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Mr. Graham Stuart: To ask the Secretary of State for Health how many (a) full-time and (b) part-time staff work at the NHS Institute for Innovation and Improvement; what the Institutes budget is for 2006-07; how much has been spent on the Institute since its inception; and if she will make a statement. 
The 2006-07 revenue budget signed off by the NHS Institutes board in June was £82 million. The NHS Institutes year to date expenditure for 2006-07 as at December 2006 is £34 million and the full year expenditure in 2005-06 was £45 million. This equates to £79 million spend between July 2005 (the time of the Institutes inception) and December 2006.
Caroline Flint: We understand that FibroScan machines are already available for national health service organisations to purchase, should they decide to do so. The NHS Health Technology Assessment Programme (www.hta.nhsweb.nhs.uk) is considering commissioning a review of research literature on the effectiveness of different methods of assessing degree of liver fibrosis.
Dr. Gibson: To ask the Secretary of State for Health whether the (a) Office of Fair Trading and (b) Competition Commission were consulted in drawing up the proposed pricing model in the Department of Health's Consultation Paper Arrangements for the remuneration of services relating to appliances under Part IX of the Drug Tariff. 
Caroline Flint: The pricing model was not included in the consultation paper relating to arrangements for the remuneration of services relating to appliances within Part IX of the Drug Tariff, but was in a companion paper, Arrangements for the reimbursement pricing of stoma and incontinence appliances under Part IX of the Drug Tariff.
Neither the Office of Fair Trading nor the Competition Commission was consulted in drawing up the proposed pricing model. However, the proposed pricing model is based on economic principles recognised by both organisations with regard to pricing behaviour in competitive markets.
Mr. Stephen O'Brien: To ask the Secretary of State for Health (1) how many people have smartcards to access the care records database; and how many it is estimated will have smartcards when the database is fully rolled out; 
The early adopter implementation of the summary care record will be phased, initially being deployed in a small number of healthcare communities. Access to the system across these communities will be limited to healthcare professionals in accident and emergency departments, primary care out of hours services, walk-in centres, and minor injuries units that require access for the provision of care. Over time, our obligations to patients who receive care outside traditional national health service settingsfor example in the voluntary sector, from mixed teams of health and social care professionals, and in the independent sector under contract to the NHSwill mean that by the time an electronic care record has been created for every NHS patient in England in 2010 we anticipate there will be in excess of 850,000 users.
In all cases, access to records will only be permitted for the staff of organisations involved in delivering care to NHS patients, working as part of a team that is providing a patient with care, and will be limited to only as much information as is needed for the purpose of the care or other job role being performed in relation to the patient. Where those providing care are not NHS staff, patients will be informed of this and any objections raised will be respected.
(2) how (a) the audit trail, (b) role-based access and (c) legitimate relationships operate when smartcards are shared between NHS personnel; and what security measures are in place to protect patient confidentiality when smartcard access is shared. 
Caroline Flint: Access to the national health service care records service (NHS CRS) is determined by local NHS organisations using policies, processes and technology provided by NHS Connecting for Health. In general only staff who are working as part of a team that is providing a patient with carethat is, those having a legitimate relationship with the patientwill be able to see a patient's health record.
Because of the differences that exist between and within organisations in the duties and responsibilities of individual staff within their work teams, access is not uniquely determined by profession, specialism or grade. Users are vetted and sponsored by their local organisations for specific access appropriate to their job role and area of work. Stringent proof of identity is required along with the endorsement of the local sponsor, a senior member of staff, for the receipt of a smartcard, a secure token that, together with a passcode, confirms the identity of a user at the time of access.
NHS organisations must undertake to observe strict conditions to ensure the NHS CRS is used appropriately, and the user is required to sign up to a set of conditions for use of the smartcard. The obligations and conditions are complemented by the various existing codes of conduct and professional
responsibilities by which all NHS staff are bound. These obligations and conditions are assessed on a regular basis with the organisation, and the user is subject to local and national checking through audit trails and alerts.
Actions that do not conform to these obligations and conditions, which includes the sharing of smartcards, are dealt with locally. Sharing of information between members of a team has happened routinely prior to the introduction of smartcards. However, though there is no evidence that smartcards have been shared beyond members working as part of a team that legitimately needs access to a patients record, we recognise that the sharing of smartcards can undermine the assurance that patient confidentiality will always be appropriately respected. Staff who breach patient confidentiality are subject to professional disciplinary measures. Offending doctors and nurses will be reported to their professional regulatory bodies and may face additional disciplinary action, including removal of their licence to practice.
Arrangements known as role-based access controls will limit what a member of staff can do within the system and consequently which parts of a record he or she can see. Access to record content will therefore be controlled by a member of staffs relationship with the patient, and by what they need to see to do their jobs. Senior clinicians within an organisation will also be able to see patient records when assuring the quality of care provided by their staff, but other access will only be authorised when required or permitted by law.
Mr. Stephen O'Brien: To ask the Secretary of State for Health how many times a day the care records database was accessed in the last period for which figures are available; and how many times a day she expects it to be accessed when it is fully rolled out. 
Caroline Flint: On a typical working day, by the end of January 2007, the spine database, which forms the core of the NHS care records service (NHS CRS), was being accessed by around 50,000 authenticated unique users. And during the last full week of January 2007, the approximate volumes of messages processed in connection with the following systems and services were
personal demographic servicesix and a half million
choose and book electronic booking serviceover 1.4 million
electronic transmission of prescriptionshalf a million.
