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Mr. Jamie Reed: To ask the Secretary of State for Health what steps his Department is taking to reduce inequalities of health outcomes and life expectancy within Cumbria. [219886]

Dawn Primarolo: This information is not held centrally.

The Department has put in place a number of measures to tackle health inequalities. On 9 June 2008, my right hon. Friend the Secretary of State launched the document Health Inequalities: Progress and Next Steps. The document highlights successes in reducing inequalities and identifies how effort will be increased to meet the health inequalities 2010. National Public Service Agreement target for life expectancy and infant mortality. The document also sets the direction of travel for tackling health inequalities. It commits the Government to work together to develop the structures, systems and actions to sustain long-term delivery on health inequalities.

The document also publicised an improved health inequalities intervention tool, jointly owned by the Department and the Association of Public Health Observatories. The tool is an interactive website to help local health services and councils improve life expectancy in local areas.

The Department has also established national support teams for health inequalities and for tobacco control to disseminate best practice across all spearhead areas and areas with high infant mortality rates, and to provide intensive support for those areas that need it.

Health Services: Finance

Mr. Lansley: To ask the Secretary of State for Health for what reasons health care providers not working for or on behalf of the NHS will not be required to publish quality accounts, as referred to on page 51 of High Quality Care for All, Cm 7432. [221115]

Mr. Bradshaw: The remit of Lord Darzi’s Next Stage Review was to consider the future of the national health service, not health care in general. Independent health care providers who are currently subject to regulation by the Healthcare Commission are required to publish information about their services and, subject to passage in Parliament, similar regulatory requirements will be laid on all providers registered by the Care Quality Commission.

Health Services: North West

Mr. Lansley: To ask the Secretary of State for Health what the (a) structure and (b) objectives are of NHS North West's pay-for-performance scheme, referred to on page 42 of High Quality Care for All, Cm 7432. [221024]

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Mr. Bradshaw: This information is not held centrally. Information about the national health service North West’s Advancing Quality scheme is available on the Advancing Quality website at:

Health Services: Royal Household

Andrew Mackinlay: To ask the Secretary of State for Health pursuant to the answers of 26 March 2008, Official Report, column 201W, on health services: Royal Household and 28 April 2008, Official Report, columns 149-50W, on general practitioners: Buckingham Palace, for what reasons his Department was not aware on 25 March 2008 of the arrangements for provision of primary health care service to staff of the Royal households; and if he will make a statement. [220846]

Mr. Bradshaw: Primary care trusts have a duty to secure primary medical services or secure their provision within what it considers necessary to meet reasonable requirements. That includes arrangement for the provision of primary health care services to staff of the Royal Household who live in the PCT area.

The Department does not monitor the individual performance of practices or registration of individual patients with the practice.

The arrangements for the provision of primary care services to the Royal Household predate this Government and it was not until after the 25 March 2008 that it was brought to the Department’s attention the arrangement that has historically been provided under existing general medical services.

Health Services: Rural Areas

Mr. Jamie Reed: To ask the Secretary of State for Health what assessment his Department has made of the effect of public transport provision on accessibility of the health services in rural areas. [219883]

Mr. Bradshaw: The effect of public transport provision on the accessibility of local health services is a matter for consideration by the local commissioners and providers of those services.

Health Services: Telephone Services

Mr. Lansley: To ask the Secretary of State for Health (1) what the (a) costs and (b) benefits of a three-digit telephone number for urgent care which his Department is considering, as referred to on page 40 of High Quality Care for All, Cm 7432; which (i) officials and (ii) other parties are involved in the next phase of work on the matter; when he plans to set out further details on the next phase of work; whether his Department plans to encourage the development of local three-digit urgent care numbers ahead of its national review, as recommended in the visions documents of England's strategic health authorities; and if he will make a statement; [221020]

(2) what each of the options being considered by his Department for an urgent care number are as referred to on page 27 of NHS Next Stage Review: Our vision for primary and community care. [221049]

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Mr. Bradshaw: The Next Stage Review set out that we are currently considering various options to introduce a new three-digit telephone number to help people find the right local service to meet their urgent, unplanned care needs. Part of this phase of work will include considering the costs and benefits of introducing a three-digit number.

Officials in the Commissioning and System Management Directorate are leading this project and working with others in the Department and stakeholders including from strategic health authorities (SHAs), primary care trusts, ambulance trusts, out of hours providers, clinicians and NHS Direct. Officials will be exploring with SHAs their plans for implementing a three-digit number to inform options development. Further details from this phase of work will be set out in the autumn.

