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Daniel Kawczynski: To ask the Secretary of State for Health what public consultation (a) her Department has undertaken and (b) her Department requires regional ambulance services to undertake in their restructuring process. 
Mr. Bradshaw: The Department supported the conclusions and recommendations of the 2005 review, Taking Healthcare to the Patient: Transforming NHS Ambulance Services, one part of the implementation of which included a reduction in the number of national health service ambulance trusts broadly in line with strategic health authority boundaries. A 14-week consultation on the future configuration of ambulance services commenced on 14 December and ran until 22 March 2006.
In terms of local public consultation, I refer the hon. Member to the answer given to him on 14 May 2007, Official Report, column 570W, which set out the extent to which NHS organisationsincluding ambulance trustsare required to involve and consult patients and the public in the planning of services, in the development of proposals for changes in services, and in decisions affecting the operation of services.
Mr. Dai Davies: To ask the Secretary of State for Health pursuant to the answer of 21 June 2007, Official Report, column 2145W, on cancer, if he will make it his policy to conduct such an assessment. 
Ann Keen: We have no plans to make such an assessment. The network of Public Health Observatories, working closely with health colleagues to improve the health of communities across the United Kingdom, will continue to monitor the health and morbidity trends of the regions they cover, and highlight areas where further investigation and intervention might be required.
Ann Keen: The national service framework (NSF) for children, young people and maternity services sets out a long-term programme intended to stimulate sustained improvement in children's health and well-being. NSFs are long-term strategies for improving specific areas of health care by setting national standards for a defined service (e.g. cancer services or renal services) or a particular care group (e.g. children or older people). Standard eight of the NSF sets out an expectation that:
Children and young people who are disabled or who have complex health needs, receive co-ordinated, high quality child and family-centred services which are based on assessed needs, which promote social inclusion and, where possible, enable them and their families to live ordinary lives. Palliative care is available to those who need it and a range of flexible, sensitive services is available to support families in the event of the death of a child.
Dr. Kumar: To ask the Secretary of State for Health (1) which NHS hospitals in the UK offer photodynamic therapy as a treatment for cancer; and what assessment the NHS has made of the effectiveness of this therapy; 
Ann Keen: Photodynamic therapy (PDT) can be used as a treatment for skin cancer and cancers on or near the lining of internal organs, such as bile duct cancer. It can also be used to treat the classic and predominantly classic forms of age-related macular degeneration and is being investigated as a treatment for psoriasis and acne. It is for the national health service at a local level to decide whether to provide photodynamic therapy services. The Department does not collect information on where this treatment is provided.
As part of its programme of work on interventional procedures, the National Institute for Health and Clinical Excellence (NICE) has issued guidance on the use of PDT in the treatment of several cancers.
NICE has stated that PDT for the treatment of Barretts oesophagus, advanced bronchial carcinoma, endobronchial carcinoma, bile duct cancer and skin tumours is safe and works well enough for use in the
NHS, provided normal arrangements are in place for consent, audit and clinical governance.
NICE has also issued guidance on the use of PDT for early stage oesophageal cancer, stating that current evidence on PDT for the treatment of this disease is not adequate to support its use without special arrangements for consent, audit and clinical governance.
In September 2003 NICE issued guidance recommending the use of PDT for treating wet age-related macular degeneration in some patients. All primary care trusts are funding PDT for patients with age-related macular degeneration in line with this guidance.
The Department is investing £1 million in a study to gather evidence on the clinical and cost effectiveness of PDT for people with the predominantly classic form of age-related macular degeneration. This study will inform NICE when its guidance on photodynamic therapy is reviewed.
Lorely Burt: To ask the Secretary of State for Health pursuant to the answer of 21 June 2007, Official Report, column 2148W, on cardiovascular system: diseases, which recommendations made to officials considering the new national stroke strategy are of relevance to the prevention and management of peripheral arterial disease. 
Ann Keen: Copies of the consultation document on the national stroke strategy are available in the Library. The draft strategy contains recommendations on risk management that are of relevance to peripheral arterial disease. The consultation period for this draft strategy will extend to 12 October 2007.
However, the risk factors which increase an individual's chances of developing peripheral arterial disease include smoking, drinking alcohol, poor diet and lack of physical activity. Through the public health White Paper Choosing Health the Department has set out a programme of action to help improve the health of the public including action on smoking and diet. This builds on existing work such as campaigns on smoking and diet, National Institute for Health and Clinical Excellence (NICE) guidelines on the management of hypertension, points for prevention activities in the general practitioner contract
and support for the Blood Pressure Association's blood pressure awareness campaigns.
