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Mr. Laws: To ask the Secretary of State for Health how much and what proportion of NHS expenditure she estimates went to the independent sector from (a) central funds and (b) primary care trust allocations in each of the last five years. 
|ISTC programme expenditure (£ million)( 1)||Total NHS expenditure (£ million)||ISTC expenditure as a percentage of total NHS spend|
|(1 )Expenditure on locally procured independent sector treatment providers is not separately identified in the annual financial returns of national health service trusts, primary care trusts and strategic health authorities.|
The first ISTC commenced services in 2003. The above figures include central funding provided for the ISTCs, the general supplementary procurement and pathfinder contracts.
NHS spend on independent healthcare providers will be determined by the choices made by patients and those who commission services locally on their behalf.
Mr. Sanders: To ask the Secretary of State for Health whether she has submitted a request to the National Institute for Health and Clinical Excellence to undertake a comparison of the different types of insulin in its future work programme. 
Mr. Baron: To ask the Secretary of State for Health pursuant to the answer of 2 February 2007, Official Report, column 546W, on insulin, (1) what adverse effects are associated with the use of (a) animal insulins, (b) synthetic human insulins and (c) analogue insulins; what the incidence is of each effect; and if she will make a statement; 
Caroline Flint: Detailed information regarding the adverse effects known or suspected to be associated with a medicine is provided in the summary of product characteristics (the product information for prescribers) and the patient information leaflet.
Generally the side effects observed are broadly similar for all types of insulins with the most commonly observed side effects being hypoglycaemia, visual disturbance and injection site reactions. Tables which summarise the current knowledge of frequencies of adverse reactions with different insulins have been placed in the Library. These provide a breakdown of the types of adverse effects and their frequencies, where known. The tables contain the information relating to animal, human and analogue insulins and are separated by the classification of the medicine into the following four groups: rapid; intermediate; long and biphasic action. It is important to note that a report of an adverse reaction does not necessarily mean that the drug caused it and a number of the adverse reactions reported by patients treated with insulin may be due to the underlying diabetes.
There is less information available on the frequency of side effects for some of the older products. Guidelines for the investigation of the safety and efficacy of new medicinal products have developed over the years and the evidence base available for older products tends to be much less than that available for newer products such as the insulin analogues.
Manufacturing data, including biological purity, stability and viral removal processes;
Laboratory testing of the product activity such as its binding to the relevant tissues;
Testing on animals for safety and activity;
Clinical trials in healthy volunteers and/or patient volunteers to;
Establish the mechanism of action;
Study distribution of the product within human body;
Evaluate safety in sufficient numbers of volunteers to reflect safety issues that would be usually expected in clinical practice; and
Evaluate efficacy in sufficient number of volunteers to demonstrate that the product in question would be clinically useful as intended.
A summary of the available data on safety and effectiveness submitted in support of the licence applications for many of the insulin analogues is made publicly available in the form of a European Public Assessment Report available on the website of the European Medicines Agency (www.emea.europa.eu).
Assessing the cost-effectiveness of a treatment is the responsibility of the National Institute for Health and Clinical Excellence (NICE). The Appraisal Committee of NICE are asked to take account of the overall resources available to the national health service. Decisions on the cost-effectives of a treatment must include judgments on the implications for other patient groups.
Caroline Flint: The four United Kingdom Health Departments are responsible for the overall implementation of modernising medical careers. The Health Departments co-ordinate action through a United Kingdom modernising medical careers strategy group which includes members from the Academy of Medical Royal Colleges, the General Medical Council, the Postgraduate Medical Education and Training Board (PMETB) and national health service employers. Each country also has a dedicated implementation team.
The Royal Colleges are directly responsible for developing the new competency-based curricula which are approved by PMETB. The Royal Colleges also work closely with postgraduate deans over the development of person specifications for the recruitment process and the postgraduate deans themselves oversee selection into posts.
Mr. Laws: To ask the Secretary of State for Health pursuant to the answer of 27 February 2007, Official Report, column 1291W, on maternity services, what information is available on the number of maternity units in (a) 1997 and (b) 2001. 
Ms Rosie Winterton: Data derived from Hospital Episode Statistics show that for 1997 there were 213 hospital trusts providing maternity services and 192 in 2001. Most trusts have one principal hospital site with delivery facilities and the majority of deliveries are reported through that main hospital trust. Any decrease in the number of units is likely to be due to reconfiguration of national health service trusts without any decrease in the number of hospitals, wards and birthing centres offering services.
