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Stimulants such as methylphenidate are recognised to cause cardiovascular adverse effects such as
tachycardia or palpitations, (increased or fast heart rate), arrhythmias (abnormal heart rhythm), changes in blood pressure (usually increased) and angina. There are warnings about these potential risks in the United Kingdom product information for methylphenidate, which also states that these products should not be used in patients with certain heart conditions.
Concerns have arisen about the risk of serious cardiovascular events (including sudden deaths) in association with stimulant treatment in children and adolescents with structural heart defects. Although it is recognised that some serious heart conditions alone carry an increased risk of sudden death, in the United States the Food and Drug Administration has requested that the product information for stimulant medications, including methylphenidate, be amended to reflect this risk and to advise that they should not be used in those with known serious structural cardiac abnormalities and also to strengthen warnings about the risk of other cardiovascular adverse effects.
The MHRA, with other European regulatory authorities, has also carefully evaluated the available data relating to the reports of sudden death in children with structural heart defects and taken into account the work of the United States FDA. As a result of these Europe-wide discussions, the product information for methylphenidate is being updated accordingly to advise about serious cardiovascular adverse effects and to recommend that methylphenidate should not be used in children or adolescents with known serious structural cardiac abnormalities. This will result in alignment of UK and European recommendations with those of the FDA.
Annette Brooke: To ask the Secretary of State for Health if she will issue guidance to primary care trusts and GP practices that methylphenidate should not be prescribed for children less than six years old. 
Andy Burnham: Methylphenidate is only authorised for the treatment of attention deficit hyperactivity disorder in children aged six years and over and should only be initiated by or under the supervision of a specialist in childhood behavioural disorders. These restrictions on its use are clearly stated in the summary of product characteristics, which provides prescribing guidance to health care professional, and are also reflected in the British national formulary for children which is distributed on behalf of the Department to all general practices.
Mr. Dai Davies: To ask the Secretary of State for Health what safety assessment her Department has (a) conducted and (b) evaluated into potential interference with sensitive medical equipment caused by mobile phone use in hospitals. 
The Medicines and Healthcare products Regulatory Agency (MHRA) published a detailed study on the effects of mobile phones and other communication equipment on a range of medical devices in its device bulletin DB9702 Electromagnetic Compatibility of
Medical Devices with Mobile Communications, in March 1997the Medical Devices Agency at that time.
A further bulletin, DB 1999(02) Emergency Service Radios and Mobile Data Terminal: Compatibility Problems with Medical Devices was published in May 1999, and addressed the impact of radio communications on the safe use of a range of medical devices.
An update document, SN 2001(06), was published in March 2001, which covered the potential interference with medical devices by TETRA radio systems employed by the emergency services and media broadcasts from hospital premises.
In July 2004 guidance on the MHRA website, which referenced DB 9702 and DB 1999(02), advised that health-care providers should actively manage the use of radio frequency spectrum on their own sites, and consider the potential effects of communication equipment on all medical devices.
The most recent MHRA website advice published is Frequently asked questions on the use of mobile phones in hospitals. This has links to the other MHRA publications on the effects of mobile phones on medical equipment.
MHRA's advice is that each hospital trust should conduct its own risk assessment and introduce the necessary controls to protect areas such as intensive treatment units where sensitive equipment is in use. Areas that are generally accessible to members of the public may be suitable for the unrestricted use of mobile phones, and signage should make this clear.
Andy Burnham: Tackling methicillin resistant Staphylococcus aureus (MRSA) is a priority for Government and the NHS. We have set a target to halve the number of MRSA bloodstream infections by 2008 and each acute trust has its own target. The Department and its partner organisations have developed a range of mutually reinforcing activities that ensure combating the spread of MRSA is embedded in everyday procedures and policies, in particular:
all acute trusts are signed-up to the Saving Lives package of best practice which, if implemented in full, should combat MRSA spread in the acute sector. It is supplemented by the Essential Steps initiative, designed for non-acute care settings;
mandatory MRSA surveillance, which continues to be developed/enhanced;
the first ever national hand hygiene programme for hospital staff, cleanyourhands, has progressed to its second year;
a statutory code of practice which requires national health service bodies to have appropriate management and clinical governance systems in place to deliver effective infection control came into force on 1 October; and
advice on screening patients at risk is about to be published.
Additionally, tailored support is available for those trusts in the most challenging positions. Improvement teams will during 2006-07, work with about 50 trusts,
so as to help identify those issues that prevent reduction in infections at the local level, and help them develop action plans to speed up and sustain progress.