The coronary heart disease and diabetes national service frameworks have also driven forward improvements in primary and secondary prevention of risk factors associated with circulatory disease in general. This includes better control of blood pressure and blood glucose, cholesterol management and the use of aspirin.
Mr. Hancock: To ask the Secretary of State for Health when the Gateway Approval (ref 7698) concerning consent for a dental screening epidemiological survey for school children was issued; for what reasons the practice of negative permission was discontinued; and what other tests on children are subject to negative permission consents. 
Ann Keen: We decided that, under the current good practices followed on consent to treatment, dental examinations in schools should only be carried out when the parents/carers or, if judged competent, the child had given positive consent. The guidance advises on how consent can be obtained in connection with the arrangements made for the admission of children to school. We are not aware of other screening tests conducted in connection with epidemiological surveys, which are subject to negative consent.
Mr. Baron: To ask the Secretary of State for Health pursuant to the answer of 20 March 2007, Official Report, column 863W, on consultant midwives, how many consultant midwives there were in the NHS in England in 2006, broken down by strategic health authority. 
|NHS Hospital and Community Health Services: Consultant Midwives, England|
|As at 30 September 2006||Headcount|
| Source: NHS non-medical census.|
Ann Keen: Where a provider of national health services dental services delivers more than 96 per cent. but less than 100 per cent. of the annual service levels agreed with the local primary care trust (PCT), the PCT is responsible for setting a period during the following contract year during which these services are to be provided.
It is a breach of contract to provide less than 96 per cent. of the annual service levels agreed in a contract. In these circumstances, it is up to the PCT to decide whether to allow some or all of these unprovided services to be carried forward to the following contract year. Where a provider has failed to provide at least 96 per cent. of the agreed annual service levels, the PCT may depending on the circumstances wish to propose a reduction in the future contract value and corresponding service levels for that contract, so that these resources can be reinvested in other local dental services.
Sandra Gidley: To ask the Secretary of State for Health what the average number of units of dental activity is which an NHS dentist with a majority NHS patient list is expected to undertake in a year. 
Ann Keen: It is for primary care trusts to agree locally with providers of national health service (NHS) dental services the service levels to be provided over the course of each year, subject to transitional provisions governing dentists with NHS contracts in the period before April 2006. These service levels will vary depending on a range of local factors.
However a special analysis of general dental services costs over a 12-month reference period from 1 October 2004 to 30 September 2005 was prepared to help calculate funding levels for the new primary dental service arrangements introduced from 1 April 2006. Tables have been placed in the Library which draw on that analysis and set out the total payments during that 12-month reference period for all courses of treatment
which included an element of orthodontic care in each of the primary care trusts in England operational at the time.
Sandra Gidley: To ask the Secretary of State for Health how many (a) dental practices and (b) dentists in Hampshire provide NHS treatment; how many hours of NHS dentistry they offered in each (i) week and (ii) month in the latest period for which figures are available; and if he will make a statement on the availability of NHS dental treatment in Hampshire. 
Ann Keen: As at 31 March 2007 there were 632 dentists on open national health service contracts within Hampshire primary care trust (PCT). This information is also contained in the report published by the Information Centre for health and social care, NHS Dental Statistics for England: Quarter 4: 31 March 2007, which is available in the Library. Information on numbers of dental practices could be made available only at disproportionate cost.
PCTs hold contracts with providers of NHS dental services, setting out the agreed level of services to be provided over the course of the year. Services are measured primarily in terms of the number of courses of treatment provided for NHS patients (with courses of treatment grouped into three main bands and given different weightings to reflect their relative complexity). The Department does not hold information on the number of hours of NHS dentistry provided.
The dental reforms implemented last year gave PCTs, for the first time, the responsibility for providing or commissioning dental services in their area. It is for PCTs locally, working with dentists and with the local public, to assess patient needs, review current service provision and develop services in ways that most effectively reflect local needs and priorities.
|Number of hospital and community health services (HCHS): medical and dental staff working within the orthodontics specialty, grade and year, England as at 30 September each year|
1. denotes zero
2. 0 denotes more than zero, less than one.
The Information Centre for health and social care medical and dental workforce census.
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