Mr. Ivan Lewis:
This is a local issue. The Department expects national health service organisations to use
sensible names that are clear, ideally with a geographical reference, without acronyms.
Mr. Hancock: To ask the Secretary of State for Health pursuant to her answer of 12 October 2006, Official Report, column 847W, on Mackinsey Review, what plans she has to monitor cross border arrangements in any review outcome; and if she will make a statement. 
Andy Burnham: The reconfiguration of local health services is a matter for the local national health service. It is for local NHS organisations, in conjunction with local stakeholders, to plan and develop services to meet both national and local priorities.
|Total number of finished admission episodes where the primary diagnosis is malnutrition;
1. A finished admission episode is the first period of in-patient care under one consultant within one health care provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.
2. The primary diagnosis is the first of up to 14 (seven prior to 2002-03) diagnosis fields in the Hospital Episode Statistics (HES) dataset and provides the main reason why the patient was in hospital.
3. Figures have not been adjusted for shortfalls in data, i.e. the data are ungrossed.
Hospital Episode Statistics (HES), The Information Centre for health and social care. Information on the extent of malnutrition in hospital is not collected centrally as HES does not cover assessment of malnutrition once a patient has been admitted.
Mr. Ivan Lewis
[holding answer 16 October 2006]: We do not always engage consultants on a project basis, but McKinsey and Co. were involved in the
following workstreams for assisting the Department with national health service reforms in 2004-05, 2005-06 and 2006-07:
Preparing case studies on implementing new financial flows and contracting arrangements for NHS Foundation Trusts. Two further projects were commissioned to assess international best practice in funding health care systems through payment by results, and evaluating wave one foundation trusts.
Assisting in developing a strategy for the Commercial Directorate's Commercial Advisory Board;
Acting as advisers to the Commercial Directorate to assist in the development of the independent sector procurement programme;
Assisting in developing and implementing the Department's internal high level review;
Engaged in delivering waves one and two of the PCT fitness for purpose programme;
Supporting the Department in assessing the impact of UK health system reform on clinical quality.
Mr. Hollobone: To ask the Secretary of State for Health if she will assess the impact on the funding of mental health and learning disability services in Northamptonshire of the merger of the countys primary care trusts. 
Ms Rosie Winterton [holding answer 24 October 2006]: The Department does not expect any mental health or learning disability service to be asked to contribute more in financial savings or cost improvement plans, than any other service in the local health economy, unless that service contributed to the deficit. Where mental health services are being asked to put up money this year to assist the health community overall, then they should get it back in the following financial year, as set out in the Operating Framework 2006-07.
The Departments recovery and support unit, as part of its performance management of strategic health authorities (SHAs), is investigating cases brought to its attention, to determine if financial plans have failed to observe the above principles. In particular, if mental health services contribution to savings constitute a greater percentage of their turnover, than that of other local providers (as a rule of thumb, mental health services should not be contributing above the local average).
The rationale for the disproportionate savings;
a commitment to reduce the savings expected to be made by mental health providers in 2007-08, by the same amount they have been asked to over-contribute this year;
an affirmation of their commitment to deliver their local development plans in mental health for early intervention, crisis resolution and the community development workers.
Annette Brooke: To ask the Secretary of State for Health what representations she has received relating to new research conclusions on the long term effects of methylphenidate; and if she will make a statement. 
Andy Burnham: Methylphenidate is a stimulant drug that is authorised in children over six years of age as part of a comprehensive treatment programme for attention deficit hyperactivity disorder (ADHD). Treatment should be under the supervision of a specialist. Clinical trials submitted at the time of licensing have examined the safety and efficacy of methylphenidate in children with ADHD who received treatment for up to 12 months.
Since methylphenidate was first authorised in the United Kingdom, a range of representations regarding its safety profile have been received from Members of Parliament, patients and health care professionals. Some of these have specifically questioned the need for further research into its long-term safety profile but none have specifically provided information about the findings of new research.
It is recognised that there is limited information about the long term efficacy and safety profile of methylphenidate. This is reflected in the product information, which advises that treatment should be discontinued periodically to assess the childs condition and that treatment should usually be discontinued during or after puberty.
Stimulants such as methylphenidate are known potentially to affect weight gain and growth in children following long-term use. The product information, for prescribers and patients/carers and the British National Formulary contain warnings about this risk and advise that the child's weight and height should be regularly checked throughout treatment. A number of studies have been conducted to examine this issue and these inform current clinical guidance which recommends regular monitoring and treatment breaks in children who are not gaining weight or growing as expected.
The longer term safety of the use of methylphenidate in routine clinical practice is closely monitored by the Medicines and Healthcare products Regulatory Agency (MHRA) in conjunction with other European regulatory authorities. There are currently ongoing discussions at European level on whether further formal studies are required to extend the knowledge about the safety profile of methylphenidate, including the long term safety profile. As new data emerge they are carefully evaluated by the MHRA and where necessary current prescribing advice is updated to reflect the new evidence.
