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Mr Watson: To ask the Deputy Prime Minister when he plans to answer (a) Question 226, on the Committee on Nuclear Deterrence and Security tabled on 25 May 2010, (b) Question 291, on departmental official cars, tabled on 25 May 2010 and (c) Question 576, on the use of Chevening, tabled on 26 May 2010. 
The Deputy Prime Minister [holding answer 22 June 2010]: I refer the hon. Member to my answers of 29 June 2010, Official Report, column 532W on departmental official cars and 30 June 2010, Official Report, column 563W on Chevening.
I also refer the hon. Member to the answer given by the Minister of State, Cabinet Office the right hon. Member for West Dorset (Mr Letwin) on 17 June 2010, Official Report, column 519W on the Committee on Nuclear Deterrence and Security.
Mr Allen: To ask the Secretary of State for Health what discussions officials in his Department have had (a) with NHS organisations and (b) the National Audit Office on the 18-week referral-to-treatment standard for people with rheumatoid arthritis; and what assessment has been made of the effects on people with rheumatoid arthritis of the introduction of that standard. 
Mr Burstow: During the National Audit Office's field work for the value for money report "Services for people with rheumatoid arthritis", departmental officials provided referral-to-treatment data to the National Audit Office to inform the study.
Latest data show that in April 2010, the average (median) waiting time from referral to treatment was 3.4 weeks for rheumatology patients admitted to hospital for treatment and 5.7 weeks for rheumatology patients whose treatment did not require an admission to hospital. Rheumatology is the treatment function category into which most rheumatoid arthritis patients will fall.
The revised NHS Operating Framework for 2010-11, published on 21 June, removed the burden of politically determined central performance management of the 18 week waiting times target set by the Department. The Department will continue to publish and monitor referral to the treatment data. This will incentivise providers and commissioners to work together to keep clinically unjustified waits down and to tackle unnecessary variation.
Targets that were not grounded in clinical evidence had unintentional consequences and fettered clinical judgments and autonomy. The Government are determined to liberate clinicians and empower patients to deliver better outcomes.
Mr Burstow: It is the responsibility of commissioners of healthcare services to ensure that their populations have access to and information about the services available to them. "Your Guide to Local Health Services" enables primary care trusts to ensure that patients receive local information about services including support for self care.
At a national level, NHS Choices provides people living with long-term conditions, including rheumatoid arthritis, with information about the choices that should be available to them locally to enable them to self care in partnership with health and social care professionals.
The Expert Patient Programme Community Interest Company has developed a training course specifically on rheumatoid arthritis that is co-delivered by a lay person with rheumatoid arthritis and a rheumatology specialist nurse. The programme will be available nationally and is supported by the National Rheumatoid Arthritis Society.
Mr Allen: To ask the Secretary of State for Health what his most recent estimate is of the number of rheumatoid arthritis specialist nurses working in the NHS; how many rheumatoid arthritis specialist nurses he expects to be working in the NHS in 2012; with reference to the oral evidence taken before the Public Accounts Committee on 23 November 2009, on services for people with rheumatoid arthritis, HC 46, Session 2009-10, what the evidential basis is for the expectation that the number of specialist rheumatoid arthritis nurses in the NHS is increasing; and if he will make a statement. 
Mr Burstow: The expectation that the number of rheumatology specialist nurses is increasing is based on the rounded care model for rheumatoid arthritis which is built around a multidisciplinary team approach. Multidisciplinary teams within rheumatology services see some of the functions traditionally carried out by consultant rheumatologists appropriately transferred to other members of the team, such as specialist nurses.
National Institute for Health and Clinical Excellence clinical guideline 79 "The management of rheumatoid arthritis in adults" makes the multidisciplinary team, including a specialist nurse, a key priority for implementation.
Mr Allen: To ask the Secretary of State for Health with reference to the oral evidence taken by the Committee of Public Accounts on 23 November 2009, on services for people with rheumatoid arthritis, HC 46, Session 2009-10, what progress his Department's Acting Director-General for Commissioning and System Management has made in responding to the request made in question 21 to investigate the potentially adverse effects of commissioning decisions on patient care in the rheumatology specialty; and if he will make a statement. 
Mr Burstow: The Department's policy is clear-all patients should be treated without unnecessary delay according to their clinical need, it is for doctors to determine a patient's clinical priority, and patients should not experience undue delay at any stage of their treatment pathway. It is important, therefore, that services match their capacity with demand so that no patient waits unnecessarily to be seen whether for their first appointments or for follow-up appointments.
Data published by the Department of Health looking on an all speciality basis show that the ratio of subsequent attendance (follow-up) to first out-patient appointment has remained broadly stable over the last three years at around two (subsequent attendances) to one (first out-patient appointment).
Department of Health Monthly Activity Return (MAR) and Quarterly Activity Return (QAR)
Mr Burstow: We plan to build on the National Dementia Strategy published on 3 February 2009 by accelerating the pace of improvements through a greater focus on delivery and local accountability and through empowering citizens to hold local organisations to account. This process will be aided by driving up quality standards through a tariff for dementia patients, better regulation of providers, improving commissioning processes to deliver greater efficiencies and through national health service and public health interventions having a greater focus on outcomes for individuals.
Additionally, revisions to the NHS Operating Frameworks for 2010-11 identified dementia as an area for local prioritisation. It is for primary care trusts (PCTs) to decide locally how best to deliver the national requirements and local priorities set out in the NHS Operating Framework including the National Dementia Strategy. Local PCTs are asked to publish their plans for implementing the strategy.