Health Services: Voluntary Organisations

Mr. Stephen O'Brien: To ask the Secretary of State for Health what progress his Department has made towards implementation of the Government’s commitment to introduce full cost recovery for the voluntary sector; and when the commitment will be fully implemented. [221430]

Mr. Ivan Lewis: The Department fully supports the principle of full cost recovery (FCR) for the voluntary sector. Its new Third Sector Investment programme, launched on 17 July 2008, has been designed so that Compact principles, including FCR, are embedded from the outset and reflected in the guidance for applicants for grant funding, to support applicants in submitting well costed proposals.

Policy supporting procurement activities for goods and services within the Department signpost staff to the Office of Government Commerce and the Home Office document “Think smart, think voluntary sector” on procurement from the voluntary and community sectors.

Guidance within the “Commissioning Framework for Health and Wellbeing” makes clear that Commissioners should adopt procurement practices that are fair and open—meaning neutral between different types of providers and transparent on pricing—minimising transaction costs and allowing providers to frame realistic economic tenders. We believe this is the most straightforward way to deal with the issue of ‘full cost recovery’.

Heart Diseases: First Aid

Mrs. Riordan: To ask the Secretary of State for Health what steps are being taken to encourage people to learn resuscitation techniques for heart attack and stroke victims. [220013]

Mr. Bradshaw: No specific steps are being taken by the Government to encourage people to learn resuscitation techniques for heart attack and stroke victims.

The NHS Plan made a commitment to provide 3000 automatic external defibrillators (AED) in public places. This helps to save the lives of those heart attack sufferers who have a cardiac arrest. National Defibrillator Programme resulted in over 6,050 site personnel from public places such as airports, railway stations and bus stations receiving training in basic life support (BLS) and the use of an AED. By the end of 2006, a further
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11,405 people had been trained and 10,642 re-trained. Current responsibility for training lies with the Ambulance Service Trusts.

The Department has been working with the Department for Children, Schools and Families and the Healthy Schools initiative to improve the information available to schools wishing to provide first aid and cardiac pulmonary resuscitation (CPR) training to their pupils. A number of first aid and CPR training providers have been involved in this work and it is intended to publish a package of information for schools shortly.

People with stroke also require urgent treatment initiated by a 999 call. At the launch of the National Stroke Strategy in December 2007 (copies of which have already been placed in the Library), £12 million of central funding was set aside for raising awareness of the signs and symptoms of stroke and the need to call 999. This work is in progress and will support a more urgent and timely response of the national health service and the public to stroke.

Heart Diseases: Waiting Lists

Mr. Donohoe: To ask the Secretary of State for Health what the average waiting times for heart operations in NHS hospitals were in (a) 2005 and (b) the last 12 months; and how many operations were carried out in each period. [220567]

Ann Keen: The information is in the following table:

Mean and median days waited for heart operations and the number of finished consultant episodes where a heart operation was the main or secondary procedure in both 2005-06 and 2006-07, NHS hospitals England, and activity performed in the independent sector in England commissioned by English NHS

Mean days waited Median days waited Finished consultant episodes









Data quality Hospital Episode Statistics (HES) are compiled from data sent by over 300 NHS trusts, and primary care trusts (PCTs) in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. The NHS Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain. Finished admission episodes A finished admission episode is the first period of in-patient care under one consultant within one health care provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year. Finished consultant episode (FCE) An FCE is defined as a period of admitted patient care under one consultant within one health care provider. Please note that the figures do not represent the number of patients, as a person may have more than one episode of care within the year. Main procedure/intervention The main procedure/intervention is the first recorded procedure or intervention in the HES data set and is usually the most resource intensive procedure or intervention performed during the episode. Heart operations K01-K78 Secondary procedure As well as the main operative procedure, there are up to 11 (three prior to 2002-03) secondary operation fields in Hospital Episode Statistics (HES) that show secondary or additional procedures performed on the patient during the episode of care. Time waited (days) Time waited statistics from Hospital Episode Statistics (HES) are not the same as the published waiting list statistics. HES provides counts and time waited for all patients admitted to hospital within a given period whereas the published waiting list statistics count those waiting for treatment on a specific date and how long they have been on the waiting list. Also, HES calculates the time waited as the difference between the admission and decision to admit dates. Unlike published waiting list statistics, this is not adjusted for self-deferrals or periods of medical/social suspension. The IC have provided the mean (average) and median (middle in ranking) days waited where there was a main procedure of 'heart operation' in 2005-06 and 2006-07. The median figures are a better proxy to the average time waited as mean figures can cloud the real picture as some anomalies (long-waiters) may be artificially increasing the average. Ungrossed data Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed). Source: Hospital Episode Statistics (HES), The NHS Information Centre for Health and Social Care.

