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22 Apr 2008 : Column 1993W—continued

Myofascial Pain Syndrome

Bob Spink: To ask the Secretary of State for Health if he will commission research into the treatment of (a) myofascial pain syndrome and (b) fibromyalgia; and if he will make a statement. [198853]

Dawn Primarolo: The usual practice of the Department's National Institute for Health Research and of the Medical Research Council is not to ring-fence funds for expenditure on particular topics. Research proposals in all areas compete for the funding available. Both organisations welcome applications for support into any aspect of human health and these are subject to peer review and judged in open competition, with awards being made on the basis of the scientific quality of the proposals made.

Bob Spink: To ask the Secretary of State for Health what assessment he has made of evidence on a potential link between the use of hydrocortisone injections and (a) myofascial pain syndrome and (b) fibromyalgia; and if he will make a statement. [198854]

Dawn Primarolo: Hydrocortisone is a synthetic anti-inflammatory steroid which is licensed for use in replacement therapy in adrenocortical insufficiency and a range of anti-inflammatory conditions. Hydrocortisone injections are not licensed for the treatment of fibromyalgia or myofascial pain syndrome, but may sometimes be used for the temporary symptomatic relief of pain associated with fibromyalgia when a prescriber judges that such unlicensed use is in the patient's best interest.

The use of hydrocortisone is associated with a number of adverse effects which are listed in the Summary of Product Characteristics and Patient Information Leaflet, fibromyalgia and myofascial pain syndrome are not recognised side-effects of treatment. As with all medicines, the Medicines and Healthcare products Regulatory Agency continuously monitors the safety of hydrocortisone and has not received any reports of fibromyalgia or myofascial pain syndrome in patients treated with hydrocortisone.

NHS Organisations

Mr. Stephen O'Brien: To ask the Secretary of State for Health if he will place in the Library a list of NHS organisations in England, broken down by local authority area. [199988]

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Mr. Bradshaw: A list of all strategic health authorities, special health authorities, national health service trusts, NHS foundation trusts and primary care trusts as at 18 April 2008, broken down by region, has been placed in the Library. Information about corresponding local authority area is not held centrally.

NHS: Alarms

Mr. Pickles: To ask the Secretary of State for Health (1) if he will place in the Library a copy of the guidance his Department has issued to NHS organisations on the use of carbon monoxide alarms; [199501]

(2) how many hospitals had audible carbon monoxide alarms fitted at the most recent date for which figures are available; and if he will make a statement. [199502]

Dawn Primarolo: The Department is committed to help prevent deaths and injuries caused by carbon monoxide (CO) poisoning and the focus of the initiatives it has taken has been on raising awareness of the dangers of CO poisoning among the public and medical profession. It has not issued specific guidance to the national health service about the use of CO alarms.

In his winter update issued in November 2007, which is sent to all doctors registered with the General Medical Council in England, the Chief Medical Officer (CMO) provides a range of advice on diagnosis of CO poisoning, including the use of neurological examination.

This builds on two previous publications, the advice of which is still current: “CMO Winter 2005 Update”; and the CMO and Chief Nursing Officer (CNO) joint letter issued in 2002. CMO’s update includes recognition of the symptoms of CO poisoning, key questions to ask in diagnosis, appropriate tests and treatment. The CMO/CNO letter, distributed to community nurses, midwives, health visitors and general practitioners, provides detailed advice for recognising the symptoms of CO poisoning and specific advice about investigations and testing techniques. A copy of the letter has been placed in the Library.

In addition, the Department has recently called for research to investigate the incidence of CO poisoning, health outcomes and patient’s experience following exposure, which will help inform the development of appropriate policy.

The Department also provides funding to leading national voluntary organisations through the Section 64 General Scheme of Grants, which helps in their work in raising awareness about the dangers of CO with both the public and health professionals and in supporting victims and providing information on how to prevent poisoning.

In collaboration with key stakeholders, the Department is currently looking at options for new awareness-raising initiatives as well as reviewing activities in which it is already engaged.

Information on the number of hospitals fitted with audible carbon monoxide alarms is not collected centrally.

