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To ask the Secretary of State for Health (1) pursuant to the answer of 29 February 2008,
Official Report, column 1977W, on the NHS: private sector what definition he uses of an episode of care; when an episode of care (a) begins and (b) ends; and if he will make a statement; 
(2) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, and with reference to paragraph 23 of the 1986 guidance entitled The Management of Private Practice in National Health Service hospitals in England and Wales, when private inpatients are permitted to change their status to NHS inpatients during the course of a single visit to an NHS hospital; 
(3) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, and with reference to paragraph 23 of the 1986 guidance entitled The Management of Private Practice in National Health Service Hospitals in England and Wales, whether private inpatients are only permitted to change their status during a course of a stay in hospital at the conclusion of an episode of care; 
(4) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, what the (a) maximum, (b) minimum and (c) mean length of an episode of care delivered in the NHS was in the most recent year for which figures are available; 
(5) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, how many different types of episode of care exist; and for each whether other episodes of care are allowed to run concurrently with it; 
Mr. Bradshaw: As outlined in the 1986 guidance, The Management of Private Practice in NHS Hospitals in England and Wales, the precise definition of an episode of care in this context is a judgment that must be made locally by clinicians and the local national health service, not by the Government, and so there is no reason to specify different types of episode of care. Clinicians may judge that treatments that run concurrently should be regarded as separate episodes.
With reference to paragraph 23, there are no restrictions on when a private inpatient may choose to become an NHS patient. However, the guidance says that private patients who change their status should have their clinical priority for treatment assessed, and should not gain any advantage over other NHS patients. This was reiterated in the 2004 guidance A Code of Conduct for Private PracticeRecommended Standards of Practice for NHS Consultants, which said that:
a patient cannot be both a private and a NHS patient for the treatment of one condition during a single visit to a NHS organisation; and
should a patient be admitted to an NHS hospital as a private inpatient, but subsequently decide to change to NHS status before having received treatment, there should be an assessment to determine the patient's priority for NHS care.
Anne Milton: To ask the Secretary of State for Health pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, and with reference to paragraph 14.2 of the 1986 guidance entitled The Management of Private Practice in National Health Service Hospitals in England and Wales, what assessment he has made of the extent to which earlier private consultations lead to earlier NHS admission; and if he will make a statement. 
Mr. Bradshaw: The Department produced the sustainable development: environmental strategy for the NHS in 2005 which advocates that national health service bodies produce locally based strategies and plans of action for a number of environmental aspects, including waste. The Department did not set targets specific for recycling but rather adopted a more holistic waste management regime based on the Department for Environment, Food and Rural Affair's (DEFRA's) Waste not want not report and the waste strategy recommendations. This aims to prevent waste occurring in the first instance, advocating a waste hierarchy approach with reduction, reuse and recycling being addressed.
The Department does not retain records of those trusts that have produced recycling strategies. In recognising the importance of recycling as part of the waste hierarchy, the Department collects information about waste produced and recycling undertaken by the NHS in England. The NHS reported that on average it recycled 14 per cent. of its waste in 2006-07.
Health technical memorandum HTM 07-01 Environment and Sustainability: Safe Management of healthcare waste was published in 2006 and provides a framework for best practice waste management to help healthcare organisations and other producers to meet legislative requirements. The Department has made plans to review HTM 07-01 during 2008 and is consulting with key stakeholders in DEFRA and the Department for Transport, as well as the regulators, as part of this process.
|2007||Total number of calls taken|
|(1) Figures are for all calls to NHS Direct which includes calls to 0845 46 47 and other calls to services provided to national and local commissioners.|
Mike Penning: To ask the Secretary of State for Health how many calls were made to NHS Direct in (a) 2007 and (b) 2006; what the forecast number of calls for each of those years was before the start of each year; and if he will make a statement. 
|Calls made to NHS Direct||Actual||Forecast|
|(1) Figures are provided for the financial years 2006-07 and 2007-08.|
(2) Figures are for all calls to NHS Direct which includes calls to 0845 46 47 and other calls to services provided to national and local commissioners.
David Taylor: To ask the Secretary of State for Health what recent submissions he has received on the consideration given to cost by the National Institute for Health and Clinical Excellence in its appraisal process of potential drug treatments; and if he will make a statement. 
Dawn Primarolo: The Department regularly receives representations, from hon. Members and other interested parties, on different aspects of the work of the National Institute for Health and Clinical Excellence (NICE). NICE is responsible for determining the approach taken to cost in its technology appraisal work.