Greg Mulholland: To ask the Secretary of State for Health (1) what assessment her Department has made of the impact of proposed changes to midwifery services in Leeds on (a) the number and frequency of home visits and (b) the provision of post-natal care; 
(2) what assessment she has made of the impact of proposed changes to midwifery services in Leeds on the distances midwifery staff will have to travel in the course of their duties; and what provision has been made for the effect on costs of such travel; 
Caroline Flint [holding answer 22 March 2007]: The NHS Yorkshire and the Humber Strategic Health Authority reports that the proposed changes were formulated in November 2006 and consultation involving the Royal College of Midwives, human resources and local staff side commenced in December 2006. Staff have been invited to raise their concerns at one to one meetings. The head of midwifery works in close collaboration with the primary care commissioners, midwifery educationalists, and the health visiting lead, who are aware of the proposed changes and welcome the modernisation schedule for maternity services taking shape. Focus groups have also been held with women to better understand their expectations of the service.
The Leeds Teaching Hospitals National Health Service Trust may require staff to change their work base for operational reasons. Eligibility for reimbursement of excess travel does not normally apply in these circumstances under the current agenda for change terms and conditions for staff employed in the NHS.
Caroline Flint: Data will be available online in April at www.camhsmapping.org.uk. The 2006 Child and Adolescent Mental Health Services Mapping report is scheduled to be published in July.
Caroline Flint: The main agency through which the Government support medical and clinical research is the Medical Research Council (MRC). The MRC is an independent body funded by the Department of Trade and Industry via the Office of Science and Innovation.
The MRC is not currently funding research specifically relating to migraine. However, a strategic grant award to Dr. Leone Ridsdale, Kings College, London for a prospective study on diagnostic management referral and one year outcome for patients with headache in primary care has recently been completed. The aim of this study was to provide evidence about the accuracy of diagnosis, the prognosis, reasons for referral, and the economic costs for patients and society.
The Department funds research to support policy and to provide the evidence needed to underpin quality improvement and service development in the NHS and through its health technology assessment programme has supported a pragmatic, randomised trial into the use of acupuncture for migraine and headache in primary care; and is planning a randomised placebo controlled trial of propranolol and Pizotifen in preventing migraine in children.
Over 75 per cent. of the Departments total expenditure on health research is devolved to and managed by national health service organisations. Details of individual projects, including a number concerned with migraine, are available on the national research register at:
Mr. Lansley: To ask the Secretary of State for Health how much and what proportion of the NHS budget has been paid to non-NHS providers in each financial year since 1997-98 in (a) cash and (b) real terms. 
|Total cash terms (£ million)||Total real terms (£ million)||As a proportion of NHS expenditure (percentage)|
| Notes: 1. Figures include £15.0 million of spending in 2004-05 and £19.6 million in 2005-06 by NHS foundation trusts. 2. HM Treasury Gross Domestic Product Deflator used to provide the real terms figures with 2005-06 as the base year. 3. Figures for 2005-06 are provisional. Source: Annual financial returns for primary care trusts, strategic health authorities and NHS trusts for 1997-98 to 2005-06. Review and consolidated accounts of NHS foundation trusts 2005-06.|
Mr. Todd: To ask the Secretary of State for Health whether data obtained in processing NHS treatment at a private sector treatment centre may be used for marketing purposes by the company owning the centre. 
Choice is a key part of health reform. Going forward, NHS providers, independent and public sector, should be providing patients with information which enables them to make an informed decision about their health care options. This will include information gathered from the treatment of NHS patients.
The marketing schedule for phase 2 ISTC contracts states that marketing brochures produced by the provider for patients of the facilities must include (among other things) patient and provider statistics consistent with those contained in the NHS choice booklets, to the extent that they are relevant to the ISTC programme. These include details of in-patient waiting times, cancelled operations, out-patient waiting times, methicillin resistant s taphylococcus aureus infection rates and the results of patient satisfaction surveys.
The schedule also provides that marketing material should not include information relating to private health care services or products and services offered by the IS provider, or a third party, which do not relate to the services being provided under the ISTC agreement with the authority.
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