Annette Brooke: To ask the Secretary of State for Health (1) what representations she has received on the breaching of National Institute for Health and Clinical Excellence guidelines on the prescription of methylphenidate to young children; and if she will make a statement; 
(2) what estimate she has made of how many children (a) are diagnosed as having attention deficit hyperactivity disorder and (b) are receiving
(i) prescribed medication, (ii) alternative treatments and (iii) a combination of such treatments. 
NICE recommended in March 2006 that drug treatment for attention deficit hyperactivity disorder (ADHD) should only be initiated by an appropriately qualified healthcare professional with expertise in ADHD and it should be based on a comprehensive assessment and diagnosis. Continued prescribing and monitoring of drug treatment may be performed by general practitioners, under shared care arrangements. Information on the number of prescriptions issued for methylphenidate in the community for children aged 0-15 years and those aged 16-18 years in full-time education is in the following table.
Information is not collected on the number of children diagnosed as having ADHD; nor how many are receiving (a) prescribed medication, (b) alternative treatments or (c) a combination of such treatments.
NICE has estimated that around five per cent of school-aged children meet the diagnostic criteria for ADHD, equivalent to 366,000 children and adolescents in England and Wales, but not all these children will require treatment.
|Prescriptions issued for methylphenidate (Ritalin) for 0-15 years and 16-18 years in full-time education
1. Data are for 0-15 year olds and those aged 16-18 in full time education.
2. Data cover prescriptions prescribed by general practitioners, nurses, pharmacists and others in England and dispensed in the community in the United Kingdom.
Ms Rosie Winterton: Midwives wishing to renew their registration with the Nursing and Midwifery Council must meet the requirements of the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules Order of Council 2004. A copy of the order is available in the Library.
From August 2006, the PREP standard requires registrants to have practised for 450 hours in the three years prior to their registration expiring. If a midwife fails to meet this standard they will need to successfully complete a return to practice programme before being considered for re-entry to the register.
Sir Malcolm Rifkind: To ask the Secretary of State for Health what action has been taken to ensure that there will be enough training posts for young doctors under the modernising medical careers scheme; if she will delay its introduction; and if she will make a statement. 
Ms Rosie Winterton: The four United Kingdom Chief Medical Officers (CMOs) announced on 29 September indicative figures for the number of places planned to be available during the transition to new specialty training programmes in 2007. The figures suggest that the there will be between 22,000 and 23,000 training opportunities to doctors across the UK. Of these, the CMOs preliminary estimate is that 17,000 to 18,000 will provide access to run-through training programmes. Work is continuing on refining these figures.
Modernising Medical Careers (MMC) is a major initiative aimed to improve both patient care and doctors training. It is subject to effective governance processes involving the four Health Departments and the national health service. We are satisfied that MMC is proceeding satisfactorily and we do not consider it necessary to delay it, which would only cause uncertainty and confusion at this stage.
Mr. Stewart Jackson: To ask the Secretary of State for Health what estimate she has made of the likely cost to the NHS of (a) clinical negligence claims, (b) non-clinical negligence claims and (c) costs associated with each category of claims in 2006-07; and if she will make a statement. 
Andy Burnham: The national health service litigation authority (NHSLA) makes a provision in its accounts for all existing claims and for claims that might arise for incidents that have occurred but have not yet been reported. The NHSLA accounts for 2005-06 declare a provision for clinical negligence claims of £8,219,452,000, and for non-clinical negligence claims of £125,528,000.
Mr. Ivan Lewis [holding answer 23 October 2006]: The Department measures independent sector treatment centre contract performance on the basis of value rather than activity. This is to allow for the variations, which can occur through substitution of activity between procedures of varying value.
Mr. Gordon Prentice: To ask the Secretary of State for Health if she will make it her policy to give reasons when she rejects a recommendation from an Overview and Scrutiny Committee for a proposed NHS re-configuration to be referred to the Independent Review Panel. 
Andy Burnham: An overview and scrutiny committee (OSC) may make a referral to the Secretary of State on the grounds of inadequate consultation or that the proposals are not in the best interests of the health service. In making her decision the Secretary of State may seek advice from the independent reconfiguration panel but is not required to do so. The response to the OSC focuses on the specific grounds of referral and there are no plans to change this.
Mr. Iain Wright: To ask the Secretary of State for Health if she will make it her policy to give reasons when she accepts a recommendation from an overview and scrutiny committee for a proposed reconfiguration of NHS services when the proposed reconfiguration spans two local authority areas. 
Andy Burnham: An overview and scrutiny committee (OSC) may make a referral to the Secretary of State on the grounds of inadequate consultation or that the proposals are not in the best interests of the health service. The response to the OSC will address the specific grounds of referral.