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Paul Rowen: To ask the Secretary of State for Health what assessment she has made of the role of patient involvement in the National Institute for Health and Clinical Excellences appraisals of new lymphatic cancer treatments. 
Caroline Flint: The public and patient involvement unit of the National Institute for Health and Clinical Excellence (NICE) has well-developed strategies for ensuring that appropriate patient and carer organisations are invited to act as stakeholders or consultees in all NICEs guidance programmes, including technology appraisals. Lists of all stakeholders involved in each piece of guidance are published on NICEs website at www.nice.org.uk
Paul Rowen: To ask the Secretary of State for Health what plans her Department has to continue funding for pump-primed lymphoma nurse specialist positions; and if she will increase expenditure on such positions. 
Ms Rosie Winterton: It is for local trusts in partnership with local stakeholders to determine how best to use their funds to meet national and local priorities for improving health and to commission services accordingly, which includes provision of specialist nursing posts. Where agreements have been made for alternate funding of these posts, this is a local matter.
Carrick Veterinary Centre
Onevet and Co.
Grants Veterinary Services Ltd.
Hallmark Meat Hygiene Ltd.
Gordon Laboratory Group Ltd.
Aro Company Ltd.
Eville and Jones
Scotvet OVS Services
Raoul Dowding Veterinary Services
Perriferell Veterinary Services
The Corporation of London
Willows Veterinary Group
Merlin Veterinary Group
Harbit and Ryder
Fenton Veterinary Centre
Clyde Veterinary Group
Lerwick Veterinary Practice
S. A. Goodall
Deveron Veterinary Surgeons
Miller and Swann Vet. Surgeons
McTaggart Veterinary Group
Malcolm J Wheeler
Armac Veterinary Group
Southern Isles Vet. Practice
Patrick A Boyd
The Crofts Veterinary Centre
Bellevue Veterinary Group
Bodrwnsiwn Veterinary Group
F C IFood Consultancy and Inspection Ltd.
Paws Veterinary Health Centre
Acorn Vets Ltd.
Mount Services Wellington LTD
Quarry Veterinary Group
The Avenue Veterinary Centre
Old Courts Veterinary Practice
Crescent Veterinary Clinic
G and P J Nute
Oaksford and Birch
Midforest Veterinary Practice
Pearson, Thompson and Callery
John Highet Ltd.
Sinclair and Wight
Paragon Veterinary Group
County Veterinary Group
Grants Veterinary Services Ltd.
Eville and Jones
The Corporation Of London
F C IFood Consultancy and Inspection Ltd.
Mr. Drew: To ask the Secretary of State for Health what hourly charges the Meat Hygiene Service pays to each contract agency in respect of (a) contract veterinarians and (b) contract meat inspectors. 
Mr. Drew: To ask the Secretary of State for Health what checks the Meat Hygiene Service (MHS) carries out to determine the technical competence of contract veterinarians and contract meat inspectors; and what actions have been taken by the MHS in circumstances where such contractors have not met that level of technical competence. 
Caroline Flint: The Meat Hygiene Service (MHS) holds contracts with a number of companies for the supply of official veterinarians (OVs) and meat hygiene inspectors. The contracts specify the qualifications and level of technical competence required by the MHS. When deployed to approved establishments, the technical competence of all contract staff is assessed and monitored; in-depth initially and periodically thereafter. Each month the technical competency of contract staff is assessed by the MHS as part of contract performance management against a range of key performance indicators. Contractors will also periodically assess the technical competence of their staff.
In addition to the above management checks, the MHS Internal Audit Unit undertakes audits in approved establishments to assess whether MHS teams, which may include contract OVs and meat hygiene inspectors, are carrying out their duties in line with written instructions and regulatory requirements. The Internal Audit Unit also audits contractors procedures, including the recruitment, induction, training and development, and appraisal of contract OVs and meat hygiene inspectors.
In cases where a contract veterinarian or meat hygiene inspector is assessed as not meeting the required level of technical competence, the employing contractor is instructed to remove the individual and provide a technically competent replacement.
Mr. Drew: To ask the Secretary of State for Health what the cost was to the Meat Hygiene Service of hiring contract veterinarians and contract meat inspectors in each of the last three years. 
