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The organisation having little prospect of achieving balance within a three or five year period

Other reasons including fraud and suspicious payments

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Avon, Gloucestershire and Wiltshire Strategic Health Authority

Mr. Drew: To ask the Secretary of State for Health if she will take steps to ensure that all the organisations within the Avon, Gloucestershire and Wiltshire strategic health authority tackle their deficits within the timescale identified by the local operating framework. [79651]

Caroline Flint: The role of the Department is to ensure that strategic health authorities (SHAs) comply with the operating framework guidance published on 26 January 2006. Individual SHAs are responsible for the performance management of their national health service organisations and for ensuring that they achieve financial balance. The aim is for the NHS as a whole, is to have returned to financial balance by the end of 2006-07. In addition, we are aiming for all overspending organisations to have monthly balance of income and expenditure (run rate balance) by the end of 2006-07.

There will be some exceptional cases where an organisation cannot achieve run rate balance in 2006-07 without an undue impact on patient services.

However, where one organisation overspends, an organisation elsewhere in the system needs to underspend for the NHS as a whole to be in financial balance. It is important, therefore, that organisations return to financial balance as quickly as possible.

Bowel Cancer

Harry Cohen: To ask the Secretary of State for Health what advice the chief medical officer has provided on preventing bowel cancer; and if she will make a statement. [72617]

Ms Rosie Winterton: Bowel cancer is one of several cancers linked to diet and other lifestyle factors, including physical activity. Government advice on how to reduce cancer risk is to eat a healthy, balanced diet that is high in fibre, fruit and vegetables, low in fat, and containing a moderate amount of red and processed meat. Other known risk factors include obesity, smoking and alcohol consumption.

Breast Cancer

Dr. Blackman-Woods: To ask the Secretary of State for Health if she will give greater priority to the (a) treatment of, (b) research into and (c) financing of treatment of inflammatory breast cancer. [78987]

Ms Rosie Winterton: Cancer is a Government priority. However, decisions on the provision and funding of cancer services are a matter for the national health service and individual primary care trusts to consider as part of their local priority setting.

In the ‘NHS Cancer Plan’, published in 2000, the Department confirmed its commitment to increasing investment in cancer research and breast cancer trials constitute the largest proportion of trials in the national cancer research network’s portfolio.

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In 2004-05, £3.8 billion was spent on cancer services. However, figures are not routinely collected centrally on the treatment of individual cancers, including inflammatory breast cancer.

Mr. Baron: To ask the Secretary of State for Health pursuant to the answer of 21 June, Official Report, column 1936W, on breast cancer, in what circumstances a breast cancer patient may not benefit from Herceptin. [81082]

Ms Rosie Winterton: It is for individual clinicians, in discussion with a patient, to decide whether or not it is suitable to prescribe a specific drug, taking into account any relevant guidance from the National Institute for Health and Clinical Excellence (NICE). Primary care trusts may need to be involved to decide whether to support the clinician's decision and supply the drug at the national health service expense.

On 9 June 2006, NICE published its draft guidance on Herceptin. This recommends the drug for women with early stage HER2-positive breast cancer, except where there are concerns about cardiac function.

However, there may be other individual patients for whom it is not suitable—for example, if the woman is too frail to tolerate chemotherapy. This will be a matter for discussion between a woman and her clinician.

These recommendations are subject to an appeal period which closed on 28 June 2006. Final guidance is expected to be issued at the beginning of July, assuming there are no appeals. There are no national restrictions on the NHS using Herceptin in the interim.

Care Homes

Mr. Stephen O'Brien: To ask the Secretary of State for Health how many pages of (a) guidance and (b) forms (i) her Department and (ii) its arm’s length bodies sent to care homes in each year since 1997. [79674]

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

Child Malnutrition

Steve Webb: To ask the Secretary of State for Health what assessment she has made of child malnutrition levels in each of the last 10 years. [74154]

Caroline Flint: Malnutrition occurs when a deficiency, excess or imbalance of energy, protein, and other nutrients causes measurable adverse effects on tissue, function and clinical outcome.

