA)), and is based on a full analysis of all prescriptions dispensed in the community in England.

A comparable volume figure on the use of diamorphine hydrochloride in hospitals is not available, however estimates of the cost of diamorphine issued in hospitals in England is in the following table.

Estimated list price cost of diamorphine hydrochloride issued in hospitals in England
Estimated list price cost (£000)











This information is taken from the hospital pharmacy audit database supplied to the Department by IMS health.

Overall costs of diamorphine hydrochloride dispensed in the community and in hospitals are at a similar level. The cost figures may have fallen in recent years due to a reduction in price as well as a decrease in use.

The Department is aware that there is an ongoing shortage of diamorphine injection. This began in December 2004, when Chiron (now Novartis), one of the two suppliers of this product to the NHS, experienced problems at its manufacturing plant. The other supplier, Wockhardt
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UK, immediately increased its production but was unable to fill the gap. Chiron came back into production in July 2005, and both companies are now manufacturing to their full available capacity. However, supplies are limited and are likely to remain so for the coming months.

It is not possible to predict how much will be used in 2006-07, or how much diamorphine the NHS requires. There is a continuing shortfall of production against historic demand, and use will depend, to some extent, on availability of the product. It will also depend on whether doctors and other healthcare professionals maintain the prescribing and purchasing strategies established to cope with the shortage, following Departmental guidance issued in December 2004.

The Department is in close contact with both suppliers of diamorphine and is continuing to monitor the supply situation carefully.

Ear Piercing

Mr. Amess: To ask the Secretary of State for Health under what legislation ear piercing is regulated in England and Wales; what plans she has to review this legislation; and if she will make a statement. [75531]

Caroline Flint: Ear piercing businesses are regulated in England and Wales under the Local Government (Miscellaneous Provisions) Act 1982. This provides local authorities with powers to regulate ear piercing by requiring businesses to register and observe byelaws relating to the cleanliness and hygiene of premises, practitioners and equipment. It is an offence for a business to trade without being registered or to breach byelaws and such offences may lead to the suspension or cancellation of registration.

This legislation is kept under ongoing review, and there are no current plans to amend the provisions relating to ear piercing.

Ear piercing businesses in London are regulated by local authorities under private legislation which requires licensing and observance of licence conditions. It is an offence for a business to trade without a licence or fail to observe licence conditions. Local authorities also have enforcement powers in relation to ear piercing businesses under Health and Safety at work legislation.

Mr. Amess: To ask the Secretary of State for Health if she will bring forward legislation to require those who practise ear piercing on persons under 16 years of age to display in a prominent position a notice stating the requirements for parental consent; and if she will make a statement. [75532]

Caroline Flint: There is no statutory minimum age of consent for ear piercing. Minors, that is, those who are under the age of 18, are able to give valid consent if they are capable of understanding the nature of the act to be done. Furthermore, the courts have held that a parent's right to decide on behalf of his/her child yields to the child's competence to make a decision.

There are no current plans to introduce a statutory minimum age of consent for ear piercing nor to require parental consent for those under 16 years of age. We believe that introducing a minimum age of consent might result in children piercing themselves or each other in an unhygienic or unsafe manner or going to disreputable businesses. However, we keep the position under review.

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The Health and Safety Executive has produced guidelines on the enforcement of skin piercing activities for local authorities including advising businesses on adopting a reasonable approach to age of consent issues. The guidelines are available at

Food Broker Businesses

Mr. MacNeil: To ask the Secretary of State for Health what progress has been made by the Food Standards Agency in establishing a timetable for the comprehensive inspection and licensing of food broker businesses. [79495]

Caroline Flint: Food brokers do not have to be licensed under the new European Union hygiene regulations, but they are required to register their establishments with the appropriate local authority. Local authorities’ food hygiene inspection programmes are planned on a risk-based approach laid down in the statutory Food Law Code of Practice, to which enforcers must have regard. This code also covers circumstances at a food establishment that may warrant an inspection outside the planned inspection programme.

Health Service Circular 1999/176

Mr. Keetch: To ask the Secretary of State for Health if she will review and re-issue Health Service Circular 1999/176 to clarify her instructions to trusts. [78312]

Andy Burnham: The Department is planning to update and issue guidance to the national health service on the managed introduction of new health technologies later this year.

Healthcare Commission

Mr. Gale: To ask the Secretary of State for Health, pursuant to paragraph 25 of the Department’s interim guidance of March 2006 (Gateway Ref 6212), on the role of the Healthcare Commission, under what statutory provision the Commission will be responsible for the regulation of controlled drugs. [79575]

Andy Burnham: Responsibility for the regulation of controlled drugs will be given to the Healthcare Commission by regulations stemming from the current Health Bill. Subject to Parliamentary procedure and approval, we expect the regulations to be laid in the autumn.

Mr. Gale: To ask the Secretary of State for Health on how many occasions representatives of the Healthcare Commission have (a) examined and (b) taken copies of patients’ private and confidential notes held by (i) private clinics and (ii) general practitioners offering a private health service in each of the last five years. [79576]

Andy Burnham: I understand from the Chairman of the Healthcare Commission that the information is not available in the form requested. I also understand from the chairman that since March 2006 the Commission
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has been recording the details of occasions when confidential personal information has been obtained from independent healthcare providers without the data subject’s consent: however, the data are not broken down by type of establishment.

Hepatitis C

Norman Lamb: To ask the Secretary of State for Health what plans her Department has to reassess its Hepatitis C action plan following the report of the all-party parliamentary hepatology group; and if she will make a statement. [78590]

Caroline Flint: The results of the all-party parliamentary hepatology group report indicate that progress is being made in implementing the Hepatitis C action plan for England. Around two thirds of the primary care trusts who responded are taking steps to implement the action plan and the majority of national health service hospital trusts did not report significant delays for patients awaiting treatment.

However, the results of the surveys may serve as a useful focus for discussion by local NHS organisations. They are responsible for implementation of the action plan at the local level and are best placed to assess what is needed in their areas, taking account of other priorities.

Hospital Procedures (Costs)

Mrs. Iris Robinson: To ask the Secretary of State for Health what the average cost was of (a) an elective in-patient hospital procedure, (b) a hospital day case procedure and (c) an NHS hospital procedure in 2005-06. [74704]

Andy Burnham: Cost data relating to the financial year 2005-06 are not yet available.

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