Caroline Flint: The Meat Hygiene Service's expenditure on contract official veterinarians and contract meat hygiene inspectors in each of the last three financial years is shown in the following table.
|Financial year||Contract official veterinarian cost||Contract m eat h ygiene i nspector cost|
Mr. Dai Davies: To ask the Secretary of State for Health what controls she plans to put in place to ensure that patient records entered on the electronic care record database are not misused by researchers using the secondary uses service. 
Caroline Flint: The primary purpose of the national health service care records service (NHS CRS) is to support the delivery of care to patients. However, the aim is that data extracted from NHS services supporting direct patient care, including the NHS care records service, choose and book and electronic transmission of prescriptions, will be made available either in aggregate form or, where detailed information is provided, in anonymised or pseudonymised form, via the so-called secondary uses service. The use of consistent pseudonym enables individual cases to be tracked.
Identifiable information will be available only where patient consent has been formally given or where specific permissions apply. Permission is required from the Patient Information Advisory Group (PIAG), set up under the Health and Social Care Act 2001. The PIAG assesses each application to test that the use of patient information is justified, taking into account issues of confidentiality and consent.
Access to the secondary uses service requires each user to be formally registered and to use individual smart card access, just as for other systems in the national programme for information technology. Each user is allocated a role which determines what reports, and what organisations or geography of data they may access. Key user activities, including logon and extraction of data, are recorded.
The Secondary Uses Group set up by the Care Record Development Board to advise on the ethical use of patient data and how the potential for research, statistics and management can be realised without compromising confidentiality or security, is due to report shortly.
Mr. Dai Davies: To ask the Secretary of State for Health what representations she has received from GPs on plans to create an electronic care record for patients; and what assessment she has made of the implications for patient confidentiality of such a scheme. 
Caroline Flint: Since the start of the national programme for information technology, the Department and NHS Connecting for Health have worked closely with individual, and groups of general practitioners (GPs), including the Royal College of General Practitioners (RCGP) Health Informatics Standing Group. At the outset, the aim was to ensure that the wealth of some 20 years experience in clinical computing, in particular clinical noting and medication management, was distilled into the output based specification (OBS) for the integrated care records service. The OBS, which was published in July 2003, set the template for the subsequent procurement of all the clinical systems. Week-long design workshops were held to clearly define complex areas of functionality, in which the input of many GPs, both individual, and as representatives from RCGP and British Medical Association committees, was key.
Since that time, representatives of around 60 professional organisations, including 14 Royal Colleges, among them the RCGP, have participated on national advisory groups which provide a forum for debate on development and implementation of the national programme, and the sharing of specialist expertise and experience of organisations that are already benefiting from IT implementation. Of NHS Connecting for Healths eight National Clinical Leadssenior figures representing different areas of the health servicetwo are for general practitioners.
NHS Connecting for Health continues to engage on a daily basis with clinicians throughout England, and as a direct result of feedback from clinicians, improvements continue to be made across the range of programmes. This involvement is impossible to quantify precisely, but equates to hundreds of staff years of input.
With regard to patient confidentiality, while no system can be 100 per cent. secure, we believe that the procedural and technical safeguards surrounding the new electronic care record service provide an unprecedented degree of assurance of security for national programme systems and services, and confidentiality of the personal data they will contain. With regard to specific evaluation arrangements, a ministerial taskforce was established in 2006 specifically to consider matters relating to confidentiality and patient consent. This taskforce reported in December 2006 and the follow-up actions are being overseen by an advisory group chaired by the Deputy Chief Medical Officer. In addition, a contract for independent evaluation of the summary care record early adopter programme, now under way in the north- west, has been awarded to a team at University College London. The evaluation will involve extensive fieldwork to capture the views and experiences of GPs, practice managers, nurses, other NHS clinical and management staff, and, of course, patients. The final report of the evaluation will be published in summer 2008, but emerging findings will influence the continued rollout of the summary care record.
Andrew George: To ask the Secretary of State for Health what plans she has to require independent midwives to obtain professional indemnity insurance; and whether there is any requirement by the European Commission for her Department to compel independent midwives to obtain such insurance. 
European Directive 2005/36 on the recognition of professional qualifications allows (but does not
require) regulatory bodies to demand evidence of indemnity insurance from incoming European migrants, provided that they demand the same information from United Kingdom nationals.
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