Bill Wiggin: To ask the Secretary of State for Health (1) what assessment he has made of the effect on the (a) viability and (b) distribution of GP surgeries of preventing such surgeries dispensing medicines; and if he will make a statement; 
Dawn Primarolo: There is no intention to abolish dispensing by general practitioners (GPs). The White Paper Pharmacy in England Building on strengths - delivering the future commits to carrying out a formal consultation that covers, among other things, the market entry controls that apply to pharmacy and dispensing doctor services. The consultation paper will be published later in the summerafter the publication of the primary and community care strategyand will look at options for the future. Copies of the White Paper are available in the Library.
Information is not held centrally on how many of the number of GP practices which dispense medicines are within one mile of a pharmacy. However, the Department will carry out an analysis of the impact of any changes on the overall provision of primary medical services.
Mr. Breed: To ask the Secretary of State for Health what percentage of the General Medical Services budget for the next three years has been allocated to be spent on the implementation of the polyclinics recommended in Lord Darzi's review. 
Mr. Bradshaw: The Government are investing an additional £250 million to provide patients with better access to primary care services. This new investment will deliver new general practitioner (GP)-led health centres in each primary care trust (PCT) area and over one hundred new GP practices targeted at under-served area. The funding for GP-led health centres has been included in PCT revenue allocations: £45 million in 2008-09, 120 million in 2009-10 and £120 million in 2010-11. PCT allocations are deliberately not broken down into individual funding streams as it is for PCTs to decide how best to deliver these new services in view of their local circumstances.
Mr. Bradshaw: There is no standard definition of a polyclinic, which is why most of the debate about them is ill-informed and inaccurate. Polyclinic is usually a term used to describe a range of possible health service models characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.
London Strategic Health Authority has defined polyclinic service models that bring together a range of primary care services, specialist services, urgent care services and social care into either single centres or federated networks of care. However, this model is not being replicated across the country. Local commissioners will determine the scope and scale of these services in collaboration with their clinicians and patients to reflect local needs and circumstances.
Mrs. Dean: To ask the Secretary of State for Health what steps he is taking to ensure that the polyclinic model of health service delivery does not have an adverse impact on the continuity of care for people with long-term conditions currently afforded by the doctor-patient relationship in primary care. 
Mr. Bradshaw: Patients with complex and/or multiple long-term conditions may wish to continue to see their registered general practitioner (GP). They may however, choose to register at a GP-led health centre and receive at least the same quality and continuity of care delivered by the GP and other primary care clinicians working in these facilities. Additionally, any member of the public may choose to visit a GP led health centre to see a GP or nurse and they can do this whilst still being registered with their own GP.
Mr. Bradshaw: How primary care trusts (PCTs) choose to configure or commission local primary medical care services is a local matter. However, all PCTs have been asked to commission additional general practitioner (GP)-led health centre services and have been given additional funding to secure those services. Patients want and expect to receive convenient access to GP services wherever they are. Therefore, providing locally accessible and convenient GP-led services from 8 am to 8 pm, seven days per week will help to ensure this is possible. PCTs will decide after local consultation where and how these services should be provided and will carry out an open and fair procurement to secure the services they specify.
Mr. Davey: To ask the Secretary of State for Health what guidance his Department has issued to primary care trusts and doctors on developing proposals for polyclinics; and if he will make a statement. 
Mr. Bradshaw: The Government do not have a polyclinic policy. We are asking the local national health service to develop new general practitioner (GP)-led health centres for local communities. This does not mean applying the specific proposals for a polyclinic model of care on which the NHS in London has recently been consulting.
As part of our £250 million investment to improve access to primary medical care services, we have issued guidance to primary care trusts on how to complete open and fair local procurements to secure new GP practices and GP-led health centres. These are available on the Departments website at:
Mr. Davey: To ask the Secretary of State for Health (1) whether he has a (a) timetable for the establishment of and (b) target for the number of polyclinics in London; and if he will make a statement; 
Mr. Bradshaw: The organisation of health services is a matter for the national health service at local level. The hon. Member may wish to direct his question to the relevant primary care trust or strategic health authority.
Mr. Hunt: To ask the Secretary of State for Health how much his Department is contributing to the £140 million fund announced on 6 June 2008 to encourage local authorities to offer free swimming. 
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