In order to gauge progress overall in implementing the National Dementia Strategy, the Department is undertaking a national audit of dementia services. We will use the data from this, alongside information from locality action plans prepared by local authorities and PCTs in March 2010, in order to focus on where action is required to accelerate implementation of the Strategy.
In addition, the Department is updating the current implementation plan for the National Dementia Strategy to ensure that it is focussed on those areas that will have the most impact on the lives of people with dementia and their carers. These include: promoting early diagnosis and referral with general practitioners, care of people in hospital and care homes with dementia and reduction of the prescribing of anti-psychotic medication to people with dementia.
Gordon Banks: To ask the Secretary of State for Health (1) how many of his Department's contracts with its suppliers are under review as a result of the recently announced reductions in public expenditure; and what the monetary value is of all such contracts which are under review; 
(2) how many officials in his Department are working on renegotiating contracts for the supply of goods and services to the Department as a result of recently announced reductions in public spending; what savings are expected to accrue to his Department from such renegotiations; how much expenditure his Department will incur on such renegotiations; and when such renegotiations will be completed. 
From May 2010, the Department has targeted categories of spend worth approximately £19.5 million in the first instance-this is for information and communication technology (ICT) products and services, travel, office supplies and catering. The breakdown of this figure is:
1. ICT products and services-£6 million
2. Travel, office supplies and catering-£13.5 million
Officials have met, or are planning to meet, the current suppliers of each of these services to agree where additional monetary savings on expenditure can be derived. It is likely that the Department's suppliers will also be engaged in discussions with Cabinet Office and Office of Government Commerce colleagues relating to cross-Government savings opportunities where the supplier provides services to a number of Government Departments.
The Department is also represented on the existing procurement Category Boards and Working Groups led by the Office of Government Commerce and Cabinet Office. The Department will fully support the Government's plans to support increased efficiency savings through procurement.
The Department estimates that five officials are spending a proportion of their time working on the renegotiation of existing contracts. It is not possible at this stage to provide a savings figure, or to say how much expenditure will be incurred or when such renegotiations will be completed.
(2) what estimate his Department has made of the effect on NHS costs of manufacturers' quotas on medicines and drugs and of restrictions on the parallel importation of drugs and medicines in the last three years. 
Mr Simon Burns: Costs and savings to the national health service attributable to parallel trading and manufacturers' quotas are not separately identifiable. The Department is unaware of any restrictions placed on the parallel importing of drugs and medicines.
Mr Sanders: To ask the Secretary of State for Health what recent discussions he has had with pharmaceutical manufacturers on their quotas for the supply of medicines and drugs to the NHS in England. 
Bob Russell: To ask the Secretary of State for Health if he will require personal music players sold in the UK to have a health notice forming part of the permanent casing warning users of the potential danger to their hearing of playing them too loudly; and if he will make a statement. 
Mr Burstow: There are no plans to require personal music players sold in the United Kingdom to have a statutory health warning. The safety and regulation of consumer products, such as personal music players is, within government, primarily a matter for the Department of Business, Innovation and Skills.
Frank Dobson: To ask the Secretary of State for Health what estimate he has made of the additional cost to NHS trusts of paying hospitals for the treatment of individual patients according to their subsequent re-admission for the same condition. 
Mr Burstow: Given that emergency re-admissions into hospitals have increased from 359,719 in 1998-99 to 546,354 in 2007-08(1), we have decided that from 1 April 2011 hospitals will not receive further payment for avoidable re-admissions within 30 days of discharge. No formal estimate has been made by the Department. Officials are working on the detail of this change.
(1 ) Source:
Compendium of clinical and health indicators, National Centre for Health Outcomes Development, October 2009.
Glenda Jackson: To ask the Secretary of State for Health what estimate he has made of average waiting times to be seen at the accident and emergency department at (a) the Royal Free Hospital, (b) Whittington Hospital, (c) University College London Hospital and (d) St Mary's Hospital, Paddington in the latest period for which figures are available; and if he will make a statement. 
Information is held at the level of trusts and information is not available for specific hospital sites. The following table sets out the mean and median time spent between arrival and departure in accident and emergency (A&E) departments for Royal Free Hampstead NHS Trust, The Whittington Hospital NHS Trust, University College London Hospitals NHS Foundation Trust and Imperial College Healthcare NHS Trust in 2008-09 (latest data available).
|Hospital provider||Mean duration to departure||Median duration to departure|
1. An attendance is a record for every patient that attends an A&E department, including a major A&E department, single specialty A&E departments, walk-in centres and minor injuries units. Any one patient can have multiple attendances, which may be in the same or different time periods, for the same or different condition.
2. Duration to Departure: The time (expressed as a whole number of minutes) between the patients arrival and the time the A&E attendance has concluded and the department is no longer responsible for the care of the patient.
3. A&E Data Quality: Hospital Episode Statistics (HES) are compiled from data sent by a number of NHS providers across England. The NHS Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seek to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain. The A&E HES publications addresses some of the key data quality and coverage issues. These are available on HESonline at:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care
Mr Anderson: To ask the Secretary of State for Health when he expects to publish the results of the Health Technology Assessment's pilot study undertaken as part of the UK Lung Cancer Screening Trial; and if he will make a statement. 
Mr Burstow: The Department's current expectation is that the United Kingdom lung cancer screening trial pilot study will start in early 2011. The result of the study is likely in these circumstances to be published in the second half of 2013.
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