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NHS: Belgium

Sandra Gidley: To ask the Secretary of State for Health how much was allocated to the running of the NHS office in Brussels in each of the last three years. [198214]

Dawn Primarolo: The NHS European office was established in September 2007 and therefore no funding and expenditure was allocated prior to this date. The NHS European office is jointly funded by the strategic health authorities and financial information for the office will be published in the accounts of South-East Coast Strategic Health Authority, for part of the financial year 2007-08 which the office was operational.

NHS: Drugs

Mr. Lansley: To ask the Secretary of State for Health pursuant to the answer of 25 March 2008, Official Report, columns 23-4W, on NHS: drugs, (1) what the basis was of his calculation of the target reduction in Category M medicines expenditure as specified in the answer; [197876]

(2) what proportion of the reimbursement prices paid to pharmacy contractors he estimates to be represented by the profit margin of pharmacy contractors; [197927]

(3) to what he ascribes the increase in Category M cost of reimbursement, expressed at March 2005 prices, between financial years 2005-06 and 2006-07. [197928]

Dawn Primarolo: The basis of the target reductions was provided in the answer I gave to the hon. Member on 25 March 2008, Official Report, columns 23-4W.

In addition, adjustments are also made to reimbursement prices to take account of the reduction in market prices that usually occurs in the months after the introduction of a generic medicine following patent expiry of an in-patent medicine.

In the period 1 April 2005 to 30 September 2007 the target reduction for the adjustment in category M medicines expenditure was £1.05 billion by reference to March 2005 prices. To include medicines joining category M since April 2005, the planned, further reduction of £100 million per quarter from 1 October 2007 was implemented by reference to July 2007 prices.

£500 million of the annual level of funding agreed by the Department and the Pharmaceutical Services Negotiating Committee is derived from profits made by pharmacies buying medicines for less than they are reimbursed by the national health service (the retained purchase margin).

The increase of the Category M cost of reimbursement is attributable to the increased growth in the volume of the cost of NHS generic medicines reimbursed in England since the introduction of the Category M system. However, although the cost of Category M generic medicines prescribed and dispensed has increased (22 per cent.) that growth would have been greater (27 per cent.) if Category M had not been introduced. The breakdown is shown in the following table.

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Increased cost of the Category M reimbursement for NHS generic medicines reimbursed in England
At March 2005 prices (£) Actual cost (£)







Increase between 2005-06 and 2006-07



Percentage increase



NHS: Identity Cards

Mr. Stephen O'Brien: To ask the Secretary of State for Health (1) with reference to the Answer of 29 June 2005, Official Report, column 1608W on identity cards, to the hon. and learned Member for Harborough, what the conclusions were of his Department’s consideration of the costs and benefits of using identity cards within the National Health Service, including the cost of card readers, with particular reference to the NHS Connecting for Health National Programme for IT; [200111]

(2) what stage has been reached in the development of the proposed NHS card referred to in section 2.21 of the NHS Improvement Plan, published on 24 June 2004; [200135]

(3) with reference to the Answer of 27 February 2006, Official Report, column 439W, on the European Health Insurance Card, what discussions he has had with the Secretary of State for the Home Department on links between (a) an NHS card and (b) Connecting for Health, and the identity cards programme. [200230]

Mr. Bradshaw: It is too early in the process to make any conclusions of the costs and benefits of using identity cards within the national health service.

There are no current plans to introduce an NHS card, although this will be kept under review.

My right hon. Friend the Secretary of State meets the Home Secretary and other ministerial colleagues to discuss matters of common interest, including on occasion the National Identity Scheme.


Mr. Brady: To ask the Secretary of State for Health (1) what assessment he has made of changes in the incidence of schizophrenia in 15 to 25 year olds in the last 30 years; [199997]

(2) what assessment he has made of the evidence linking cannabis use and the onset of schizophrenia in the 15 to 25 year age group; [199999]

(3) what assessment he has made of the changes in incidence of psychosis in 15 to 25 year olds in the last 30 years. [200000]

Mr. Ivan Lewis: It is difficult to assess the trends in incidence of psychosis or schizophrenia for this age group over the last thirty years due to the relatively small numbers of people suffering from these conditions. This makes any assessment of statistical significance of a change vulnerable to error. Also during this time diagnosis classifications have changed for these conditions,
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which could mean that comparisons over this period would not be measuring like for like.

