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Mr. Harper: To ask the Secretary of State for Health when she will provide an answer to question (a) 85094, on guidance to foundation trusts, tabled on 11 July 2006, (b) 84857, on the powers of local authority overview and scrutiny committee, tabled on 11 July 2006 and (c) 72913, on Gloucestershire primary care trust, tabled on 22 May 2006 by the hon. Member for Forest of Dean. 
Mr. Ivan Lewis: A reply was given to question number 85094 on 24 July 2006, Official Report, columns 1082-83W, and to question number 84857 on 25 July 2006, Official Report, column 1241W. Question number 72913 was withdrawn on 19 May.
Kerry McCarthy: To ask the Secretary of State for Health what proposals in the Department of Healths White Paper, Our health, our care, our say: a new direction for community services (Cm 6737) will advance patient choice for respite care service users. 
Mr. Ivan Lewis:
The White Paper, Our health, our care, our say, sets out our proposals for giving people
more choice and control over the type of support and help they want and when they want it. We are taking a number of steps to increase the uptake of direct payments and are piloting individual budgets which we hope will place even greater control in the hands of individuals, opening up the range and availability of services to match needs.
However, we also recognise that there may be occasions when the need for respite care cannot be easily anticipated. We also made a commitment in the White Paper to ensure that provision of short term home based respite care for carers in emergency and crisis conditions is available in each council area. We are currently scoping out the details of this work.
Sandra Gidley: To ask the Secretary of State for Health what discussions her Department has had with local NHS providers and commissioners about the scale of the proposed independent sector treatment centre at the Royal South Hants Hospital in Southampton. 
The number and type of patient treatments to be included, the case mix, the under-pinning rationale and service requirements of the scheme were determined through discussions between Southampton University Hospitals National Health Service Trust, the commissioning primary care trusts and the local strategic health authority.
Mr. Stewart Jackson: To ask the Secretary of State for Health whether she plans to delay the implementation of the Modernising Medical Careers reforms in respect of Senior House Officer grades beyond August 2007; and if she will make a statement. 
Ms Rosie Winterton: Modernising Medical Careers (MMC) is a major initiative aimed to improve both patient care and doctors training. For this reason it is subject to significant governance processes involving both the Department and the national health service. We are satisfied that MMC is proceeding satisfactorily and we do not consider it necessary to delay it.
Mr. Ivan Lewis:
The child health promotion programme (CHRP) provides opportunities for parents to raise any concerns that they might have about their child's language development. The programme
encompasses heath screening, immunisations, health promotion, needs assessment and action to address identified needs. Health professionals will also work with staff in pre-school settings such as nurseries and children's centres, who are well placed through their regular contact with a child, to identify any speech and language difficulties. Where there are concerns, a referral can be made to specialist speech and language services.
Paul Flynn: To ask the Secretary of State for Health what estimate she has made of the number of (a) heart attacks, (b) strokes and (c) other adverse side effects that may have been caused in England from using (i) Vioxx and (ii) other COX-2 inhibitors. 
Andy Burnham: Vioxx (rofecoxib) was one of a relatively new group of anti-inflammatory medicines known as COX-2 selective inhibitors. It was licensed in the United Kingdom and many other countries for the treatment of arthritic conditionsosteoarthritis and rheumatoid arthritisand also for the short-term treatment of some painful conditions. COX-2 selective inhibitors are effective anti-inflammatory, pain-relieving medicines that are thought to have less risk of gastrointestinal side effects, for example stomach ulcers, than conventional anti-inflammatory medicines.
Since 2000, evidence from clinical trials had raised concerns about a possible increased risk of heart attacks and other cardiovascular conditions associated with Vioxx, and the Medicines and Healthcare products Regulatory Agency (MHRA)/committee on safety of medicines (CSM) had continually reviewed the cardiovascular safety of this drug since it was first licensed. The product information for healthcare professionals and patients, which lists all the known side effects of the medicine, was updated on a number of occasions on the basis of emerging evidence, and in accordance with CSM's advice.
Data are not available on which to base a valid estimate of the number of heart attacks, strokes and other adverse effects that may have been caused by Vioxx and other COX-2 inhibitors. The underlying medical condition of many patients treated with COX-2 inhibitors means that they are at higher risk of heart attack and stroke than the rest of the population, and the impact of the COX-2 inhibitor on this risk is not possible to calculate.
Since Vioxx was voluntarily withdrawn by the manufacturer in 2004, the safety of other COX-2 inhibitors and traditional anti-inflammatory drugsnon-selective non-steroidal anti-inflammatory drugs (NSAIDs)has been under continual and intense assessment in the UK and Europe. The latest evidence suggests that both NSAIDs and COX-2 inhibitors might pose a small increased risk of heart attacks or strokes, although the exact level of risk may vary between medicines. Planning is now under way to introduce new information into product information that will support informed decision-making for healthcare professionals and patients in relation to the choice of anti-inflammatory medicine.