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Herbal Medicine

Mike Penning: To ask the Secretary of State for Health (1) how many applications under the provisions of the Traditional Herbal Medicinal Products Directive the Medicines and Healthcare products Regulatory Agency expects to receive for (a) single ingredient products and (b) more complex products; [221075]

(2) if he will list the principal quality and efficacy tests which must be met by manufacturers submitting products for registration under the Traditional Herbal Medicinal Products Directive; and if he will indicate in the case of each such test the costs of compliance assumed in the context of the regulatory impact assessment produced in connection with this legislation; [221076]

(3) what the requirements are under the Traditional Herbal Medicinal Products Directive for a qualified person to be employed to authorise the release of herbal products to the market; what purpose is served by this requirement; and what assessment he has made of the costs associated with this provision for a small manufacturer of specialist herbal remedies; [221077]

(4) what the outcome was of the recent review of the operation of the Traditional Herbal Medicinal Products Directive undertaken by the European Commission; what period was covered by the review; and whether he intends to make it his policy to press for the review to be repeated now that member states have had the opportunity to use the provisions of the Directive. [221079]

Dawn Primarolo: It is a commercial decision for individual companies whether to apply for a traditional herbal registration (THR) under the provisions flowing from directive 2004/24/EC. The Medicines and Healthcare products Regulatory Agency (MHRA) is not in a position to estimate how many applications will be submitted. So far, the MHRA has received 38 THR applications, of which 33 are for products containing a single active ingredient and five are for combination products. The MHRA expects that a high proportion of early applications will be for relatively simple products while companies become accustomed to meeting the regulatory requirements of the scheme.

There is normally no requirement for applicants to submit information on the efficacy of the product under the THR scheme. The quality requirements for herbal medicinal products and traditional herbal medicinal products are set out in detailed guidance documents following consultation with industry. The European Pharmacopoeia also sets out legally binding standards for herbal ingredients as well as excipients used in herbal medicinal products. The purpose of the quality tests is to ensure that the herbal medicinal product is safe for use and has a reproducible quality over its proposed shelf-life. Tests are required to ensure that the correct plant materials are used, free from potentially hazardous contaminants such as pesticide residues, fumigant residues, heavy metals/other toxic elements, mycotoxins, bacteria/fungi. Where herbal extracts are employed, tests are required on all materials used, including solvents and reagents used for extraction, to ensure that they are as intended and of acceptable quality. The herbal extract undergoes tests to ensure it is of reproducible quality and that it is free from hazardous levels of, for example,
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residual solvents, micro-organisms or potential contaminants from the starting plant materials. The finished dosage form is tested to ensure that it contains the declared amount of herbal ingredients and that it will remain of suitable quality throughout the proposed shelf-life.

European and United Kingdom medicines legislation requires manufacturers and/or importers of registered traditional herbal medicines for human use to hold a manufacturer’s licence. It is a condition of such a licence that the holder must have a Qualified Person (QP). The QP must either meet existing specific educational and vocational requirements or attain status through transitional arrangements. The QP has a personal responsibility for certifying that each batch of registered traditional herbal medicine, has undergone the appropriate tests, complies with its registered specification and has been manufactured in accordance with good manufacturing practice. The purpose of these requirements is to ensure that a safe quality traditional herbal medicine is placed on the market.

In its regulatory impact assessment of the THR scheme, the MHRA estimated that typically the costs of registering a product under the scheme could be several tens of thousands of pounds but that the figure would vary widely according to specific circumstances, not least depending on whether companies already had systematic quality control systems in place. This assessment has not changed.

The European Commission launched a public consultation in May 2007 on the review of the operation of directive 2004/24/EC. The consultation included data up to March 2007. It is the European Commission’s responsibility to report on the findings of that review and, pending that outcome, we have no present plans to press for an early second review.

Mike Penning: To ask the Secretary of State for Health what the requirements are under the provisions of the Traditional Herbal Medicinal Products Directive for the certification of manufacturing premises; what charges are levied by the Medicines and Healthcare Products Regulatory Agency for inspections associated with such certification; and how many facilities have (a) been inspected and (b) been certified as meeting the necessary standards. [221078]

Dawn Primarolo: The Directive on Traditional Herbal Medicinal Products requires manufacturers of registered herbal medicines to be authorised by the national competent authority. In the United Kingdom, the Medicines and Healthcare products Regulatory Agency authorises and inspects manufacturers. The inspection fee is currently £1,496 for a full day and £920 for half a day. Manufacturers must meet certain conditions and employ a qualified person in order to be authorised. A number of manufacturers were already authorised to manufacture herbal medicines before the Directive came into force. Since the implementation of the Directive all of the small number of manufacturers who have applied specifically to manufacture registered herbal medicines have been authorised.

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