Data on child malnutrition levels in each of the last 10 years can be obtained from the hospital episodes statistics (HES) which uses the international classification for diseases (ICD) to record and collate hospital admissions data. Malnutrition is defined by a primary diagnosis between the ICD-10 codes E40 to E46. The data from HES for child malnutrition in each of the last 10 years is shown in the table.

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Count of finished admission episodes and patients where primary diagnosis is malnutrition in children under 18 at national health service hospitals, England 1995-96 to 2004-05
Finished admission episodes Patient counts































Source: HES, The Information Centre for health and social care

Contracts (Termination Clauses)

Mr. Stephen O'Brien: To ask the Secretary of State for Health what steps she plans to take to ensure that NHS organisations contracting with private sector contracts have effective termination clauses in their contracts. [75022]

Ms Rosie Winterton: All national health service organisations should have appropriate clauses for the termination of contracts that they give based on legal advice. Where termination of a contract is necessary this should be done on the basis of the terms within that contract and any further legal advice the commissioner may need. The Department will be issuing guidance to NHS commissioners for framework contracts later this year.

Deafblind People (Care Services)

Mr. Stewart Jackson: To ask the Secretary of State for Health when she next plans to review the implementation by local authorities of (a) the statutory guidance for deafblind children and adults and (b) section 7 of the Local Authority Social Services Act 1970 on fair access to care services; and if she will make a statement. [81073]

Mr. Ivan Lewis: There are no plans to review the implementation by local authorities of the statutory guidance for deafblind children and adults. It is the responsibility of councils to identify the number of deafblind people in their area.

There are no plans to review the implementation by local authorities of fair access to care services (FACS), which is published as statutory guidance under section 7 of the Local Authority Social Services Act 1970.

As part of the consultation on the adult social care Green Paper “Independence, Well-being and Choice”, we asked for views on the impact on FACS of shifting the balance of services from high-level need to earlier, preventative interventions. Following analysis of consultation, we believe that FACS is compatible with a preventative approach to social care.

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Mr. Laws: To ask the Secretary of State for Health what estimate she has made of the (a) number and (b) proportion of children eligible for orthodontic treatment (i) prior to 1 April and (ii) following the introduction of an assessment based on an index of treatment need, broken down by primary care trust. [78954]

Ms Rosie Winterton: Contractors only provide orthodontic treatment to a person who is assessed as having a treatment need in grade four or five of the dental health component of the index of orthodontic treatment need (IOTN) or grade three of the dental health component of that index with an aesthetic component of six or above. This is unless the contractor is of the opinion that orthodontic treatment should be provided to a person who does not have such a treatment need by virtue of the exceptional circumstances of the dental and oral condition of the person concerned.

Research has shown that IOTN grades four and five constitute about 30 per cent., of the 12 year old child population, the age most suitable for treatment. Although many orthodontic practitioners based their treatment planning on IOTN, all grades could be treated in the general dental services. It should also be noted that children do not necessarily receive orthodontic treatment within the primary care trust which they reside.

Mr. Graham Stuart: To ask the Secretary of State for Health (1) whether her Department treats referrals to hospital-based orthodontists from dentists as consultant to consultant referrals; and if she will make a statement; [76953]

(2) whether her Department collects statistics on referrals to hospital-based orthodontists by dentists; and if she will make a statement. [76960]

Ms Rosie Winterton: Where the referral is from a general dental practitioner it is recorded in the same way as a referral from a general medical practitioner. If the referral is from a primary care dentist other than a general dental practitioner, it is recorded as a consultant to consultant referral.

The table shows the number of referral requests for first out-patient appointments in orthodontics between 2002-03 and 2005-06. The information collected is split by written referrals by general practitioners (GPs) and other. GP referrals include referrals by general dental practitioners and other referrals include consultant to consultant referrals and referrals to optometrists.

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