The Department is concerned about the negative impact of cannabis use and intoxication on acute mental health patients and on mental health services, and about the increased evidence for a possible role for cannabis in the causation of longer-term disorders such as schizophrenia.

The Department advises that cannabis use is harmful for people with existing mental health problems, being linked with relapse and resistance to treatments.

Research data also indicate that the impact of cannabis is likely to be on those already vulnerable to onset of schizophrenia.

It is also recognised that cannabis can cause an acute, short lived psychosis, from which the person recovers quickly following cessation of cannabis use but which, in severe cases, may require a short period of inpatient care. We keep the evidence and research in this area under constant review.


Norman Lamb: To ask the Secretary of State for Health how many cases of self harm were diagnosed in each of the last five years, broken down by (a) region, (b) sex and (c) those aged (i) under 10, (ii) 10 to 18 and (iii) over 18 years. [199940]

Mr. Ivan Lewis: The information is not available in the format requested. Such information as is available has been placed in the Library. The Department has supplied the number of finished admissions where the external cause code of admission to hospital was self harm.

Many cases of self harm may be diagnosed in a primary care setting rather than in hospital (apart from serious cases where hospital/medical care is required). We do not know what proportion of people diagnosed are actually treated in hospital so can only give the number of admissions. This is not a count of people who are admitted to hospital as one person could be admitted several times.

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Damian Green: To ask the Secretary of State for Health how much his Department has allocated to (a) Eastern and Coastal Kent Primary Care Trust (PCT) and its predecessor PCTs and (b) PCTs with a similar smoking prevalence for smoking cessation in each of the last five years; and what the average smoking cessation budget was for PCTs in England in each of the last five years. [195150]

Dawn Primarolo: The total revenue allocations made to Eastern and Coastal Kent primary care trust (PCT) for the period 2003-04 to 2008-09 are provided in the following table. These include allocations for national health service stop smoking services (SSS).

PCT name 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09

Eastern and Coastal Kent PCT







Comparisons cannot be made between allocations rounds for the following reasons:
organisational changes and changes are made to the weighted capitation formula for each allocations round, therefore, comparisons would not be on a like with like basis; and
the first year that primary medical services were incorporated into revenue allocations was 2006-07.

The information requested on revenue allocations to PCTs with a similar smoking prevalence is not available in the exact format requested.

Data on NHS SSS PCT allocation are not collected or held centrally.

Aggregated data on total allocation to NHS SSS for strategic health authorities (SHAs) are collected and held centrally as part of the NHS stop smoking services quarterly monitoring return forms. Data for 2006-07 can be found in table 1.

Data on smoking prevalence by PCT are not available. The General Household Survey provides estimates of smoking prevalence for adults by Government office region. This information is presented in table 2 for 2002 to 2006.

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Table 1: NHS stop smoking services allocation by strategic health authority, 2006-07, England



North East Government Office Region


County Durham and Tees Valley


Northumberland, Tyne and Wear


North West Government Office Region


Cheshire and Merseyside


Cumbria and Lancashire


Greater Manchester


Yorkshire and the Humber Government Office Region


North and East Yorkshire, Northern Lincolnshire


South Yorkshire


West Yorkshire


East Midlands Government Office Region


Leicestershire, Northamptonshire and Rutland




West Midlands Government Office Region


Birmingham and the Black Country


Shropshire and Staffordshire


West Midlands South


East of England Government Office Region


Bedfordshire and Hertfordshire




Norfolk, Suffolk and Cambridgeshire


London Government Office Region


North Central London


North East London


North West London


South East London


South West London


South East Government Office Region


Hampshire and Isle of Wight


Kent and Medway


Surrey and Sussex


Thames Valley


South West Government Office Region


Avon, Gloucestershire and Wiltshire


Dorset and Somerset


South West Peninsula


The NHS Information Centre.

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