The Department does not allocate specific funds to the NHS to tackle MRSA, as this is part of the NHS's mainstream activity. The MRSA/cleaner hospitals programme, which co-ordinates and resources actions and joint working aimed at delivering the target, including the provision of tailored support, spent £1,300,000 in 2005-06 and has been allocated £2,780,000 this year.
Mr. Laurence Robertson: To ask the Secretary of State for Health whether Velcade may be prescribed to those with myeloma; what representations she has received from users of this drug; and if she will make a statement. 
Ms Rosie Winterton: From 1 October 2005 to 25 October 2006, the Department has received 992 letters and emails about Velcade from users of this drug and other interested parties. It would be possible to identify the exact number from users only at disproportionate cost. We have also received two petitions about this drug.
It is for clinicians, in discussion with patients, to determine treatments for a patient's condition. Treatments that have been positively appraised by the National Institute for Health and Clinical Excellence (NICE) must be funded by primary care trusts within three months of publication of guidance, if the patient concerned is eligible.
Where NICE guidance is not available, PCTs should continue with local arrangements for the managed introduction of new technologies. These arrangements should involve an assessment of the available evidence for the technology in question. Funding for such treatments should not be withheld simply because guidance from NICE is not available.
Dr. Francis: To ask the Secretary of State for Health what progress has been made in reviewing the national strategy for carers as set out in the White Paper Our Health, Our Care, Our Say; and if she will make a statement. 
Mr. Ivan Lewis: A number of commitments to improve support for carers were set out in the White Paper Our Health, Our Care, Our Say which are currently being discussed with national carers' organisations. Work will begin shortly to plan how best to take forward the commitment to update and extend the Prime Minister's strategy for carers, published in 1999.
Mr. Baron: To ask the Secretary of State for Health whether it will be one of the main functions of the national voice for patients being considered by the national voices project to represent the views and concerns of local involvement networks at a national level. 
Ms Rosie Winterton: Baroness Morgan of Drefelin is leading work by a number of national patient organisations to develop national voices. In their recent publication, Are you being heard?, they stated that the projects basic function is to provide a mechanism for existing voices to come together for greater effect on policymaking at national level. The publication also states membership will be open to national organisations in the first instance but could perhaps open up to local organisation and individuals in the future.
Mr. Iain Wright: To ask the Secretary of State for Health what her Department's policy is in respect of strategic health authority and NHS trust consultation with (a) NHS unions, (b) the general work force, (c) patients' groups and (d) the wider public before services are transferred from one hospital to another. 
Ms Rosie Winterton: Section 11 of the Health and Social Care Act 2001 requires all NHS bodies to involve and consult patients and the public in decisions affecting the operation of services. NHS organisations are also required to consult local authority overview and scrutiny committees on any proposals that represent a substantial service change.
Individual employing organisations are required under employment legislation to inform and consult staff and staff/union representatives on various issues affecting their own organisations. Each NHS organisation will have its own locally agreed consultation procedures.
|NHS (England) non-administrative staff expenditure|
|In cash terms||In real terms (at 2004-05 prices)|
2004-05 data does not include information relating to NHS foundation trusts.
Figures are the total staff costs less the administrative and clerical staff costs reported in annual financial returns.
Financial returns of health authorities, strategic health authorities, primary care trusts and NHS trusts. HM Treasury gross domestic product deflator.
Andy Burnham: NHS resource allocation is based on the principle of weighted capitation, whereby resources are distributed between areas on the basis of the relative needs of their populations. Since 1997 there have been changes to:
the areas to which resources are allocated;
the frequency of allocations;
the range of services covered;
the population base; and
the weighted capitation formula which informs these allocations.
Mr. Ruffley: To ask the Secretary of State for Health how many NHS operations were cancelled in Suffolk due to (a) administrative errors, (b) lack of beds, (c) outbreaks of MRSA or other infections, (d) the lack of correct or clean equipment and (e) missing notes in each year since 1997. 
Andy Burnham: The information is not held in the format requested. The Department collects data on the number of operations cancelled at the last minute for non-clinical reasons. The following tables show data for the number of operations cancelled at the last minute for non-clinical reasons for acute trusts in the Norfolk, Suffolk and Cambridgeshire areas for the period 2002-03 to 2005-06.
|Cancelled operations for non-clinical reasons, NHS organisations in England, 2002-03 to 2005-06|
|Number of last minute cancellations for non-clinical reasons||Number of patients not admitted within 28 days of cancellation on the day of surgery||Number of last minute cancellations for non-clinical reasons||Number of patients not treated within 28 days of last minute cancellation|
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