Growth in all these volumes is rising dramatically with the increase in functionality across the NHS CRS and continuing roll-out of the various elements of the system, but already the spine is the world's biggest structured health care messaging system.
It is not possible to provide a realistic estimate of what these volumes will be by the time substantial integration of health and social care information systems in England has been achieved by 2010. These will depend significantly on the way in which health care management and delivery processes in the NHS adapt and develop to reflect the enormous potential of the systems and services being delivered under the national programme for information technology.
Mr. Stewart Jackson: To ask the Secretary of State for Health how many whole-time equivalent midwives per 1,000 maternities there were working in the NHS in the most recent period for which figures are available, broken down by NHS trust; and if she will make a statement. 
Please note that these are estimates. Compatibility between the deliveries information and staff in post is not strict, as the deliveries information covers the financial year and the work force census information is at 30 September 2004.
Mr. Stewart Jackson: To ask the Secretary of State for Health how many whole-time equivalent midwives per 1,000 maternities were working in the NHS in the most recent period for which figures are available, broken down by NHS trust; and if she will make a statement. 
Mr. Lancaster: To ask the Secretary of State for Health whether Milton Keynes primary care trust is considering the removal of the physiotherapy provision to some Milton Keynes GP practices as part of its service review. 
Caroline Flint: It is the responsibility of primary care trusts (PCTs) and strategic health authorities to analyse their local situation and develop plans, in liaison with their local national health service trusts and primary care providers, to deliver high quality NHS services.
Mrs. Humble: To ask the Secretary of State for Health (1) what consideration she has given to the merits of strengthening (a) safeguards against and (b) the reporting of the use of unlicensed drugs, with particular reference to the administration of spinal injections to treat acute and chronic back pain; 
(2) what steps she has taken to prevent consultants and doctors working in (a) the NHS and (b) the private sector from offering treatment requiring the use of (i) unlicensed drugs and (ii) spinal injections to treat acute and chronic back pain. 
Under the current medicines legislation, doctors and consultants, whether working in the national health service or in the private healthcare sector, are free
to use their own clinical judgment to use an unlicensed medicine or a spinal injection when they consider that to be in the best interests of an individual patient. Doctors and consultants are personally responsible for such decisions and must comply with the legislation. There are no plans to change this.
Norman Baker: To ask the Secretary of State for Health what rules apply to (a) consultants and (b) general practitioners working within the NHS in respect of the receipt by them of (i) gifts from drug companies and (ii) attendances at seminars or similar events outside the UK, where such events are financed by drug companies. 
Ms Rosie Winterton [holding answer 23 February 2007]: Measures to prohibit both the offer by pharmaceutical companies of financial or other inducements to prescribe medicines and their acceptance by consultants and general practitioners are contained in the Medicines (Advertising) Regulations 1994. Where medicines are being promoted to them, the regulations prohibit the offer or acceptance of any gift, pecuniary advantage or benefit in kind unless it is inexpensive and relevant to the practice of medicine. The regulations permit the acceptance by health professionals of hospitality at meetings, provided it is strictly limited to the scientific or promotional purpose of the meeting.
The Medicines and Healthcare products Regulatory Agency investigates complaints under the regulations. This is supported by industry self-regulation under the Association of the British Pharmaceutical Industry code of practice for the pharmaceutical industry.
Miss McIntosh: To ask the Secretary of State for Health (1) how much of the centrally funded initiatives and services and special allocations budget was spent on (a) strategic health authorities, (b) primary care trusts, (c) NHS hospitals, (d) general practitioners and (e) private companies operating in the health service in each of the last five years; and on what services the money was spent; 
(3) what percentage of the budget for the Centrally Funded Initiatives and Special Allocations fund was allocated to (a) strategic health authorities and (b) primary care trusts in each of the last three years; and what the money was used for. 
allocations made to strategic health authorities;
allocations made to primary care trusts (PCTs);
the percentage that the above figures for 2002-03 to 2005-06 represent of the total final programme; and
the major areas of the Department's expenditure with national health service trusts.
Details of expenditure incurred by the Department, including the NHS, from overall resources can be found in the annually published Department of Health resource accounts. From 2004-05 a further breakdown of expenditure by programme budget category is provided.
The budget established for the 2005-06 centrally funded initiatives services and special allocations programme prior to the start of the year was £18,300 million. Total expenditure, including allocations to NHS bodies, was £18,736 million. The increase was funded by adjustments to PCT allocations largely for payments by results, multi-professional education and training and the national specialist commissioning.
Mr. Lansley: To ask the Secretary of State for Health (1) what estimate she has made of the average percentage of the overall budget of (a) primary care trusts and (b) NHS trusts which was spent on IT in the most recent period for which figures are available; 
Caroline Flint: The great majority of funding allocated to primary care trusts (PCTs) is not ring fenced, and national health service trusts do not receive allocations but are paid for the provision of care services commissioned from them by PCTs. Each NHS organisation is free, and expected, to use its resources in the way that delivers the best available value for money.
strategic health authorities (SHAs)£24 million; and
PCTs£484 million; and
NHS Trusts£821 million.
Figures rounded to the nearest whole £ million.
These figures comprise revenue expenditure (£1,096 million) reported through a national survey of IT investment, and capital expenditure, including software licences, identified in NHS accounts (£214 million) and reported by foundation trusts (£19 million). They do not include expenditure by special health authorities or central expenditure funded by the Department.
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